الفهرس | Only 14 pages are availabe for public view |
Abstract Summary The management of term patient with PROM, especially those with unfavorable cervix remains controversial. Management options include immediate induction of labor versus delayed induction or expectant management. Several reports have detailed an increase in maternal and neonatal morbidity with expectant management, whereas active management leads to a shorter interval from PROM to delivery reducing risk of postnatal infection. Patient and clinicians desire to arrange a convenient time of delivery, and more relaxed attitudes toward marginal indications for induction. Cervical ripening is the result of realignment of collagen, degradation of collagen cross-linking due to proteolytic enzymes. Cervical dilation results from these processes plus uterine contractions. This is a complicated series of events in which many changes occur both simultaneously and sequentially. Research in this area is challenging due to both the difficulties inherent in human subjects research and the many differences existing between species. At term, infection remains the most serious complication associated with PROM for the mother and the neonate. The risk of chorioamnionitis with term PROM has been reported to be Summary 128 less than 10% and increase to 40% after 24 hours of PROM. This points out the importance of appropriate management strategies for PROM at term since risk of infection at term with ROM is small during the first 24 hours, expectant management and waiting for spontaneous labor may be considered in selected patients for the first 12-24 hours if a patient desires expectant management. The use of expectant management after the first 24 hours is questionable. Digital vaginal examinations should be avoided until labor is initiated; however, fetal presentation should be documented to avoid discovering malpresentation of the fetus long after admission for ROM. All patients with ROM should be asked to come to the hospital to ensure fetal wellbeing. The aim of this study is to compare two protocols (oxytocin versus sustained release dinoprostone followed six hours later by oxytocin) for induction of labor in pregnancies with premature rupture of membranes at term. This randomized controlled trial was conducted at Ain Shams University Maternity Hospital and Obstetrics and Gynaecolog department at El-Sahel teaching hospital during the period between May 2013 and August 2014. In total of 90 women were randomized to treatment with oxytocin (n=45) or dinoprostone followed by oxytocin (n=45). Summary 129 History was taken from all women participated in the study, they were also examined before joining to find any of the exclusion criteria. Patients in group A received intravenous oxytocin infusion at 2mU/min, double every 30 minutes to a maximum of 32mU/min or until 4 contractions in 10 minutes are achieved patients group B received single dose of sustained release dinoprostone into the posterior vaginal fornix. This sustainedreleased product releases dinoprostone at a low but steady rate (0.3 mg/hour). Results showed thatsustained release dinoprostone followed six hours later by oxytocin is an alternative safe method for induction of labor in women with term PROM with significant increase in the rate of vaginal delivery within 24 hours in comparison with oxytocin only. With shorter induction active phase and induction delivery intervals in oxytocin group than dinoprostone-oxytocin group. There is no difference in maternal and neonatal outcome between two groups |