Treatments of preterm premature rupture of the membranes: a meta-analysis.
The objective of this overview was to critically evaluate published randomized controlled trials on treatments in preterm premature rupture of the membranes. The Oxford data base on perinatal trials, MEDLINE, Excerpta Medica, and Index Medicus were searched. Through primary and secondary review with preset inclusion criteria, two independent judges identified 27 randomized controlled trials, of which 13 met inclusion criteria. The quality of these randomized controlled trials was scored. Five randomized controlled trials regarding antenatal use of corticosteroids to prevent respiratory distress syndrome could be combined meta-analytically and showed a reduction in respiratory distress syndrome in the treatment group (p = 0.001). However, no significant reduction in respiratory distress syndrome (p = 0.286) was found after one study, with the lowest quality score, was excluded. A significant increase in endometritis and a trend toward an increase in neonatal infections and cesarean section rates were noted with treatment. Tocolysis, prophylactic antibiotics, and other interventions studied were not found to be of proved benefit and therefore should not be used outside of a randomized controlled trial.
Ohlsson
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Division of Neonatology, University of Toronto Regional Perinatal Unit at Women's College Hospital, Ontario, Canada.
D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002986:Clinical Trials as Topic / Q000379:methods; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy / Q000628:therapy*; D005325:Fetal Organ Maturity; D006801:Humans; D008168:Lung / Q000473:pathology / Q000503:physiopathology; D015201:Meta-Analysis as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000628:therapy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D011256:Pregnancy Outcome; D011897:Random Allocation; D012107:Research Design; D013256:Steroids / Q000627:therapeutic use; D015145:Tocolysis / Q000009:adverse effects; D014470:Umbilical Cord / Q000503:physiopathology
D000900:Anti-Bacterial Agents; D013256:Steroids