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

Abstract

With the addition of five randomised controlled trials (2927 women) to this updated review, we found no clinically important difference in the incidence of neonatal sepsis between women who birth immediately and those managed expectantly in PPROM prior to 37 weeks' gestation. Early planned birth was associated with an increase in the incidence of neonatal RDS, need for ventilation, neonatal mortality, endometritis, admission to neonatal intensive care, and the likelihood of birth by caesarean section, but a decreased incidence of chorioamnionitis. Women randomised to early birth also had an increased risk of labour induction, but a decreased length of hospital stay. Babies of women randomised to early birth were more likely to be born at a lower gestational age.In women with PPROM before 37 weeks' gestation with no contraindications to continuing the pregnancy, a policy of expectant management with careful monitoring was associated with better outcomes for the mother and baby.The direction of future research should be aimed at determining which groups of women with PPROM would not benefit from expectant management. This could be determined by analysing subgroups according to gestational age at presentation, corticosteroid usage, and abnormal vaginal microbiological colonisation. Research should also evaluate long-term neurodevelopmental outcomes of infants.

Care of Women Presenting with Suspected Preterm Prelabour Rupture of Membranes from 24+0 Weeks of Gestation

“…More recently, a Cochrane review of 3617 women explored the effect of planned early delivery versus expectant management for women with PPROM. 43 The authors conclude that in women with PPROM 'with no contraindications to continuing the pregnancy, expectant management with careful monitoring is associated with better outcomes for the mother and baby'. The Cochrane review found no differences between early birth and expectant management in neonatal sepsis or infection.…”

“…There were no differences in overall perinatal mortality or intrauterine deaths when comparing early delivery with expectant management. Early birth was associated with a higher rate of neonatal death (RR 2.55, 95% CI 1.17–5.56) and need for ventilation (RR 1.27, 95% CI 1.02–1.58) Evidence level 1++ …”

“…The individual studies included in the Cochrane review had a number of ‘exclusion criteria’ including: active labour, chorioamnionitis, concerns about fetal wellbeing, monochorionic multiple pregnancy, hypertensive disorders and other contraindications to continuing the pregnancy. Therefore the timing of birth should be discussed with each woman on an individual basis with careful consideration of patient preference and ongoing clinical assessment.…”

“…Early birth was associated with a higher rate of neonatal death (RR 2.55, 95% CI 1.17-5.56) and need for ventilation (RR 1.27, 95% CI 1.02-1.58). 43…”

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

“…This review (Bond et al, ) aimed to compare the results of planned early birth and expectant management in women who went into premature labour between 24 and 37 weeks gestation following rupture of their membranes. Planned early birth occurs as soon as possible after rupture of membranes, and the methods include induction of labour and caesarean section.…”