title: Transabdominal amnioinfusion for preterm premature rupture of membranes: a systematic review and metaanalysis of randomized and observational studies.
abstract: OBJECTIVE
  The purpose of this study was to review systematically the efficacy of transabdominal amnioinfusion (TA) in early preterm premature rupture of membranes (PPROM).
  
  
  METHODS
  We conducted a literature search of EMBASE, MEDLINE, and ClinicalTrials.gov databases and identified studies in which TA was used in cases of proven PPROM and oligohydramnios. Risk of bias was assessed for observational studies and randomized controlled trials. Primary outcomes were latency period and perinatal mortality rates.
  
  
  RESULTS
  Four observational studies (n = 147) and 3 randomized controlled trials (n = 165) were eligible. Pooled latency period was 14.4 (range, 8.2-20.6) and 11.41 (range -3.4 to 26.2) days longer in the TA group in the observational and the randomized controlled trials, respectively. Perinatal mortality rates were reduced among the treatment groups in both the observational studies (odds ratio, 0.12; 95% confidence interval, 0.02-0.61) and the randomized controlled trials (odds ratio, 0.33; 95% confidence interval, 0.10-1.12).
  
  
  CONCLUSIONS
  Serial TA for early PPROM may improve early PPROM-associated morbidity and mortality rates. Additional adequately powered randomized control trials are needed.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mt Sinai Hospital, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shay
authors.initials: S
authors.lastname: Porat
authors.forename: Hagai
authors.initials: H
authors.lastname: Amsalem
authors.forename: Prakesh S
authors.initials: PS
authors.lastname: Shah
authors.forename: Kellie E
authors.initials: KE
authors.lastname: Murphy
mesh_terms: D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000628:therapy*; D006801:Humans; D007263:Infusions, Parenteral / Q000379:methods*; D016104:Oligohydramnios / Q000628:therapy; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic