MANAGEMENT STRATEGIES IN TERM PROM AND ITS IMPACT ON FETOMATERNAL OUTCOMES

Background: Premature rupture of membranes (PROM) at term, defined as rupture of fetal membranes before labor onset at or beyond 37 weeks of gestation, is a common obstetric event affecting approximately 8–10% of pregnancies. It poses a clinical dilemma due to its association with maternal infections such as chorioamnionitis and neonatal complications including sepsis and birth asphyxia. The decision between conservative and active management can significantly influence maternal and neonatal outcomes. Objective: To compare the maternal and neonatal outcomes of conservative versus active management in women with the term PROM, focusing on cesarean section rates, neonatal hyperbilirubinemia, and birth asphyxia. Methods: This prospective randomized controlled trial was conducted on 138 pregnant women with singleton-term pregnancies diagnosed with PROM. Participants were randomly allocated into two equal groups: Group A (n = 69) received conservative management with close observation, antibiotics, and supportive care, while Group B (n = 69) underwent active management involving labor induction within six hours using prostaglandin E2 and oxytocin. Primary outcomes included cesarean section rate, neonatal hyperbilirubinemia (serum bilirubin >5 mg/dL), and birth asphyxia (Apgar score <5 at 1 minute). Secondary outcomes assessed included latency period, maternal infection, and postpartum hemorrhage. Results: The cesarean section rate was 8.13% in Group A and 17.44% in Group B. Neonatal hyperbilirubinemia occurred in 13.37% of Group A and 21.51% of Group B. Birth asphyxia was recorded in 9.88% of Group A and 25.58% of Group B. Group A had a longer latency period (17.8 ± 4.2 hours) compared to Group B (9.3 ± 3.6 hours), with no significant increase in maternal infection. Conclusion: Conservative management of the term PROM was associated with better neonatal outcomes and lower cesarean rates, indicating its suitability in selected low-risk patients under close monitoring.