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

Show simple item record Buchanan Sarah, L en Crowther Caroline, A en Levett Kate, M en Middleton, P en Morris, J en 2018-10-24T00:40:08Z en 2010-03-17 en
dc.identifier.issn 1469-493X en
dc.identifier.uri en
dc.description.abstract Delivery after preterm prelabour rupture of the membranes (PPROM) may be initiated soon after PPROM or, alternatively, be delayed. It is unclear which strategy is most beneficial for mothers and their babies.To assess the effect of planned early birth compared with expectant management for pregnancies complicated with PPROM prior to 37 weeks' gestation.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 1), MEDLINE (1996 to May 2009), EMBASE (1974 to May 2009), and reference lists of trials and other review articles.Randomised controlled trials comparing expectant management with early delivery 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.We included seven trials (690 women) in the review. We identified no difference in the primary outcomes of neonatal sepsis (risk ratio (RR) 1.33, 95% confidence interval (CI) 0.72 to 2.47) or respiratory distress (RR 0.98, 95% CI 0.74 to 1.29). Early delivery increased the incidence of caesarean section (RR 1.51, 95% CI 1.08 to 2.10). There was no difference in the overall perinatal mortality (RR 0.98, 95% CI 0.41 to 2.36), intrauterine deaths (RR 0.26, 95% CI 0.04 to 1.52) or neonatal deaths (RR 1.59, 95% CI 0.61 to 4.16) when comparing early delivery with expectant management. There was no significant difference in measures of neonatal morbidity, including cerebroventricular haemorrhage (RR 1.90 95% CI 0.52 to 6.92), necrotising enterocolitis (RR 0.58, 95% CI 0.08 to 4.08), or duration of neonatal hospitalisation (mean difference (MD) -0.33 days, 95% CI -1.06 to 0.40 days). In assessing maternal outcomes, we found that early delivery increased endometritis (RR 2.32, 95% CI 1.33 to 4.07), but that early delivery had no effect on chorioamnionitis (RR 0.44, 95% CI 0.17 to 1.14). There was a significant reduction of early delivery on the duration of maternal hospital stay (MD -1.13 days, 95% CI -1.75 to -0.51 days).There is insufficient evidence to guide clinical practice on the benefits and harms of immediate delivery compared with expectant management for women with PPROM. To date all of the clinical trials have had methodological weaknesses and have been underpowered to detect meaningful measures of infant and maternal morbidity. en
dc.publisher Cochrane Collaboration en
dc.relation.ispartofseries Cochrane Database of Systematic Reviews en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri en
dc.subject Female [checkword] Humans [checkword] Pregnancy [checkword] Fetal Membranes, Premature Rupture Cesarean Section [utilization] Chorioamnionitis [epidemiology] Delivery, Obstetric [methods] Fetal Death Infant, Newborn Infant Mortality Labor Onset Length of Stay Perinatal Mortality Premature Birth Randomized Controlled Trials as Topic Respiratory Distress Syndrome, Newborn [epidemiology] [prevention & control] Sepsis [epidemiology] [prevention & control] Hm-preg en
dc.title Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome en
dc.type Journal Article en
dc.identifier.doi 10.1002/14651858.cd004735.pub3 en
pubs.issue 3 en
dc.rights.holder Copyright: The author en
dc.identifier.pmid 20238332 en en
dc.rights.accessrights en
pubs.subtype Review en
pubs.elements-id 344346 en Liggins Institute en LiFePATH en
dc.identifier.eissn 1469-493X en
pubs.number CD004735 en
pubs.record-created-at-source-date 2012-05-16 en
pubs.dimensions-id 20238332 en

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