Term PROM Research Articles

Are there any risk factors for foetal hypoxia in term PROM?

Are there any risk factors for foetal hypoxia in term PROM?

Management of term PROM in SGA pregnancies: what to do?

Management of term PROM in SGA pregnancies: what to do?

158 Nulliparas with term PROM and an unfavorable cervix, induction of labor with prostaglandin or oxytocin

158 Nulliparas with term PROM and an unfavorable cervix, induction of labor with prostaglandin or oxytocin

Evaluation of Fetomaternal Outcome in Expectant and Active Management of Term Prelabour Rupture of Membranes

Background: PROM is a complex condition with multifactorial etiology, including factors like multigravida, low socioeconomic status, concomitant infections, late symptom presentation, and a history of preterm PROM. Conventional management strategies include expectant management, waiting for spontaneous labor, and active management, involving induction with oxytocin or prostaglandins. Objectives: This prospective cross- sectional observational study aimed to evaluate fetomaternal outcomes in both expectant and active management of term PROM. Methods: Conducted at the Obstetrics and Gynecology Department of Rangpur Medical College Hospital, the study included 50 pregnant women with a history of PROM, gestational age ≥37 weeks, and spontaneous membrane rupture. Data were collected from March to September 2019 using purposive sampling. Demographic information was recorded, and clinical examinations were performed. Data were processed, analyzed, and compared between active management (Group-A) and expectant management (Group-B). Results: The study population's age ranged from 17 to 35 years, with a majority aged 20-25 years (42.0%). Most patients were from urban areas (52.0%), with 52% belonging to a socioeconomically disadvantaged class. Group-A, which underwent active management, showed a significantly higher rate of delivery within 12 hours (80.0%) compared to Group-B (48%). Both groups had similar induction-to-delivery intervals. Vaginal deliveries were more frequent in Group-A (84% vs. 64%), while Group-B had a higher rate of C-sections due to fetal distress. Group-B experienced more maternal complications, including puerperal sepsis, wound infections, and postpartum hemorrhage. Neonatal outcomes were better in Group-A, with higher Apgar scores at both 1 and 5 minutes. Conclusion: Active management was associated with better outcomes in term PROM cases compared to expectant management. Early antenatal diagnosis and risk factor identification are essential tools.....

Analysis of factors increasing the risk of prelabour rupture of membranes and its effect on fetomaternal outcome

Perinatal morbidity and mortality due to prelabour rupture of membranesPROM) is 18-20% and 21.4% respectively. Multiple risk factors are associated with the development of PROM. Limited data is available on the risk factors of term PROM and relation of its duration with adverse maternal and fetal outcomes from India. To assessfactors increasing the risk of PROM and effect of duration of rupture of membranes on fetomaternal outcome. Five hundred and ten patients presented with term PROM in the Department of Obstetrics and Gynaecology, Sultania Zanana Hospital, Gandhi Medical College, Bhopal, Madhya Pradesh (M.P.) from December 2018 to February 2019 were studied. After the detailed history, sociodemographic details, risk factors for PROM and neonatal outcomes were recorded. PROM was more common in women with age 21-25years (73.3%), who were housewife (92.5%), were underweight (21.37%), were from the rural area (58.4%), belong to lower SES (62.8%) and were primigravida (59.2%). Majority were leaking for 13-24 hours (70.2%). Majority (85.64%) of patients had spontaneous onset of labour in less than 24 hours of PROM and 28(14.35%) went into spontaneous labour after 24 hours of PROM. Most common risk factor was malpresentation (46.52%) followed by history of PROM (30.04%), Polyhydramnios (13.19%), multiple pregnancy (10.99%) and febrile illness (6.96%). Out of 312 women who had vaginal delivery, labour was induced in 87.82% women. The most common indication for Caesarean section was previous 1 LSCS (13.1%), followed by fetal distress (8.6%), breech presentation (7.3%) and cephalopelvic disproportion (2.9%). Most of the women presenting with PROM were delivered vaginally (61.2%), while 38.8% women underwent caesarean section. Out of 529 babies, 6.24% were admitted in NICU. Majority of the neonates were admitted for 3 days (39.39%). PROM is associated with poor fetomaternal outcome and timely diagnosis and prompt management is required for better outcome.

