ACTIVE MANAGEMENT OF TERM PRELABOUR RUPTURE OF MEMBRANES WITH ORAL MISOPROSTOL VERSUS

Abstract

Objectives: To compare the active management of term pre- labour rupture of membranes with oral misoprostol and conservative management for 6 hours after rupture followed by stimulation with oxytocin.
Setting: Labour wards of Enugu State University Teaching Hospital, Mother of Christ Catholic Hospital and Annunciation Catholic Hospital, Enugu.
Design: Double-blinded; randomized, controlled trial.Methods: Women randomized to the oral misoprostol group received 50mcg oral misoprostol at four hourly interval, if required, to a maximum of three doses (active group), and placebo intravenous infusion. Those in the expectant group received oral placebo tablets 4-hourly.This was followed by stimulation of labour with oxytocin only if not in spontaneous labour 6-hours after pre-labour rupture of membranes.
The outcome measures were time to vaginal delivery, uterine hyperstimulation with associated fetal heart rate changes, caesarean section and perinatal outcome.

Women were asked about their preferences for care using the two methods.
Results: Analysis involved 73 women in the active group and 73 women in the conservative group. The mean time (+standard deviation) to vaginal delivery in the active group was 846(+385) minutes compared with 1072(+593) minutes in the conservative group (P=0.004).There were no significant differences in the caesarean rate, or perinatal outcomes. More frequent tachysystole for 15 minutes (P<0.01) and hyperstimulation (P<0.004) were observed in the active group than in the conservative group.

More women in the misoprostol group were satisfied with everything associated with their labour and birth experience than those in the expectant group.(Misoprostol28/73 (38.4%)

versus Oxytocin 18/73 (24.7%) RR=1.26; 95% CI 1.02-1.57; P=0.036

Conclusion: Active management with oral misoprostol resulted in more women going into labour and delivering within 24 hours of the pre-labour rupture of membranes, with no increase in maternal or neonatal complications. Women tended to view active management of pre-labour rupture of membranes more favourably.Oral misoprostol will be an option to consider especially were access to health care facilities may be a real problem.

ACTIVE MANAGEMENT OF TERM PRELABOUR RUPTURE OF MEMBRANES WITH ORAL MISOPROSTOL VERSUS