Effect of Progesterone on Latent Phase Prolongation in Patients With Preterm Premature Rupture of Membranes

After taking informed written consent, the recruited patients will be subjected to the following:

• Detailed history

• Personal History: Name, age ,residence ,special habits of medical importance
• Obstetric history: first day of last menstrual period for accurate estimation of gestational age and antenatal care
• Past history: history of any medical disorder or surgical history with particular emphasis on prior PPROM or preterm labor
• History of the present pregnancy: Medical or surgical condition to define high risk pregnancy.
• Examination of the patients General examination: blood pressure, pulse, temperature

Abdominal examination:

• Inspection: fundal level, scars, umbilicus.
• Palpation: presence of contractions, fetal lie and presentation.
• Pelvic Examination only by sterile speculum to exclude cord prolapse , bloody liquor and cervical dilatation and effacement
• Non stress test to ensure reassuring fetal well being
• Ultrasound examination to:-

• Assess fetal viability.
• Amniotic fluid index.
• Determine gestational age.
• Exclude major anomalies.
• Placental location.
• Baseline laboratory investigations:

• Complete blood count (CBC).
• Prothrombin time (PT).
• Activated partial thromboplastin time (aPTT).
• Liver and kidney function.

The included patients were randomized using sealed opaque envelope method into one of two groups:

Group I (study group): in which 17-hydroxyprogesterone caproate (17P) (250 mg in castor oil, 1 mL total volume, intramuscular injection weekly) will be administered.

Group II (control group): in which an identical-appearing placebo (1 mL castor oil only) will be administered.

Inclusion criteria

• Singleton pregnancy
• Gestational age between 24 and 34 weeks

Exclusion criteria

• Medical or obstetric conditions that could put them at risk for uterine atony , postpartum hemorrhage AND infection, such as

• Emergency Cesarean section.
• Chorioamnionitis.
• Placenta previa.
• Multiple gestation.
• Preeclampsia.
• Macrosomia.
• Non reassuring fetal status or fetal distress
• Presence of fetal anomalies incompatable with life
• Woman with antepartum haemorrhage
• Diagnosis of Established preterm labor