The cesarean section rate in cases with premature rupture of membrane (PROM) at 36th week of pregnancy or later

Abstract

Premature rupture of membrane (PROM) is one of the complications of pregnancy which is blamed for increasing the rate of cesarean. Therefore, we studied pregnant women who were admitted in Shariati hospital during March 1996 and March 2000, to determine the rate of cesarean delivery in cases with PROM after 36th week of pregnancy (Term PROM). In a retrospective study, we included pregnant women who had these criteria;1-PROM 2- Gestational age>36 weeks 3- Single pregnancy 4- cephalic presentation and 5- no prior history of cesaren delivery. We extracted their demographic factors, age of pregnancy, induced labor its absence, interval duration between the onset of PROM and induction of labor, interval duration between the onset of PROM and normal vaginal delivery or cesarean delivery, the circumstances of cervix before beginning of induction of labor, type of delivery, indications of cesarean section and new born weight, from their files and entered them in a check list.We reviewed 7544 cases and only 536 cases matched to our criten and were registered. The Rate of PROM and cesarean delivery in the study group was 7.5% and 28.06%, respectively. Indications of cesarean section contained; Fetal distress, 30.8% CPD, 27.3% failure to progress, 18.6% High risk pregnancy, 16.9% and Macrosomia, 6.4% the rate of cesarean section decreased significantly when cervix dilatation or effacement significantly when cervix dilatation or effacement (each alone) increased (Dil, p=5×10-7; Eff, p=7× 107). Interval duration between the rupture of amniotic sac and the onset of induction had no effect on the cesarean rate (p=0.58). An increase in induction cases did not increase the rate of cesarean section (p<107). PROM at 36th week of pregnancy and later did not increase the chance of cesarean delivery, and neither did not increase in induction rates. Longer interval duration between rupture of membranes and onset of induction played no role in decreasing the rate of cesarean section but it is possible to shorten hospitalization time by decreasing that interval duration without increasing cesarean rate. Thus, we suggest immediate induction of labor in the term PROM. PROM at 36th week of pregnancy and later didn’t increase the cesarean rate