“STUDY OF MATERNAL AND FETAL OUTCOME IN TERM PRELABOR RUPTURE OF MEMBRANES STRATIFIED WITH AFI SCORE.”

Background: Amniotic uid index (AFI), a component of modied Biophysical prole, is commonly used for antepartum fetal surveillance, and can be considered an essential parameter to predict adverse fetal and maternal outcome in patients with PROM. The present study is Objective: undertaken to study the feto-maternal outcome in patients with term PROM by stratifying them into two groups with AFI <5 and AFI ≥5. Methodology: Prospective cross-sectional study was conducted on 151 pregnant term, singleton live gestation with cephalic presentation with PROM admitted to the labor ward in Department of OBG at ESIC & PGIMSR. On admission based on amniotic uid index measured by ultrasonography the study population was grouped as Group A with AFI < 5cm and Group B with AFI ≥5 cm. Patients with AFI <5 cm Results: (Group A) had higher febrile morbidity (p-0.0001). Caesarean delivery was signicantly higher in Group A (50%, p-0.0001), most common indication was fetal distress (60.9 %). Group A also had higher incidence of wound infection (9.8%, p-0.008) and increased duration of hospital stay (p-0.0001). More patients in Group B had successful induced vaginal delivery (82.6%). Higher incidence of perinatal morbidity with APGAR<7 (p-0.032) and prolonged NICU admissions were observed in Group A (p - 0.0001). The present study co Conclusion: ncludes that AFI stratication in patients with term PROM on admission is useful to predict maternal and neonatal outcomes

SAFETY AND EFFICACY OF SUBLINGUAL MISOPROSTOL AND INTRACERVICAL DINOPROSTONE GEL AS CERVICAL RIPENING AGENT IN TERM PRELABOUR RUPTURE OF MEMBRANES: A COMPARATIVE STUDY

Introduction: "premature rupture of membranes" (PROM) refers to the chorioamnionitis membranes spontaneously rupturing before the start of labour. This study compares the safety and effectiveness of intracervical dinoprostone gel and sublingual misoprostol for cervical ripening in term PROM. Methods: This is an analytical cross-sectional study including 100 term mothers with spontaneous PROM attending obstetric casualty at the Department of Obstetrics and Gynaecology, Government Raja Mirasudhar Hospital, Thanjavur, India, selected using a multistage sampling technique from the study period of February 2021 – November 2021 (10 months). One hundred samples were assigned randomly into two groups which were 50 in each group as group A (Misoprostol group) and group B (Dinoprostone gel group). Results: In group A, the study participants' median ages were 25 years (8.48) and 26.2 years (6.42), respectively. The difference in age averages between groups A and B was found to be 6.03, with a statistically significant p-value of 0.016. In both groups, the induction delivery interval was nearly equal. The link between the Indication for Lower Segmental Caesarean Section and both groups was statistically significant. When the two groups' delivery modes were compared, natural labour was shown to be statistically significant (p = 0.048). Normal and abnormal heart rates were statistically significant for the association between fetal heart rate and the groups, respectively, with chi-square values of 6.854 and 9.281 (p = 0.022 and 0.013, respectively). The remaining groups were not statistically significant. Conclusion: It was concluded that though sublingual misoprostol is more efficacious than intracervical dinoprostone, its safety margin is significantly less; hence, misoprostol induction should be done only in a double setup under medical supervision.

Delivery and neonatal outcomes ofpregnant women during the Shanghai lockdown: A retrospective analysis.

