الفهرس 
Induction of LaborOnly 14 pages are availabe for public view
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Abstract
Summary
The management of term patient with PROM, especially
those with 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 risk of postnatal infection.
Patient 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 dilation 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
Summary
128
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 wellbeing.
The aim of this study is to compare two protocols
(oxytocin versus sustained release dinoprostone followed six
hours later by oxytocin) for induction of labor in pregnancies
with premature rupture of membranes at term.
This randomized controlled trial was conducted at Ain
Shams University Maternity Hospital and Obstetrics and
Gynaecolog department at El-Sahel teaching hospital during the
period between May 2013 and August 2014. In total of 90
women were randomized to treatment with oxytocin (n=45) or
dinoprostone followed by oxytocin (n=45).
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129
History was taken from all women participated in the
study, they were also examined before joining to find any of the
exclusion criteria.
Patients in group A received intravenous oxytocin
infusion at 2mU/min, double every 30 minutes to a maximum
of 32mU/min or until 4 contractions in 10 minutes are achieved
patients group B received single dose of sustained release
dinoprostone into the posterior vaginal fornix. This sustainedreleased
product releases dinoprostone at a low but steady rate
(0.3 mg/hour).
Results showed thatsustained release dinoprostone
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-oxytocin group. There is no difference in
maternal and neonatal outcome between two groups