What is the Best Course of Action Following PPROM Between 24 and 37 Weeks?
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.
Systematic Review and meta-analysis
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.
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)
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)
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
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
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