Shanghai witnessed an unprecedented outbreak of COVID-19 and experienced a strict lockdown from March 28, 2022 to May 31, 2022. Most studies to date are on the first lockdown after the outbreak in December 2019. This study aimed to examine the impact of lockdown on delivery and neonatal outcomes among uninfected pregnant women in the new phase of the COVID-19 outbreak. A retrospective analysis was conducted in the Obstetrics and Gynecology Hospital of Fudan University. Pregnant women without COVID-19 who delivered from March 28, 2022 to May 31, 2022 (lockdown group) and the same period in 2021 (non-lockdown group) were recruited for this study. Logistic regression models and 1 : 1 propensity score matching (PSM) were used to assess the effect of lockdown on delivery outcomes. A total of 2,962 patients were included in this study, 1,339 of whom were from the lockdown group. Compared with the non-lockdown group, pregnant women giving birth during lockdown had an increased risk of term prelabor rupture of membranes (TPROM) (aOR = 1.253, 95% CI: 1.026-1.530), and decreased risks of postpartum hemorrhage (PPH) (aOR = 0.362, 95% CI: 0.216-0.606) and fetal malformation (aOR = 0.309, 95% CI: 0.164-0.582). The risk of large for gestational age (LGA) (aOR = 0.802, 95% CI: 0.648-0.992) and rate of admission to the neonatal intensive care unit (NICU) (aOR = 0.722, 95% CI: 0.589-0.885) also significantly declined. After 1 : 1 PSM, the impact of lockdown on the risk of TPROM (aOR = 1.501, 95% CI: 1.083-2.080), PPH (aOR = 0.371, 95% CI: 0.211-0.654), fetal malformation (aOR = 0.332, 95% CI: 0.161-0.684), LGA (aOR = 0.749, 95% CI: 0.594-0.945) and rate of admission to the NICU (aOR = 0.700, 95% CI: 0.564-0.869) all remained. There were no other delivery or neonatal outcomes affected by the lockdown after the COVID-19 outbreak. This study indicated a significant increase in the risk of term PROM, significant decreases in the risk of PPH, fetal malformation and LGA, and a marked decline in the rate of admission to the NICU during Shanghai Lockdown.

A STUDY OF PREGNANCY OUTCOME IN CASES WITH PREVIOUS FIRST TRIMESTER SPONTANEOUS ABORTION

Introduction:Abortion is dened as pregnancy termination or loss before 20 weeks gestation or with a fetus delivered weighing & lt; 500g. About 80% of spontaneous pregnancy losses occur in rst trimester. Aim: To evaluate & study pregnancy outcome in cases with history of previous spontaneous abortions. Objective: To compare the outcomes of pregnant women with history of previous spontaneous abortion and pregnant women without any history of previous abortion. Methods: Total 200 patient were studied 100 cases(with previous history of spontaneous abortion) and 100 control(without history previous abortion) for foetomaternal outcome. Results: A total of 100 patients with history of previous spontaneous abortion were admitted. Majority (58 %) of patients belong to the age group 21-25 years. Maximum patients (77%) were with history of previous one abortion followed by previous two abortions (17%). The nal outcomes were term live birth (64%), abortion (6%), preterm delivery (16%), and PROM (10%). Caesarian section was done in 33% patients for various indications in cases. In control group term live birth (93%),abortion(1%),preterm (4%) and IUGR (1%).Caesarian section was done in 2% control group. Conclusions: Our study showed that previous history of spontaneous abortion is associated with adverse pregnancy outcome like increased risk of abortion, preterm delivery, need for caesarean sections and fetal loss in cases of previous spontaneous abortions

Acute and chronic maternal exposure to fine particulate matter and prelabor rupture of the fetal membranes: A nation-wide survey in China

BackgroundPrelabor rupture of the fetal membranes (PROM) is a major contributor to adverse perinatal outcomes. Some epidemiologic studies explored the association between maternal PM2.5 exposure and PROM but failed to treat the labor induction and prelabor cesarean section as censored observations. ObjectiveWe aimed to evaluated whether acute and chronic maternal ambient PM2.5 exposure may increase the risk of PROM in China. MethodsThis study was based on the China Labor and Delivery Survey, a nationwide multicenter investigation. Included in the current analysis were 45,879 singleton spontaneous births in 96 hospitals in mainland China from 2015 to 2017. Outcomes were PROM, preterm PROM (<37 weeks’ gestation) and term PROM (≥37 weeks’ gestation). Daily concentration of PM2.5 at 1 km spatial resolution was estimated by gap-filling model. Generalized linear mixed model and mixed effects Cox model were applied to assess the associations of acute (from 0 to 4 days before delivery) and chronic (average gestational and trimester-specific) ambient PM2.5 exposure with outcomes, respectively. ResultsSignificant associations were found between acute PM2.5 exposures (per interquartile range increase) and the risk of preterm PROM (OR = 1.11; 95 % CI: 1.03, 1.19 for PM2.5 on delivery day; OR = 1.10; 95 % CI: 1.02, 1.18 for PM2.5 1 day before delivery) but not for term PROM. An interquartile range increase in PM2.5 during the second trimester was associated with elevated risks of PROM (HR = 1.14; 95 % CI: 1.07, 1.22), preterm PROM (HR = 1.22; 95 % CI: 1.02, 1.45) and term PROM (HR = 1.13; 95 % CI: 1.06, 1.22), respectively. Women who were less educated, obese, or gave birth in a cold season appeared to be more sensitive to ambient PM2.5 exposure. ConclusionOur findings suggest that both acute and chronic maternal exposures to ambient PM2.5 during pregnancy are risk factors for PROM.

A comparative study of active vs expectant management and maternal and neonatal outcome in premature rupture of membranes at term pregnancy

Background: In term PROM, labour is likely to follow soon afterwards, but in preterm PROM, about 35-50% cases labour starts within 24 hours, 70% cases starts within 72 hours, about 90% delivery occurs usually within 7 days. Perinatal morbidity and mortality is increased while rupture occurs prior to term resulting in delivery of premature foetus. Approximately 80% of patients with PROM at term go into labour within 24 hours and 95% within 72 hours. The incidence of PROM, is variable, most studies report an incidence of 2-18% with an avg. Of 10%. In 70%of cases, it occurs in pregnancies at term (Williams 23rd edition.); Aim:1) The active versus expectant management in women with Premature rupture of membranes at term pregnancy 2) The maternal outcome in active as well as expectant management in patients with premature rupture of membrane at term pregnancy.3) The neonatal outcome in active as well as expectant management in patients with premature rupture of membrane at term pregnancy.Methods: 200 patients were selected after confirming foetal maturity and rupture of membrane by history and clinical examination. Foetal well-being was assessed by clinical examination and ultrasonography. Informed consent was taken from every patient included in this study. Results: Duration of labour between both groups observed no significant variation. Selected patients with favourable Bishop’s score (>6) may be the cause of no incidence of undue delay or complications. In Group 1, 44% delivery occurred within 6 hours, 52% within >6-12 hours, 4% took more than 12 hours for delivery. In Group 2, 40% delivered within 6 hours, 56% in the span of >6-12 hours, 4% took more than 12 hours for delivery. In Expectant group (Group 2) duration of labour is significantly lower in multigravida whereas no such difference is seen in Active Management (Group 1) Group in relation to gravida.Conclusions: In case of premature Rupture of Membranes at term –both expectant and active management leads to similar maternal and neonatal outcome. Since outcome of active and expectant management may not be very different5, women need to have appropriate monitoring and counselling to make informed choices.

Prelabor rupture of membranes at term: A possible hematological triage in addition to vagino-rectal beta-hemolytic streptococcus screening for early labor induction.

IntroductionA potential complication of term prelabor rupture of membranes (term PROM) is chorioamnionitis with an increased burden on neonatal outcomes of chronic lung disease and cerebral palsy. The purpose of the study was to analyze the efficacy of a standing clinical protocol designed to identify women with term PROM at low risk for chorioamnionitis, who may benefit from expectant management, and those at a higher risk for chorioamnionitis, who may benefit from early induction.Material and methodsThis retrospective study enrolled all consecutive singleton pregnant women with term PROM. Subjects included women with at least one of the following factors: white blood cell count ≥ 15×100/μL, C-reactive protein ≥ 1.5 mg/dL, or positive vaginal swab for beta-hemolytic streptococcus. These women comprised the high risk (HR) group and underwent immediate induction of labor by the administration of intravaginal dinoprostone. Women with none of the above factors and those with a low risk for chorioamnionitis waited for up to 24 hours for spontaneous onset of labor and comprised the low-risk (LR) group.ResultsOf the 884 consecutive patients recruited, 65 fulfilled the criteria for HR chorioamnionitis and underwent immediate induction, while 819 were admitted for expectant management. Chorioamnionitis and Cesarean section rates were not significantly different between the HR and LR groups. However, the prevalence of maternal fever (7.7% vs. 2.9%; p = 0.04) and meconium-stained amniotic fluid was significantly higher in the HR group than in LR group (6.1% vs. 2.2%; p = 0.04). This study found an overall incidence of 4.2% for chorioamnionitis, 10.9% for Cesarean section, 0.5% for umbilical artery blood pH < 7.10, and 1.9% for admission to the neonatal intensive care unit. Furthermore, no confirmed cases of neonatal sepsis were encountered.ConclusionsA clinical protocol designed to manage, by immediate induction, only those women with term PROM who presented with High Risk factors for infection/inflammation achieved similar maternal and perinatal outcomes between such women and women without any risks who received expectant management. This reduced the need for universal induction of term PROM patients, thereby reducing the incidence of maternal and fetal complications without increasing the rate of Cesarean sections.

