Amnioinfusion vs. standard management for the second trimester PPROM: a systematic review and meta-analysis of observational studies and RCTs

Abstract

Objective

This meta-analysis aims to review the effect of serial transabdominal amnioinfusion (TAI) on short-term and long-term perinatal outcomes in mid-trimester preterm premature rupture of membranes (PPROM).

Methods

Literature searches of PubMed, Web of Sciences, Scopus, and Cochrane Library were performed from their inception to April 2022. Studies comparing conventional treatment with serial TAI in women with proven PPROM at less than 26 + 0 weeks of gestation with oligohydramnios were included. Studies that included oligohydramnios due to other reasons such as fetal growth retardation or renal anomalies were excluded. Risk of bias in observational studies was assessed using the tool of the Cochrane Review group identified as risk of bias in non-randomized studies – of interventions. The risk of bias assessments for RCTs were performed according to the Cochrane risk-of-bias tool for randomized trials. An I² score was used to assess the heterogeneity of included studies. The analyses were performed by using random-effect model, and the results were expressed as relative risk (RR) or mean difference with 95% confidence intervals (CIs).

Results

Overall, eight relevant studies including five observational studies (n = 252; 130 women allocated to the intervention) and three RCTs (n = 183; 93 women allocated to the intervention) were eligible. The pooled latency period was 21.9 days (95% CI, 13.1–30.8) and 5.8 days (95% CI, −11.6–23.2) longer in the TAI group in the observational studies and RCTs, respectively. The perinatal mortality rate reduced in the intervention group when tested in observational studies (RR 0.68; 95% CI, 0.51–0.92), but not in RCTs (RR 0.79; 95% CI, 0.56–1.13). The rate of long-term healthy survival was higher in the children whose mothers were treated with the TAI (35.7%) than those were treated with the standard management (28.6%) (RR 1.30, 95% CI 0.47–3.60, “best case scenario”).

Conclusions

The efficacy of serial TA on early PPROM associated morbidity and mortality is not attested. Additional randomized control trials with adequate power are needed.

Keywords:

• PPROM
• amnioinfusion
• oligohydramnios
• perinatal mortality
• healthy survival

Acknowledgements

We appreciated the work of Ertac Nebioglu who an expertise librarian is. The review was registered with PROSPERO (CRD42021262620).

Ethics statement

An ethics statement is not applicable because this study is based exclusively on published literature.

Author contributions

Ebru Celik: designing the review, analyzing data, writing the manuscript, and assessing the published research for quality. Abdullah Burak Yildiz: reviewing the literature for meta-analysis, extracting data from the published research. Sebile Guler Cekic: reviewing the literature for meta-analysis, extracting data from the published research, assessing the published research for quality. Ceren Unal: reviewing the literature for meta-analysis, extracting data from the published research. Isil Ayhan: reviewing the literature for meta-analysis and writing the manuscript. Rauf Melekoglu: assessing the published research for quality. Tugba Gursoy: writing the manuscript.

Disclosure statement

The authors have no conflicts of interest to declare.

Data availability statement

All data generated or analyzed during this study are included in this article and its supplementary material files. Further enquiries can be directed to the corresponding author.

Additional information

Funding

No funding was necessary for the review.