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Am J Perinatol 2024; 41(12): 1604-1615
DOI: 10.1055/a-2302-8657
SMFM Fellowship Series Article

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

Alexander M. Saucedo 
1   Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, Texas
,
Chase Calvert
1   Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, Texas
,
Adrian Chiem
2   Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania
,
Alan Groves
3   Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas
,
Kobina Ghartey
1   Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, Texas
,
Alison G. Cahill
1   Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, Texas
,
Lorie M. Harper 
1   Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, Texas
› Author Affiliations Funding None.
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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.

Keywords

periviable - previable - midtrimester - second trimester - rupture of membranes - expectant management - immediate delivery - termination

Note

This study was presented as a poster at the 2023 American College of Obstetricians and Gynecologists Annual Clinical & Scientific Meeting, Baltimore, MD, May 19, 2023.


Data Availability Statement

A.M.S. and L.M.H. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.


Authors' Contributions

All authors take responsibility for the accuracy and completeness of reporting and for the fidelity of the report to the study protocol. Study concept and design: all authors; data collection: L.M.H. and C.C.; analysis and interpretation of data: all authors; drafting of manuscript: A.M.S.; critical revision of the manuscript: all authors.


Supplementary Material



Publication History

Received: 20 February 2024

Accepted: 24 March 2024

Accepted Manuscript online:
09 April 2024

Article published online:
29 April 2024

© 2024. Thieme. All rights reserved.

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