Impact of Induction Timing on Maternal and Neonatal Outcomes in Term and Late Preterm Prelabor Rupture of Membranes: A Prospective Observational Study

Induction Timing and Outcomes in Term and Late Preterm PROM

Abstract

Prelabor rupture of membranes (PROM) is a significant obstetric complication predisposing a woman to chorioamnionitis, neonatal sepsis, and placental abruption. The optimal timing of labour induction, particularly in late preterm pregnancies, remains a clinical challenge requiring a balance between infectious risk and prematurity-related morbidity. Objectives:  To evaluate the association between early versus late induction of labour and maternal and neonatal outcomes in women with term and late preterm PROM. Methods: This prospective study was conducted at the Combined Military Hospital, Malir, from October 2023 to September 2024. A total of 111 women with singleton pregnancies ≥34 weeks with confirmed PROM were grouped as term (≥37 weeks) or late preterm (34–36+6 weeks) and stratified by induction timing: early (6–12 hours) or late (>12 hours). Maternal and neonatal outcomes were analyzed using SPSS version 27.0, with Chi-square and Fisher’s exact tests applied; p<0.05 was considered significant. Results: Of 111 participants, term PROM was present in 59 (53.2%) and late preterm PROM in 52 (46.8%); 61 (55.0%) underwent early and 50 (45.0%) late induction. Spontaneous vaginal delivery was the predominant mode (63.1%). Late preterm PROM was associated with significantly worse neonatal outcomes than term PROM across all parameters, while induction timing had no significant effect on any maternal or neonatal outcome. Conclusions: Gestational age at membrane rupture is a stronger determinant of neonatal morbidity than induction timing. Thus, we cannot claim that early induction is definitively 'safe'—only that it was not associated with worse outcomes in this specific cohort.