Did the SARS-CoV-2 effect pregnancy complications?

This study aimed to evaluate the effect of SARS-CoV-2 on pregnancy complications, which increased compared to the same period before the pandemic. This prospective study was conducted at Etlik Zübeyde Hanım Women›s Health Practices & Research Center between June 2020 and July 2020. The asymptomatic term PROM and miscarriage pregnant women were screened for SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) positivity by using IgM and IgG antibody tests. All the positive cases were confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR). All the patients answered 12 questions to determine their approach to COVID-19. Four of the 205 (2%) term PROM patients had positive anti-SARS-CoV-2 IgM antibody tests, one of the 205 (0.5%) term PROM patients had a positive anti-SARS-CoV-2 IgG antibody test, and one of the 205 (% 0.5) term PROM patients had positive anti-SARS-CoV-2 IgM and IgG antibody tests. All 230 miscarriage patients had negative IgM/IgG antibody tests. Four of the positive antibody cases had positive RT-PCR tests (2%) and were referred to a pandemic hospital. The patients thought that 93.2% and 95.6% of pregnant women with term PROM and miscarriage, respectively, SARS-CoV-2 would infect themselves, and 89.8% and 92.6%, respectively, would infect their children. The number of patients who would not consider pregnancy if they were not pregnant during this period was significantly higher in the term PROM (48.3%) compared to the miscarriage (27.8%) patients (p < 0.005). No COVID-19 cases were determined in the asymptomatic miscarriage patients. In the asymptomatic term PROM patients, the effects of COVID were not observed.

Identifying the associated factors with onset of preterm PROM compared with term PROM - A retrospective cross-sectional study

ObjectiveTo determine the risk factors associated with the preterm premature rupture of membranes (p-PROM). Materials and methodsThis retrospective cross-sectional study assessed 110 p-PROM cases from among 6642 deliveries at a Japanese perinatal medical center, from June 2016 to September 2018. The control group comprised 220 term PROM (t-PROM) cases. We excluded cases with artificial PROM or rupture of membranes after labor, those with multiple pregnancies, those with p-PROM at 36 weeks and those with t-PROM at 37 weeks. In order to compare p-PROM with t-PROM, univariate and multivariate analysis were performed using several clinical factors at the time of PROM onset. ResultsThe p-PROM group included 110 cases with 14–35 weeks PROM, and the t-PROM group included 220 cases with 38–41 weeks PROM. Eleven factors were identified as significant factors on the univariate analysis. A history of cervical conization (OR 37.5, 95% CI: 2.31–607.1), cervical length <25 mm at 28 weeks (OR 9.31, 95% CI: 1.76–49.3), negative Lactobacillus (OR 4.01, 95% CI: 1.18–13.7), and bleeding during the second trimester (OR 3.35, 95% CI: 1.18–9.53) were identified as significant factors by the multivariate analysis. Based on the risk factors identified during the multivariate analysis, we divided the 330 cases in the following three groups: 0 group (n = 244), 1 group (n = 60), and 2–4 group (n = 26). The ratio of p-PROM:t-PROM was calculated and compared for each group. The ratios were 21% (0 group), 57% (1 group), and 100% (2–4 group), indicating statistically significant differences between the groups (p < 0.001). ConclusionWe found that the following four factors were associated with p-PROM: history of cervical conization, cervical length <25 mm at 28 weeks, negative Lactobacillus, and bleeding during the second trimester. Our results suggest that we can identify patients who are at increased risk for p-PROM, based on these factors. Further research is necessary to determine the optimal treatment approach for these patients to prevent p-PROM.

