title: Effects of intentional delivery on maternal and neonatal outcomes in pregnancies with preterm prelabour rupture of membranes between 28 and 34 weeks of gestation: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess the effects of intentional delivery (ID) over expectant management (EM) in pregnancies complicated by preterm prelabour rupture of membranes (PPROM) between 28 and 34 weeks of gestation on maternal and neonatal outcomes.
  
  
  METHODS
  We searched Ovid MEDLINE, EMBASE, CINAHL, CENTRAL and Science Citation Index; contacted experts and checked reference lists of relevant studies. Studies were included if they were randomized controlled trials in all languages.
  
  
  RESULTS
  Five randomized trials were included and 488 subjects were analyzed. Overall, the results showed significant heterogeneity. Maternal infection as well as respiratory distress syndrome (RDS) & neonatal sepsis (NS) were not different between the two groups. Neonatal death, however, was significantly higher (risk ratio: 5.81; 95% CI: 1.35-25.08; p = 0.03) in the ID group after excluding studies that gave antenatal steroids. Incidence of cesarean section was significantly higher in the intentional delivery group, as well (risk ratio: 1.35; 95% CI: 1.02-1.80; p = 0.03).
  
  
  CONCLUSIONS
  Based on the available evidence, ID in pregnancies complicated with PPROM between 28 and 34 weeks carries some maternal and neonatal risks with no added benefits. Thus, this treatment should not be considered as an option for women with PPROM before 34 weeks of gestation in the absence of other indications for early delivery.
authors.affiliation: Department of Obstetrics & Gynecology, King Saud University, Riyadh, Saudi Arabia. hmmandeel@gmail.com
authors.forename: Hazem
authors.initials: H
authors.lastname: Al-Mandeel
authors.forename: Mohammed Y
authors.initials: MY
authors.lastname: Alhindi
authors.forename: Reg
authors.initials: R
authors.lastname: Sauve
mesh_terms: D000075202:Contraindications; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology; D018570:Risk Assessment; D018805:Sepsis / Q000453:epidemiology