PLANNED EARLY INDUCTION OF LABOR VERSUS EXPECTANT MANAGEMENT FOR PREMATURE RUPTURE OF MEMBRANE

Abstract

Objective: To compare maternal and fetal outcomes of planned early induction of labour with expectant management in women presenting with premature rupture of membranes at term. Study Design: A randomised controlled trial. Place and Duration of the Study: Department of Obstetrics and Gynaecology, PIMS Hospital, Islamabad, Pakistan, from 1st May to 1st November 2026. Methodology: A total of 734 women with term premature rupture of membranes were included and randomly allocated into active management group (n=367) and expectant management group (n=367). Active management was done by induction within 24 hours using prostaglandin E2 vaginal gel, while expectant management involved observation for 24 hours for spontaneous labour. Maternal and fetal outcomes were recorded. Data were analysed using IBM-SPSS 26. Chi-square test or Fisher's exact test was applied with p≤0.05 considered significant. Results: Mean age was 27.00 ± 4.89 years in active management and 27.25 ± 4.67 years in expectant management group. Caesarean section was significantly higher with active management, 114 (31.1%) versus 81 (22.1%) (p=0.006). Chorioamnionitis was significantly lower with active management, 23 (6.3%) versus 39 (10.6%) (p=0.034). Fetal distress occurred in 37 (10.1%) and 49 (13.4%) respectively (p=0.168). Stratification showed significant differences in caesarean section among women aged ≤30 years and those with body mass index ≤25 kg/m². Conclusion: Planned early induction reduced chorioamnionitis but was associated with higher caesarean section rate compared with expectant management.