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

• Published in: Cochrane database of systematic reviews 2017-03, Vol.3 (3), p.CD004735
• Main Authors: Bond, Diana M, Middleton, Philippa, Levett, Kate M, van der Ham, David P, Crowther, Caroline A, Buchanan, Sarah L, Morris, Jonathan
• Format: Article
• Language: English
• Subjects: Cesarean Section - statistics & numerical data; Chorioamnionitis - epidemiology; Delivery, Obstetric - methods; Female; Fetal Death; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Induction of labour; Infant, Newborn; Intensive Care Units, Neonatal - statistics & numerical data; Labor Onset; Length of Stay - statistics & numerical data; Perinatal Mortality; Pregnancy; Pregnancy & childbirth; Premature Birth; Randomized Controlled Trials as Topic; Respiration, Artificial - statistics & numerical data; Respiratory Distress Syndrome, Newborn - epidemiology; Respiratory Distress Syndrome, Newborn - prevention & control; Sepsis - epidemiology; Sepsis - prevention & control; Watchful Waiting
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD004735.pub4

Current management of preterm prelabour rupture of the membranes (PPROM) involves either initiating birth soon after PPROM or, alternatively, adopting a 'wait and see' approach (expectant management). It is unclear which strategy is most beneficial for mothers and their babies. This is an update of a Cochrane review published in 2010 (Buchanan 2010). To assess the effect of planned early birth versus expectant management for women with preterm prelabour rupture of the membranes between 24 and 37 weeks' gestation for fetal, infant and maternal well being. We searched Cochrane Pregnancy and Childbirth's Trials Register (30 September 2016), and reference lists of retrieved studies. Randomised controlled trials comparing planned early birth with expectant management for women with PPROM prior to 37 weeks' gestation. We excluded quasi-randomised trials. Two review authors independently evaluated trials for inclusion into the review and for methodological quality. Two review authors independently extracted data. We checked data for accuracy. We assessed the quality of evidence using the GRADE approach. We included 12 trials in the review (3617 women and 3628 babies). For primary outcomes, we identified no clear differences between early birth and expectant management in neonatal sepsis (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.66 to 1.30, 12 trials, 3628 babies, evidence graded moderate), or proven neonatal infection with positive blood culture (RR 1.24, 95% CI 0.70 to 2.21, seven trials, 2925 babies). However, early birth increased the incidence of respiratory distress syndrome (RDS) (RR 1.26, 95% CI 1.05 to 1.53, 12 trials, 3622 babies, evidence graded high). Early birth was also associated with an increased rate of caesarean section (RR 1.26, 95% CI 1.11 to 1.44, 12 trials, 3620 women, evidence graded high).Assessment of secondary perinatal outcomes showed no clear differences in overall perinatal mortality (RR 1.76, 95% CI 0.89 to 3.50, 11 trials, 3319 babies), or intrauterine deaths (RR 0.45, 95% CI 0.13 to 1.57, 11 trials, 3321 babies) when comparing early birth with expectant management. However, early birth was associated with a higher rate of neonatal death (RR 2.55, 95% CI 1.17 to 5.56, 11 trials, 3316 babies) and need for ventilation (RR 1.27, 95% CI 1.02 to 1.58, seven trials, 2895 babies, evidence graded high). Babies of women randomised to early birth were delivered at a gestational age lower than those randomised to expectant managemen