BACKGROUND AND PURPOSE:

• Prelabour rupture of the membranes (PROM) can either be managed expectantly (no planned intervention within 24 hours) or planned early birth (either immediate intervention or intervention within 24 hours through some form of induction of labor or by C-section)
• This study by Middleton et al. (Cochrane Database of Systematic Reviews, 2017) sought to determine the best course of action following PROM ≥ 37 weeks

METHODS:

• Systematic Review and Meta-Analysis
• 23 trials, including 8,615 women and their infants were included
• Trials included oxytocin, vaginal prostaglandin E2, and sublingual, oral, or vaginal misoprostol
• Trials that assessed Caulophyllum and acupuncture were also included

RESULTS:

Primary Outcomes

• Early birth was associated with:
  • Lower risk of maternal infectious morbidity defined as chorioamnionitis and/or endometritis (risk ratio 0.49; 95% CI 0.33 to 0.72)
  • Lower chance of definite or probable early-onset neonatal sepsis (risk ratio 0.73; 95% CI 0.58 to 0.92)
• There were no significant differences between the two groups regarding
  • C-section risk
  • Serious maternal morbidity or mortality
  • Definite early-onset neonatal sepsis
  • Perinatal mortality

Secondary Outcomes

• Early birth was associated with:
  • Lower risk of chorioamnionitis (risk ratio 0.55; 95% CI 0.37 to 0.82)
  • Postpartum septicemia (risk ratio 0.26; 95% CI 0.07 to 0.96)
• Neonates less likely to receive antibiotics (risk ratio 0.61; 95% CI 0.44 to 0.84)
• Higher risk of induction (risk ratio 3.41; 95% CI 2.87 to 4.06; 12 trials)
• Shorter time from PROM to birth (mean difference -10.10 hours; 95% CI -12.15 to -8.06)
• Lower neonatal birthweights (mean difference -79.25 g; 95% CI -124.96 to -33.55; five trials, 1,043 infants)
• Shorter hospitalization time (mean difference -0.79 days; 95% CI -1.20 to -0.38)
• Lower risk of NICU admission (risk ratio 0.75; 95% CI 0.66 to 0.85)
  • If admitted, stay was shorter (risk ratio 0.72; 95% CI 0.61 to 0.85)
• More positive views of care from the patient perspective based on visual analogue scale and questionnaires in 2 studies

CONCLUSION:

• Following PROM at 37 weeks, planned early birth with induction decreases the risk of maternal and fetal infection compared to expectant management without increasing the risk of C-section
• No subgroup differences were found between initial mode of induction for planned early birth
• The authors report results overall reflect low quality evidence, i.e., the true effect may be substantially different from the estimate of the effect
  • Majority of studies had serious design flaws
  • Outcome estimates were imprecise
• The strength of this study is the large number of women and infants included for analysis

Learn More – Primary Sources:

Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more)

Related ObG Topics:

What is the Best Course of Action Following PPROM Between 24 and 37 Weeks?

Should Tocolytics Be Used Following PPROM?

Foley Bulb Catheter for Induction Following PROM in Nulliparas