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

OBJECTIVE: Periviable rupture of membranes 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 to immediate delivery of periviable PROM.

DATA SOURCES: We performed a search on PubMed, MEDLINE, Web of Science, PROSPERO, Cochrane library, and ClinicalTrials.gov utilizing a combination of key terms.

METHODS OF STUDY SELECTION: 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 weeks to 25 weeks. The primary outcome was maternal sepsis. Secondary outcomes included chorioamnionitis, hemorrhage, laparotomy, and neonatal survival. Pooled risk differences were calculated for each outcome using a random effects model. Publication bias was assessed using funnel plots and Harbord test.

TABULATION, INTEGRATION, AND RESULTS: A total of 2550 studies were screened. After removal of duplicates and filtering by abstract, 44 manuscripts were reviewed. A total of 5 publications met inclusion for analysis: 4 retrospective and 1 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% CI 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 to 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.