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Effects of Intentional Delivery on Maternal and Neonatal Outcomes in Pregnancies with Preterm Prelabour Rupture of Membranes between 28 and 34 weeks of Gestation: A Systematic Review and Meta-analysis.
MedLine Citation:
PMID:  22882130     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Abstract Objective: To assess the effects of intentional delivery (ID) over expectant management (EM) in pregnancies complicated by preterm prelabour rupture of membranes (PPROM) between 28 and 34 weeks of gestation on maternal and neonatal outcomes. Methods: We searched Ovid MEDLINE, EMBASE, CINAHL, CENTRAL, and Science Citation Index; contacted experts, and checked reference lists of relevant studies. Studies were included if they were randomized controlled trials in all languages. Results: Five randomized trials were included and 488 subjects were analyzed. Overall, the results showed significant heterogeneity. Maternal infection as well as respiratory distress syndrome (RDS) & neonatal sepsis (NS) were not different between the two groups. Neonatal death, however, was significantly higher (risk ratio (RR) 5.81; 95% CI, 1.35 - 25.08; p = 0.03) in the ID group after excluding studies that gave antenatal steroids. Incidence of cesarean section was significantly higher in the intentional delivery group, as well (RR 1.35; 95% CI, 1.02-1.80; p = 0.03). Conclusion: Based on the available evidence, ID in pregnancies complicated with PPROM between 28 and 34 weeks carries some maternal and neonatal risks with no added benefits. Thus, this treatment should not be considered as an option for women with PPROM before 34 weeks of gestation in the absence of other indications for early delivery.
Authors:
Hazem Al-Mandeel; Mohammed Y Alhindi; Reg Sauve
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-13
Journal Detail:
Title:  The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians     Volume:  -     ISSN:  1476-4954     ISO Abbreviation:  J. Matern. Fetal. Neonatal. Med.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101136916     Medline TA:  J Matern Fetal Neonatal Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Obstetrics & Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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