PURPOSE:

This study by Bond et al. (Cochrane Database Systematic Review, 2017) compared planned early birth vs. expectant management following preterm pre-labor rupture of the membranes (PPROM) between 24 and 37 weeks gestation.

METHODS:

Systematic Review and meta-analysis

RESULTS:

This update of a 2010 Cochrane review included 12 randomized controlled trials, with analyses on a total of 3,617 women and 3,628 infants.

Primary outcomes:

• There was no significant difference in rates of neonatal sepsis or proven neonatal infection
• Early birth was associated with
  • Increased rate of RDS (Relative Risk 1.26, 95% CI 1.05 to 1.53)
  • Increased rate of c-section (Relative Risk  1.26, 95% CI 1.11 to 1.44)

Secondary outcomes:

• There was no significant difference in rates of overall perinatal mortality or intrauterine deaths between the two groups
• Early birth was associated with the following maternal outcomes
  • Decreased rate of chorioamnionitis (Relative Risk 0.50, 95% CI 0.26 to 0.95)
  • Decreased hospital stay with a mean difference of -1.75 days (95% CI -2.45 to -1.05)
  • Increased rate of endometritis (Relative Risk 1.61, 95% CI 1.00 to 2.59)
• Early birth was associated with the following neonatal outcomes
  • Higher rates of neonatal death (Relative Risk 1.26, 95% CI 1.11 to 1.44)
  • Higher rates of ventilation (Relative Risk 1.27, 95% CI 1.02 to 1.58)
  • Delivery at lower gestational ages with a mean difference of -0.48 weeks (95% CI -0.57 to -0.39)
  • Higher rates of NICU admission (Relative Risk 1.16, 95% CI 1.08 to 1.24)
• Subgroup analyses:
  • Improved maternal and infant outcomes in expectant management greater than 34 weeks gestation for RDS and maternal infections
  • Antibiotics reduce maternal infections in the expectant management group

Authors’ conclusions:

• If there are no contraindications, overall the expectant management group with careful monitoring had better outcomes for mother and baby
• Further research needed for subgroup analysis as to who would not benefit from expectant management
• Long term neurodevelopment was not addressed in this study

Learn More – Primary Sources:

Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks’ gestation for improving pregnancy outcome

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