Risk of Intra-Amniotic Infection After Cervical Ripening Balloon for Prelabor Rupture of Membranes: A Systematic...

Area of Science:

• Obstetrics and Gynecology
• Infectious Disease Epidemiology

Background:

• Intra-amniotic infection is a risk in prelabor rupture of membranes (PROM).
• Cervical ripening balloons and pharmacologic methods are used for labor induction in PROM.

Purpose of the Study:

• To compare intra-amniotic infection odds between cervical ripening balloon induction and pharmacologic induction in individuals with PROM.
• To conduct a systematic review and meta-analysis to estimate these odds.

Main Methods:

• Searched MEDLINE, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov.
• Included 14 studies (8 RCTs, 6 cohort studies) with 2,165 participants.
• Pooled odds ratios (OR) with 95% CIs using a random-effects model.

Main Results:

• Overall intra-amniotic infection rates were 9.4% with balloons and 7.0% with pharmacologic methods (OR 1.46; 95% CI, 0.90-2.37).
• In RCTs, balloons showed increased infection odds (OR 1.84; 95% CI, 1.03-3.28).
• Low-bias studies indicated higher infection odds with balloons (OR 1.74; 95% CI, 1.01-3.01).

Conclusions:

• Overall intra-amniotic infection odds were similar between cervical ripening balloon and pharmacologic induction for PROM.
• Analysis of RCTs and low-bias studies suggests an association between cervical ripening balloon use and increased intra-amniotic infection.