Benefits of Cervical Cerclage to Improve Pregnancy Outcome in Cervical Incompetence

Background: To determine ability of cervical cerclage to improve pregnancy outcome in patients having cervical incompetence.&#x0D; Methods: A retrospective study was conducted at Central Hospital Limited, Dhanmondi, Dhaka on 35 patients. All had history of one or more mid trimester abortion and were subjected to cervical cerclage (McDonald suture).&#x0D; Results: Average pregnancy prolongation was 17 weeks. Just over half of these women (51%) delivered at term and just over half the newborns (51%) weighed above 2.5 kg. Over 11% had abortion, 14% had preterm PROM and 14% preterm labour. Term PROM was the outcome in 5.7% and cervical injury occurred in 8.6%.&#x0D; Conclusion: Cervical cerclage is beneficial for pregnancy with cervical insufficiency and hence placement of cervical cerclage can reduce early pregnancy loss.&#x0D; JOPSOM 2020; 39(2): 70-73

Effects of histone H4 hyperacetylation on inhibiting MMP2 and MMP9 in human amniotic epithelial cells and in premature rupture of fetal membranes.

Histone modification is closely associated with several diseases. The aim of the current study was to investigate the associations among histone acetylation, matrix metalloproteinases (MMPs) and premature rupture of membranes (PROM) during pregnancy. A total of 180 puerperants were divided into three groups: i) Preterm-PROM (PPROM), ii) term-PROM (TPROM) and iii) full-term labor (FTL). Enzyme-linked immunosorbent assay (ELISA) kits and western blotting were used to determine the protein concentrations of MMP2, MMP9, histone deacetylase (HDAC)1, HDAC2 and HDAC6, and the protein levels of histone H4 lysine (H4K)5 and H4K8 acetylation, respectively, in three types of fetal membranes. Additionally, human amniotic epithelial cells were used to determine the effects of the HDAC inhibitors droxinostat and chidamide on cell viability, histone acetylation and the levels of MMP2, MMP9, HDAC1, HDAC2 and HDAC6 in vitro, using the Cell Counting Kit-8 assay, western blotting and ELISA, respectively. Furthermore, the effects of droxinostat and chidamide on the invasion and migration abilities of human amniotic epithelial cells were investigated using transwell assays. In fetal membranes, the activities of MMP2 and MMP9 increased in PPROM, but decreased in TPROM. Further, the expression of HDAC1 was decreased and histone hyperacetylation was increased in both PPROM and TRPOM. In vitro experiments revealed that 5 µM droxinostat and 0.5 µM chidamide selectively decreased the level of HDAC and induced acetylation of H4K5 and H4K8. Additionally, the aforementioned HDAC inhibitors reduced human amniotic epithelial cell viability, invasion and migration, and decreased the expression levels of MMP2 and MMP9. The current study revealed a high expression level of MMP2 and MMP9 in PPROM compared with TPROM and FL tissue, which was in accordance with previously published studies. Furthermore, the in vitro tests performed in the current study revealed the effect of histone H4 hyperacetylation on inhibiting MMP2 and MMP9 levels in vitro was similar to that observed in TPROM. The results obtained in the current study may be used as a theoretical guide for clinical treatment of premature rupture of membranes.

