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

Area of Science:

• Perinatal Medicine
• Maternal-Fetal Medicine
• Neonatal Outcomes

Background:

• Counseling for periviable premature rupture of membranes (PROM) requires data on both maternal and neonatal outcomes for immediate delivery versus expectant management.
• Existing data often emphasizes neonatal outcomes, with variable maternal risk estimates.

Purpose of the Study:

• To conduct a meta-analysis comparing maternal and neonatal outcomes between expectant management and immediate delivery for periviable PROM.

Main Methods:

• A systematic literature search was conducted across multiple databases (PubMed, MEDLINE, Web of Science, etc.) for studies published after 2000.
• Included studies focused on gestational ages 14–25 weeks and reported maternal/neonatal outcomes for both management strategies.
• Maternal sepsis was the primary outcome; chorioamnionitis, hemorrhage, laparotomy, and neonatal survival were secondary. Random-effects models were used for pooled risk differences.

Main Results:

• Five studies (four retrospective, one prospective) involving 535 women were analyzed.
• Expectant management was associated with significantly higher rates of maternal sepsis (4%), chorioamnionitis (30%), and laparotomy (28%).
• Neonatal survival to discharge was 39% with expectant management, compared to 0% with immediate delivery.

Conclusions:

• Expectant management of periviable PROM significantly increases maternal risks for sepsis, chorioamnionitis, and laparotomy.
• A 39% neonatal survival rate to discharge was observed with expectant management.
• Informed patient counseling requires clear understanding of these comparative maternal and neonatal risks.