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Evidence summaries

Planned Early Birth Versus Expectant Management for Women with Preterm Prelabour Rupture of Membranes for Improving Pregnancy Outcome

Expectant management with careful monitoring carries more clinical benefits for the newborn and mother compared with immediate delivery for women with preterm prelabour rupture of the membranes. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 12 studies with a total of 3 617 women and 3 628 babies. There was no difference in neonatal sepsis or infection, overall perinatal mortality (RR 1.76, 95% CI 0.89 to 3.50; 11 trials, n=3319), or intrauterine deaths when comparing early delivery with expectant management. Early delivery increased the incidence of respiratory distress syndrome, admission to neonatal intensive care, and caesarean section (table T1), but decreased the risk of chorioamnionitis and maternal hospital stay (table T1).

Planned early birth compared to expectant management for preterm prelabour rupture of membranes prior to 37 weeks' gestation

OutcomeRelative effect(95% CI)Assumed risk - Control - Expectant managementCorresponding risk - Intervention - Planned early birth (95% CI)No of participants(studies) Quality of evidence
Neonatal infection/sepsis, Follow-up: 28 daysRR 0.93 (0.66 to 1.3)37 / 100034 / 1000(24 to 48)3628(12) Moderate
Neonatal respiratory distress syndrome,Follow-up: 28 daysRR 1.26 (1.05 to 1.53)84 / 1000109 / 1000(89 to 131)3622(12) High
Need for ventilationRR 1.27 (1.02 to 1.58)86 / 1000110 / 1000(88 to 136)2895(7) High
Admission to neonatal intensive care,Follow-up: 28 daysRR 1.16 (1.08 to 1.24)428 / 1000497 / 1000(462 to 531)2691(4) Moderate
Caesarean sectionRR 1.26 (1.11 to 1.44)172 / 1000217 / 1000(191 to 248)3620(12) High
ChorioamnionitisRR 0.50 (0.26 to 0.95)103 / 100051 / 1000(27 to 98)1358(8) Moderate
Length of hospital stay (maternal)MD -1.75 (-2.45 to -1.05)The mean length of hospital stay was 7.6 daysThe mean length of hospital stay was 1.75 days lower(2.45 to 1.05 lower)2848(6) Moderate

    References

    • Buchanan SL, Crowther CA, Levett KM, Middleton P, Morris J. Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome. Cochrane Database Syst Rev 2010 Mar 17;3:CD004735 [Assessed as up-to-date: 30 September 2016]. [PubMed]

Primary/Secondary Keywords