Expectant and early induction groups were similar with respect to age, parity, previous history of PROM, and previous history of abortions.
As shown in Table , average PROM–delivery interval was significantly shorter in the early induction group (13 h) as compared with expectant management group (22 h). 24 % in expectant group and 12 % in early induction group took more than 24 h. In early induction group, extra 12 % of women finished labor within 24 h of PROM. In expectant group, 4 % took more than 36 h. Early induction was useful to reduce maximum PROM–delivery interval from 42 to 27 h. Minimum PROM–delivery interval was similar in both groups.
As shown in Table , expectant group was subdivided into group A1, where labor finished within 24 h spontaneously, and group A2 where subsequent induction or augmentation was required after 24 h of expectancy. Out of 50 patients in expectant group, 20 % subsequently required intervention after 24 h of expectancy. Expectant group outcome shows that percentage of vaginal delivery and LSCS were quite comparable in both the groups which were 77.5 versus 80 % and 22.5 versus 20 % respectively in group A1 and A2. However, maternal and neonatal morbidity rates were high in group A2, i.e., 20 %. Thus, maternal–neonatal morbidity can be reduced by delivering patients within 24 h.
Expectant group and early induction group outcome
Early induction group was subdivided in group B1 who delivered after primary induction and group B2 where subsequent re-induction was required after 10 h of initial induction. In early induction group, 16 % patients required re-induction after first induction. Vaginal delivery and LSCS rate were quite comparable to that of expectant management group. However, in case of induction failure, i.e., in group B2, percentage of LSCS increased up to 50 %. Again Neonatal morbidity rate was also increased in the cases of re-induction from 4.6 to 12.5 %.
There was one perinatal mortality in early induction group which was because of congenital heart disease with early onset septisemia not due to induction complications such as fetal distress or hyper-stimulation of uterus.
77.5 % of patients went in spontaneous labor after 24 h of expectancy, and 81 % had successful induction. Neonatal morbidity was equal in expectant and early induction groups. Maternal morbidity was 6 % in expectant group and 4 % in early induction group.
There were no significant differences in abnormal heart patterns, i.e., 8 versus 12 % in expectant versus induction groups. No significant difference was found in meconium staining of liquor, incidence of vaginal delivery, or in the incidence of cesarean section. LSCS was required for 22 % in expectant group compared to 24 % in early induction group. In expectant group, four out of 11 LSCS were performed for fetal distress, five for nonprogress of labor with chorioamnionitis in two patients, two for failure of induction, while in early induction group, six out of 12 patients had cesarean section for fetal distress, four patients had induction failure, and two patients had nonprogress of labor with chorioamnionitis.
The average number of days in hospital was reduced in early induction group from 5 days in expectant group to 3 days in early induction group. Antibiotics administered in neonates were 60 % in expectant management versus 44 % in early induction group.