BACKGROUND AND PURPOSE:

• Second trimester preterm prelabor rupture of membranes (PPROM) occurs between 16w0d – 24w0d and is associated with severe adverse perinatal complications, including pulmonary hypoplasia
• Data is limited as to whether transabdominal amnioinfusion may result in improved outcomes
• Van Kempen et al. (Obstetrics & Gynecology, 2018) examined the effectiveness of amnioinfusion in second-trimester preterm PPROM

METHODS:

PPROM: Expectant Management versus Induction of Labor-III (PPROMEXIL-III) trial

• Multicenter, open-label, randomized controlled trial (RCT)
  • Singleton pregnancies with second trimester PROM
  • Oligohydramnios: Defined as single deepest pocket <2cm
• Patients underwent either (1:1 ratio)
  • Transabdominal amnioinfusion with repeat amnioinfusion weekly until 28w0d if deepest pocket remained <2cm
  • No intervention
• All patients were received erythromycin
  • 250 mg 4x per day for 10 days
• Primary outcome: Perinatal mortality
  • Mortality defined as fetal demise or neonatal death within 28 days postpartum
• Secondary outcomes
  • Cause of mortality | Related perinatal outcomes

RESULTS:

• 56 women were randomized
  • 28 in the amnioinfusion group | 28 in the non-intervention group
• In the amnioinfusion group, 5 women did not undergo amnioinfusion for various reasons such as delivery or sepsis prior to first scheduled amnioinfusion
• Median number of amnioinfusions: 2 per woman (range 0 to 8)
• Overall perinatal mortality rates were not statistically different
  • 64% in the amnioinfusion group
  • 75% in the no intervention group
  • Relative risk (RR) 0.86 (95% CI, 0.60–1.22, P=.39)
• Neonatal survival without morbidity was similar between the two groups
  • 27% in the amnioinfusion group
  • 23% in the no intervention group
  • RR 1.73 (95% CI, 0.38–7.98, P=.48)
• There were no differences between groups for the following
  • Cesarean section | Chorioamnionitis
  • No abruptions or maternal deaths were observied in either group
• Safety of amnioinfusion: Complications
  • Fetal: Bradycardia | inadvertent needle puncture
  • Maternal: Painless contraction | Inadvertent myometrial injection | Severe abdominal pain | Vaginal bleeding

CONCLUSION:

• Authors caution that
  • Study was only powered to detect a decrease in perinatal mortality from 70% to 35% and therefore smaller clinical differences could still be present
  • However, these data support a previous RCT that there is no benefit to amnioinfusion in the setting of second trimester preterm PROM

Learn More – Primary Sources:

Amnioinfusion Compared With No Intervention in Women With Second-Trimester Rupture of Membranes

Related ObG Topics:

ACOG Guidance Update: Diagnosis and Management of PROM (Prelabor Rupture of Membranes)

Can Azithromycin Be Used in Place of Erythromycin for Preterm PROM?

Should Tocolytics Be Used Following PPROM?