title: Amnioinfusion for third trimester preterm premature rupture of membranes.
abstract: BACKGROUND
  Preterm premature rupture of membranes (PPROM) is a leading cause of perinatal morbidity and mortality. Amnioinfusion aims to restore amniotic fluid volume by infusing a solution into the uterine cavity.
  
  
  OBJECTIVE
  The objective of this review was to assess the effects of amnioinfusion for PPROM on perinatal and maternal morbidity and mortality.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (2 December 2013).
  
  
  METHODS
  Randomised trials of amnioinfusion compared with no amnioinfusion in women with PPROM.
  
  
  METHODS
  Three review authors independently assessed trials for inclusion. Two review authors independently assessed trial quality and extracted data. Data were checked for accuracy.
  
  
  RESULTS
  We included five trials, of moderate quality, but we only analysed data from four studies (with a total of 241 participants). One trial did not contribute any data to the review.Transcervical amnioinfusion improved fetal umbilical artery pH at delivery (mean difference 0.11; 95% confidence interval (CI) 0.08 to 0.14; one trial, 61 participants) and reduced persistent variable decelerations during labour (risk ratio (RR) 0.52; 95% CI 0.30 to 0.91; one trial, 86 participants).Transabdominal amnioinfusion was associated with a reduction in neonatal death (RR 0.30; 95% CI 0.14 to 0.66; two trials, 94 participants), neonatal sepsis (RR 0.26; 95% CI 0.11 to 0.61; one trial, 60 participants), pulmonary hypoplasia (RR 0.22; 95% CI 0.06 to 0.88; one trial, 34 participants) and puerperal sepsis (RR 0.20; 95% CI 0.05 to 0.84; one trial, 60 participants). Women in the amnioinfusion group were also less likely to deliver within seven days of membrane rupture (RR 0.18; 95% CI 0.05 to 0.70; one trial, 34 participants). These results should be treated with circumspection as the positive findings were mainly due to one trial with unclear allocation concealment.
  
  
  CONCLUSIONS
  These results are encouraging but are limited by the sparse data and unclear methodological robustness, therefore further evidence is required before amnioinfusion for PPROM can be recommended for routine clinical practice.
authors.affiliation: Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, South Africa, 5200.
authors.forename: G Justus
authors.initials: GJ
authors.lastname: Hofmeyr
authors.forename: Ahizechukwu C
authors.initials: AC
authors.lastname: Eke
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Lawrie
mesh_terms: D000282:Administration, Intravaginal; D000650:Amnion; D000653:Amniotic Fluid / Q000502:physiology*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000628:therapy*; D006801:Humans; D007263:Infusions, Parenteral / Q000379:methods; D007267:Injections / Q000379:methods; D007552:Isotonic Solutions / Q000008:administration & dosage; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D012965:Sodium Chloride / Q000008:administration & dosage
chemical_list: D007552:Isotonic Solutions; D012965:Sodium Chloride