Induction of labor versus expectant management in patients with preterm premature rupture of membranes: a systematic review and meta-analysis

Abstract

Introduction: Preterm premature rupture of membranes (PPROM), is an obstetric pathology that causes a high-risk of morbidities and higher rate of hospital readmission in the first month of life. However, the management of this patology is still uncertain. Objetive: To compare maternal-fetal outcomes of induction of labor (IL) and expectant management (EM) in order to determine the actions to follow. Methodology: Systematic review and meta-analysis Data collection: We searched MEDLINE, EMBASE, SCIELO and Google Scholar. Selection Criteria, patients and interventions: Controlled randomized clinical trial and cohort studies were included. These studies compared the EM and IL in patients with PPROM within 24 to 36 6/7 weeks and take into account outcomes such as neonatal sepsis (NS), respiratory distress syndrome (RDS), neonatal death or chorioamnionitis. Analysis and data collection: Two authors independently executed the extraction and recording of data. Quality assessment was performed with the CONSORT or STROBE score, accordingly. Meta-analysis: For each outcome, a pooled Relative Risk was estimated using random effects models. Results 3378 women with PPROM were included in 9 studies (8 clinical trials). In the meta-analysis, we did not find a statistically significant differences in the occurrence of RDS (RR = 1.08; 95% CI: 0.89-1.31 or NS (RR= 0.92; IC 95%: 0.61-1.39), in the IL group in comparison with EM. We did not find either differences in the occurrence of neonatal deaths (RR= 1.34; IC 95%: 0.93-1.93) or chorioamnionitis ( RR= 0.88; IC 95%: 0.58-1.35). Conclusions: The results suggest that there is no evidence of statistically significant differences in the occurrence of major outcomes when comparing MS with IL. Further studies and larger sample sizes will be necesary