Planned Early Induction of Labor vs Expectant Management for PROM

This randomized controlled trial will compare planned early induction of labor (active management) with expectant management in women with term premature rupture of membranes (PROM).

PROM is defined as rupture of the fetal membranes before the onset of labor. At term, the optimal timing of delivery remains an important clinical consideration because prolonged rupture of membranes may increase the risk of maternal and neonatal infection, while early delivery may increase interventions such as induction of labor and cesarean section.

The study will be conducted in the Department of Obstetrics and Gynaecology, PIMS Hospital, Islamabad, over a period of six months after approval of the synopsis. A total of 734 women will be enrolled using consecutive sampling and randomly allocated into two equal groups of 367 participants each.

Group A - Active Management:

Labor will be induced within 24 hours of diagnosis of PROM. Prostaglandin E2 vaginal gel (1 mg) will be used for cervical ripening/induction, with repeat doses at 6-hour intervals when required, up to a maximum of three doses.

Group B - Expectant Management:

Participants will undergo observation for 24 hours following diagnosis of PROM while awaiting spontaneous onset of labor. An endocervical swab will be collected for microscopy, culture, and sensitivity. Participants will be monitored for signs of infection and fetal compromise.

Both groups will receive intravenous antibiotics according to the study protocol (ceftriaxone 1 g every 24 hours and metronidazole 500 mg every 8 hours until delivery) and will be followed until delivery.

The study will compare maternal and fetal outcomes between the two groups, particularly:

Cesarean section Chorioamnionitis Fetal distress Baseline demographic and clinical characteristics, including age, gestational age, parity, BMI, socioeconomic status, educational level, and residential status, will also be recorded.

The purpose of the study is to determine whether planned early induction of labor or expectant management is associated with better maternal and fetal outcomes in women with term PROM.

Inclusion criteria

• Women age 18 to 45 years
• Singleton pregnancy on ultrasound
• Gestational age 37 to 42 weeks on LMP
• Any parity
• Premature rupture of membrane as per operational definition

Exclusion criteria

• H/o active infection.
• H/o placental abruption
• H/o preeclampsia
• Fetal anomalies on ultrasound