Premature Rupture of Membranes With a Bishop Score<6: Comparison of Medical Induction/Expectant Management

In the setting of premature rupture of membranes in term pregnancies, it is customary in women who are not in active labor to wait for 24 hours before attempting to induce labor. The means of labor induction used at our medical center are either intravenous oxytocin or per-vaginal dinoprostone, depending on patient's obstetric history and cervical conditions.

The investigators hypothesize that commencing induction of labor at presentation in these women by either means of induction will lead to higher rates of vaginal delivery, shorter intervals between the time of onset of rupture of membranes and the time of delivery and lower rates of cesarean sections.

The participants in the study, upon signing informed consents, will be randomized to 4 groups-2 groups of expectant management in which labor induction will be commenced after 24 hours with either oxytocin or dinoprostone and 2 groups of active management in which labor induction will be commenced at presentation with either oxytocin or dinoprostone.

The participants will be followed from the time of presentation with rupture of membranes at the delivery room and until the time of delivery.

Further obstetric, clinical and demographic information will be acquired from the patient's electronic medical file for analysis accuracy and sub-analysis.

Inclusion criteria

• Term pregnancies >37 weeks of gestation.
• Certain rupture of membranes.
• Bishop score < 6.
• Singleton pregnancies.
• Vertex presentation.
• No obstetric or clinical contraindications for labor induction.
• Reactive non stress test on presentation.

Exclusion criteria

• Previous cesarean section.
• Previous uterine surgeries (Myomectomy etc.).
• Placenta Previa.
• Multiple gestation pregnancies.
• Pregnancies with history of fetal reduction or Intrapartum uterine fetal demise.
• Known fetal defects/Chromosomal abnormalities.
• Active genital Herpes.
• HIV carrier.
• Contractions that are less than 10 minutes apart.