2021 Update on obstetrics

Essential updated guidance on FGR workup and timing of delivery; term and preterm PROM management strategies based on gestational age; and approaches to VTE prophylaxis, including for patients with COVID-19 infection

A COMPARATIVE STUDY BETWEEN ACTIVE AND EXPECTANT MANAGEMENT OF PREMATURE RUPTURE OF MEMBRANES AT TERM TO EVALUATE FETOMATERNALAND PERINATAL OUTCOMES

Premature rupture of the membranes is defined as the spontaneous rupture of the chorioamnion before the onset of uterine contractions, this is also known as Prelabour rupture of membrane. In some Indian studies the incidence of PROM is reported as 7-12% in term pregnancy. This study was conducted at Narayana Multispeciality Hospital, Jaipur, Rajasthan, for 7 months of duration (from February 2020 to August 2020). This study was Prospective, Observational and Comparative study. A total 70 term PROM patients were recruited in our study and divided into two groups randomly- 35 (Group A) patients were managed actively by induction of labour and 35 (Group B) patients underwent expectant management. Both these patient groups were studied to compare the feto-maternal outcome. Patients in Actively managed group were induced with iv oxytocin infusion. In Expectantly management group patients were observed to await the spontaneous onset of labour pains for at least 24 hours. In our study vaginal deliveries in actively managed group are 65.7% and in expectantly managed group its 54% and in 51% cases of actively managed cases PROM to delivery interval was less than 12 hours and in 88% cases of expectantly managed group PROM to delivery interval was 12 to 24 hours. APGAR score was notably higher in expectant management group. Therefore, from our study we concluded that immediate induction of labour in term PROM cases favours vaginal deliveries, shortens the PROM to delivery interval and reduces NICU admission rate.

Oxytocin versus sublingual misoprostol for induction of labour in term prelabour rupture of membranes: A randomized controlled trial

Background: Induction of labor is one of the most common interventions practiced in modern obstetrics. In the developedWorld, the ability to induce labor has contributed to the reduction in maternal and perinatal mortality and morbidity.Aim: This study aimed to evaluate the effect of pre-labour administration of sublingual misoprostol versus oxytocin in term PROM on maternal and fetal outcomes. Materials and Methods: In a randomized single-blind controlled trial at department of obstetrics and gynecology, Menoufia University between September 2018 and October 2019. A total of 100 pregnant women who had spontaneous rupture of membrane and unripe cervix were enrolled. The group A underwent Oxytocin infusion according to low-dose standard protocol and the group B received 50 microgram sublingual Misoprostol every 6 hours. Results: There was a significant reduction in induction duration hours between Misoprostol group than Oxytocin group (p < 0.001). Second stage of labour was significantly shorter in misoprostol group. Although, some maternal sideeffects were non-significantly higher in misoprostol group. There was no significant difference between Oxytocin and Misoprostol groups regarding neonatal condition. Conclusion: pre-labour administration of sublingual misoprostol in patients with singleton term pre-labour rupture of membranes shorten duration of both active phase and second stage of labour significantly in comparison with oxytocinadministration.

Outcome of pregnancy following previous spontaneous abortion

The objective of the present study was to study the pregnancy outcome following previous spontaneous abortion.The present study included 140 patients admitted in the department of Obstetrics and Gynaecology Government Medical College Srinagar, LD Hospital Jammu &amp; Kashmir India from September 2018 to February 2019. Patients with history of spontaneous abortion preceding present pregnancy irrespective of gravidity, first visit or booked or unbooked were enrolled. Detailed history regarding previous abortion was taken and examination was done focussing on information about previous abortion. All the routine investigations along with investigation for possible etiologies of previous abortions were done. The patients were observed for complications like PROM, placenta previa, preeclampsia, placental abruption, abortion, IUFD, breech, threatened abortion, still birth during the present pregnancy.Out of 140 patients 100 were booked and 40 un-booked. Majority of the patients (39.2%) were in the age group of 25-30 years. 58.5% patients belonged to urban areas. Majority of patients (67.8%) were uneducated or educated till primary level. 15.7% of the patients had threatened abortion and 11.2% had complete abortion. Further it was found out that patients with pre term delivery and PROM were 14.2% and 9.25 respectively. 50% of patients delivered by caesarean section. It was further observed that foetal outcome was good in 72% of patients with lbw 9.2% and IUGR in 7.1% patients.From the study it was observed that patients with history of previous spontaneous abortion are associated with adverse pregnancy outcome. The pregnancy outcome in terms of maternal and foetal complications can be improved by giving proper antenatal care.