Evaluation of mechanical and non-mechanical methodes of cervix ripening in women with PROM

Abstract

Premature rupture of membranes (PROM) is defined as rupture of membranes at least 1 hour before the onset of uterine contractions. It complicates 8% of pregnancies. Among women with PROM, approximately 40 % will take more than 24 h to deliver spontaneously. Delaying onset of labor increases the risk of chorioamniotisis and neonatal sepsis. Options for cervical ripening and induction of labor include oxytocin, prostaglandins and mechanical agents. There are multiple approaches for preinduction cervical ripening, includ¬ing mechanical (eg, Foley catheter [FC]) and nonme¬chanical (eg, prostaglandin [PG]) methods. Mechanical methods of cervical ripening have several advantages over pharmacologic agents, including low cost, ease of reversibility, and lower risk of tachysystole and fetal heart rate abnormalities. The study is a prospective, controlled, randomised, clinical trial, to evaluate the use of a transcervical Foley catheter compared with misoprostol for labor induction and cervical ripening in pregnant women with prelabor rupture of membranes. Methods: A randomized controlled trial was performed in two university hospitals in Tabriz. A total of 104 women with ruptured membranes, singleton pregnancies in cephalic presentation, unfavorable cervix, and no prior cesarean section were enrolled. Participants were randomly allocated to ripening of cervix by Foley catheter or oral misoprostol in a 1:1 ratio. The main outcomes were cesarean section rate, Interval between intervention to delivery, maternal and neonatal morbidity. Results: A randomized controlled trial was performed in two university hospitals in Tabriz. A total of 104 women with ruptured membranes, singleton pregnancies in cephalic presentation, unfavorable cervix, and no prior cesarean section were enrolled. Participants were randomly allocated to induction of labor by Foley catheter or oral misoprostol in a 1:1 ratio. The main outcomes were cesarean section rate, Interval between intervention to delivery, maternal and neonatal morbidity. We enrolled 104 women: 52 were allocated to Foley catheter and 52 to misoprostol. Demographics were similar between the groups. There were no cases of clinical chorioamnionitis and asphyxia. The maternal outcomes associated with each of the two procedures were similar. Cord blood gases were worse in the misoprostol group: mean arterial pH foley catheter 7.3; misoprostol 7.28. 1-minute Apgar scores was higher in Foley catheter groups (P=0.002). 5-minute Apgar scores and base excess was similar in the two groups. The induction to delivery interval (p =0.004) and Cervical ripening time (P=0.008) was lower with misoprostol.