Treatment of premature rupture of membranes
Sübutlu məlumatların xülasələri
10.07.2017 • Sonuncu dəyişiklik 10.07.2017
Editors
Planned early birth with oxytocin or prostaglandin appears to reduce the risk of maternal infections without increasing the rate of operative births in prelabour rupture of membranes.
A Cochrane review included 23 studies with a total of 8 615 subjects. Planned management was generally induction with oxytocin or prostaglandin (vaginal prostaglandin E2 and oral, sublingual or vaginal misoprostol). Significantly fewer women in the planned groups had chorioamnionitis and/or endometritis (RR
0.49, 95% CI 0.33 to 0.72; 8 trials, n=6864; I²=72%) and fewer infants had definite or probable early-onset neonatal sepsis(RR 0.73; 95% CI 0.58 to 0.92; 16 trials, n=7314) under planned management went to neonatal intensive or special care (RR 0.72, 95% CI 0.57 to 0.92, NNT 20; 5 trials, 5679 infants). No difference was seen for caesarean section (RR 0.84; 95% CI 0.69 to 1.04; 23 trials, n=8576; I²=55%); serious maternal morbidity or mortality (no events; 3 trials; n=425); definite early-onset neonatal sepsis (RR 0.57; 95% CI 0.24 to 1.33; 6 trials, n=1303); or perinatal mortality (RR 0.47; 95% CI 0.13 to 1.66; 8 trials, n=6392).
A systematic review
including 23 studies with a total of 7493 subjects was abstracted in DARE. Immediate oxytocin versus conservative treatment gave the following outcomes: chorioamnionitis OR 0.91, 95% ci 0.51 to 1.61; endometritis OR 0.78, 95% CI 0.50 to 1.21; caesarean section OR 1.24, 95% CI 0.89 to 1.73; neonatal infection OR 0.73, 95% CI 0.47 to 1.13. Prostaglandins versus oxytocin gave the following outcomes: chorioamnionitis OR 0.68, 95% CI 0.51 to 0.91; endometritis OR 0.81, 95% CI 0.53 to 1.23; caesarean section 0.95,
95% CI 0.76 to 1.20, neonatal infection 1.06, 95% CI 0.67 to 1.66. Prostaglandins versus oxytocin gave the following outcomes: chorioamnionitis OR 1.55, 95% CI 1.09 to 2.21; endometritis OR 0.78, 95% CI 0.23 to 2.62, caesarean section OR 0.67, 95% CI 0.34 to 1.29; neonatal infection OR 1.50, 95% CI 0.91 to 2.45.
Ədəbiyyat
- Dare MR, Middleton P, Crowther CA, Flenady VJ, Varatharaju B. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database Syst Rev 2006 Jan 25;(1):CD005302 [Assessed as up-to-date: 9 September 2016].
Mozurkewich EL, Wolf FM. Premature rupture of membranes at term: a meta-analysis of three management schemes. Obstet Gynecol 1997 Jun;89(6):1035-43.