The Comparison of Fetal and Maternal outcome in Active vs Conservative Management of Prelabor Premature Rupture Of Membranes ( PPROM) at 34 to 37 weeks of gestation.

Abstract

ABSTRACT: Background: The precise management of obstetrical crisis like preterm premature rupture of membrane is necessary to be designed for an optimum outcome. Both maternal and fetal morbidity and mortality rate can be decreased by accurate approach of clinical management as it is not still established yet. This study was designed to compare the maternal or fetal outcome in conservative management with active management of prelabor premature rupture of membranes at 34 – 37 weeks of gestation. STUDY DESIGN: Randomized control trial SUBJECTS & METHODS: The patient’s data was collected from the department of Gynecology and Obstetrics, F G Polyclinic Hospital and PIMS Islamabad from July 2019 to March 2020. Two groups were made and 90 cases were included in each group on the basis of active or conservative management accordingly. Fetal and maternal morbidity and mortality was judged on the basis of number of fetal distresses, chorioamnionitis and mode of delivery. RESULTS: 180 fetuses, a total of 140 survived. In group A, with conservative management, of the 17 (18.89%) mortalities, 9 (10%) developed fetal infections, 2 (2.22%) delivered prematurely, 3 (3.33%) had RDS. In group B, the active management was observed, 23 (25.55%) babies were expired, 5 (5.55%) contacted infections and died, 9 (10%) were diagnosed to have RDS, 6 (6.66%) deaths were due to prematurity with low birth weight. In conservative management group days of admission was significantly (p-value < 0.05) higher compared to active group. The duration of NICU stay was significantly (p-value < 0.05) higher in active management group (8.88% vs. 15.55%) as compared to conservative group (table 7). The rate of respiratory distress was also significantly (p-value < 0.05) in active management group (5.55% vs. 20%) as compared to conservative group. The mortality rate (25.5%) was bit higher in active management group as compare to (18.89%) in conservative management group but this difference was not statistically significant (p-value >0.05). Conclusion: Conservative management of premature preterm rupture of membranes is more appropriate choice of management than active treatment if decided earlier