Periviable Premature Rupture of Membranes-Maternal and Neonatal Risks: A Systematic Review and Meta-analysis

Alexander M Saucedo; Chase Calvert; Adrian Chiem; Alan Groves; Kobina Ghartey; Alison G Cahill; Lorie M Harper

doi:10.1055/a-2302-8657

Periviable Premature Rupture of Membranes-Maternal and Neonatal Risks: A Systematic Review and Meta-analysis

Am J Perinatol. 2024 Apr 29. doi: 10.1055/a-2302-8657. Online ahead of print.

Authors

Alexander M Saucedo¹, Chase Calvert¹, Adrian Chiem², Alan Groves³, Kobina Ghartey¹, Alison G Cahill¹, Lorie M Harper¹

Affiliations

¹ Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, Texas.
² Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania.
³ Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas.

PMID: 38593987
DOI: 10.1055/a-2302-8657

Abstract

Objective: Periviable premature rupture of membranes (PROM) counseling should describe maternal and neonatal outcomes associated with both immediate delivery and expectant management. Unfortunately, most published data focuses on neonatal outcomes and maternal risk estimates vary widely. We performed a meta-analysis to describe outcomes associated with expectant management compared with immediate delivery of periviable PROM.

Study design: We performed a search on PubMed, MEDLINE, Web of Science, PROSPERO, Cochrane library, and ClinicalTrials.gov utilizing a combination of key terms. Published clinical trials and observational cohorts were included if published after 2000. Publications were selected if they included maternal and/or neonatal outcomes for both expectant management and immediate delivery. Gestational age range was limited from 14 to 25 weeks. The primary outcome was maternal sepsis. Secondary outcomes included chorioamnionitis, hemorrhage, laparotomy, and neonatal survival. Pooled risk differences (RDs) were calculated for each outcome using a random-effects model. Publication bias was assessed using funnel plots and Harbord test.

Results: A total of 2,550 studies were screened. After removal of duplicates and filtering by abstract, 44 manuscripts were reviewed. A total of five publications met inclusion for analysis: four retrospective and one prospective. Overall, 364 (68.0%) women underwent expectant management and 171 (32.0%) underwent immediate delivery. Maternal sepsis was significantly more frequent in the expectant group (RD, 4%; 95% confidence interval, 2-7%) as was chorioamnionitis (RD 30%; p < 0.01) and any laparotomy (RD, 28%; p < 0.01). Neonatal survival in the expectant group was 39% compared with 0% in the immediate group (p < 0.01).

Conclusion: Women who undergo expectant management following periviable rupture of membranes experience significantly increased risks of sepsis, chorioamnionitis, and laparotomy. Overall, 39% of neonates survive to discharge. Knowledge of these risks is critical to counseling patients with this diagnosis.

Key points: · Expectant management associated with 4% increased risk of sepsis.. · Expectant management associated with 30% increased risk of chorioamnionitis.. · A total of 39% of neonates survived to discharge with expectant management..