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Grand Rounds

Is Amnioinfusion a Possible Treatment for Second-Trimester PPROM?

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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


Now You Can Get Clinical Research Summaries Direct to Your Email/Text | Tap Here to Learn More

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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?

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