الفهرس 
Induction of LaborOnly 14 pages are availabe for public view
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Abstract
The management of term patients with PROM, especially those with an 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 the risk of postnatal infections.
Patients 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 dilatation 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 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 well-being.
The aim of this randomized study is to compare the efficacy of two protocols (oxytocin versus dinoprostone followed six hours later by oxytocin) for inducing labor in women with premature rupture of membranes (PROM) at term.
This randomized controlled trial was conducted at Ain Shams University Maternity Hospital and El-Galaa Maternity Teaching Hospital during the period between March and December 2014. In total of 300 women were randomized to treatment with oxytocin (n = 150) or dinoprostone followed by oxytocin (n = 150).
History was taken from all women who participated in the study. They were also examined before joining to find any of the exclusion criteria.
Patients in group A received intravenous oxytocin with an initial dose of 2 mU/min doubled every 30 minutes to a maximum of 32 mU/min or until four contractions in 10 minutes were achieved. Patients in group B received a single dose of dinoprostone vaginal pessary (3 mg) inserted into the posterior vaginal fornix. This pessary releses dinoprostone at a low but steady rate.
Results showed that dinoprostone pessary 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 group. There is no difference in maternal and neonatal outcomes between the two groups.