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

Abstract

Background: Delivery after preterm prelabour rupture of the membranes (PPROM) may be initiated soon after PPROM or be delayed. It is unclear which strategy is most beneficial for mothers and their babies. Method: We searched electronic databases and trial registries, proceedings of major conferences and reference lists of trials and other review articles. All randomised controlled trials comparing expectant management with early delivery for women with PPROM prior to 37 weeks' gestation were assessed for inclusion. Results: Seven trials were included in the review. No difference was seen 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) and endometritis (RR 2.32, 95% CI 1.33 - 4.07) while there was no effect of early delivery on chorioamnionitis (RR 0.44, 95% CI 0.17 to 1.14). Conclusions: 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.