Departments of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, and Academic Medical Centre, Amsterdam, the Netherlands; the National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia; the Department of Obstetrics and Gynaecology, Martini Hospital Groningen, Groningen, and the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands; Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney at Royal North Shore Hospital, St. Leonards, and Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, New South Wales, and Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia.
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OBJECTIVE:To compare the effects of immediate delivery an expectant management among women whose pregnancies were complicated by preterm prelabor rupture of membranes (PROM) in the late preterm period (from 34 0/7 weeks until 36 6/7 weeks of gestation).DATA SOURCES:PubMed, Scopus, ClinicalTrials.gov, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from inception until December 2016.METHODS OF STUDY SELECTION:We included all randomized controlled trials with individual participant data reporting on late preterm PROM with randomization to immediate delivery or expectant management. The primary outcome was a composite of adverse neonatal outcomes: probable or definitive neonatal sepsis, necrotizing enterocolitis, respiratory distress syndrome, stillbirth, or neonatal death.TABULATION, INTEGRATION AND RESULTS:Of eight eligible trials (total n=3,203 mothers), three (2,563 mothers, 2,572 neonates) had individual participant data available. The composite adverse neonatal outcome occurred in 9.6% of neonates in the immediate delivery group and 8.3% in the expectant management group (relative risk [RR] 1.20, 95% CI 0.94–1.55). Neonatal sepsis rates were 2.6% and 3.5%, respectively (RR 0.74, 95% CI 0.47–1.15). Neonates in the immediate delivery group were more likely to be diagnosed with respiratory distress syndrome (RR 1.47, 95% CI 1.10–1.97), and to be admitted to the neonatal intensive care unit or special care nursery (RR 1.17, 95% CI 1.11–1.23) and had longer admissions. Mothers randomized to immediate delivery were less likely to have an antepartum hemorrhage (RR 0.57, 95% CI 0.34–0.95) or chorioamnionitis (RR 0.21, 95% CI 0.13–0.35), but more likely to undergo cesarean delivery (RR 1.26, 95% CI 1.08–1.47).CONCLUSION:In women with late preterm PROM, immediate delivery and expectant management resulted in comparable rates of the composite of adverse neonatal outcomes. Effects on individual secondary maternal and neonatal outcomes were mixed.SYSTEMATIC REVIEW REGISTRATION:PROSPERO, 42016032972.