The safety, acceptability, and success rates of amniocentesis in the context of preterm prelabor rupture of membranes and threatened preterm labor: a systematic review and meta-analysis

Figures & data

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) diagram [28].

Table 1. Characteristics of included studies.

Author, year, country	Study design	Study aim	No of patients	PPROM, PTL, both	Risk, uptake, success rate
Angus et al. [32] 2001, USA	Case-control	To assess whether MMP-8 levels in amniotic fluid are a useful marker of intra-amniotic infection	77	Both	No complications reported
Cobo et al. [33] 2022, Spain	Retrospective observational study	Development and validation of multivariable model of preterm birth	531	PTL	443/531 accepted amniocentesis − 88 declined
Combs et al. [34] 2014, USA	Prospective observational study	Development of a noninvasive test for microbial invasion of the amniotic cavity (MIAC)	320	PTL	Success rate 305/320 − 15 failed
Ferrazzi et al. [35] 2012, Italy	Prospective observational study	Analysis of obstetrical and neonatal outcomes in patients with AF collected within 48 h of presentation with tPTL and PPROM	40	Both	22/40 accepted amniocentesis − 17 declined
Fulova et al. [45] 2021, Czech Republic	Prospective observational cohort study	Evaluation of point-of-care IL-6 test in amniotic fluid obtained by amniocentesis in patients with PPROM	67	PPROM	Success rate 62/67 − 5 failed
Jacobsson et al. [36] 2003, Sweden	Prospective observational cohort study	Evaluation of the relationship between MIAC, IL-6, and IL-8 levels and preterm birth	58	PPROM	Success rate 53/58 − 5 failed
Kacerovsky et al. [37] 2012, Czech Republic	Prospective observational study	Evaluating whether the bacterial load of genital mycoplasmas and gestational age are related to the intra-amniotic inflammatory response.	152	PPROM	152/153 accepted − 1 declined Success rate 145/152 − 7 failed
Kacerovsky et al. [38] 2020, Czech Republic (a)	Retrospective cohort study	Evaluate if anti-microbial agents can reduce the magnitude of the intra-amniotic inflammatory response in patients with PPROM	315	PPROM	Success rate 312/315 − 3 failed
Kacerovsky et al. [40] 2020, Czech Republic (b)	Retrospective cohort study	To determine the association between MIAC and lactobacilli dominated cervical microbiota in patients with PPROM	311	PPROM	Success rate 309/311 − 2 failed
Leaños-Miranda et al. [37] 2021, Mexico	Prospective observational cohort study	Evaluate if IL-6 levels in AF collected by amniocentesis correlated with levels of intra-amniotic inflammation and adverse outcomes	452	PTL	No complications reported
Musilova et al. [43] 2017, Czech Republic (a)	Retrospective cohort study (May 2008–July 2016)	To determine the feasibility and complication rate of amniocentesis in a large cohort of women with PPROM	590	PPROM	Success rate 567/590 − 23 failed; Complication rate 4/590 (0.7%)
Musilova et al. [44] 2017, Czech Republic (b)	Prospective cohort study	To determine the relationship between maternal WCC in pregnancies complicated with PPROM and presence of MIAC	526	PPROM	525/526 accepted − 1 declined Success rate 523/526 − 3 failed;
Musilova et al. [41] 2018, Czech Republic	Retrospective cohort study (January 2016–July 2017)	Evaluation of AF pentraxins as potential biomarkers for identifying intra-amniotic inflammatory complications in PPROM	159	PPROM	Success rate 158/159 − 1 failed
Musilova et al. [42] 2019, Czech Republic	Prospective study (October 2015–September 2016)	To determine the pulsatility in the fetal portal system with respect to the presence or absence of intra-amniotic inflammation in PPROM	87	PPROM	Success rate 86/87 − 1 failed
Ovalle et al. [31] 2002, Chile	Randomized control trial	To determine whether antibiotic administration in patients with PPROM is associated with a reduction in the rates of histologically confirmed chorioamnionitis and funisitis	100	PPROM	Success rate 99/100 − 1 failed

Table 2. Details of the studies reporting uptake rates.

Study	Setting	Number	Uptake rate (%)
Cobo et al. [33]	Standard practice	531	83.5
Ferrazzi et al. [35]	Prospective study	40	55
Kacerovsky et al. [39]	Standard practice	153	>99
Musilova et al. [44]	Standard practice	526	>99

Table 3. Details of the studies reporting their success rates, reasons for failure where applicable, and definition of a successful amniocentesis.

Study	PPROM/PTL/both	Number (*)	Success rate (%)	Reasons for failed cases	Successful amniocentesis volume
Angus et al. [32]	PTL (n = 66) PPROM (n = 11)	77	100	No reported failures	Not mentioned
Combs et al. [34]	PTL	338	90.2	No mention	15 ml
Fulova et al. [45]	PPROM	67	92.5	“Marked oligohydramnios”	Not mentioned
Jacobsson et al. [36]	PPROM	58	91.5	“Inadequate fluid for testing”	30–50 ml
Kacerovsky et al. [39]	PPROM	152	95.6	“Amniocentesis failure”	“Approximately 5 ml”
Kacerovsky et al. [38] (a)	PPROM	273 (20)	99	“Amniocentesis failure”	“Approximately 5 ml”
Kacerovsky et al. [40] (b)	PPROM	311 (212)	99	“Failed due to anhydramnios”	3ml
Musilova et al. [43] (a)	PPROM	590	96	“Amniocentesis failed”	0.5 ml
Musilova et al. [44] (b)	PPROM	525 (103)	99.9	All oligohydramnios with AFI <1	0.5 ml
Musilova et al. [41]	PPROM	158 (63)	99.9	“Amniocentesis failure”	2–3 ml
Ovalle et al. [31]	PPROM	100	99	“Failure to retrieve fluid”	Not mentioned

Note: The (*) indicates the number of individual cases in the publication that are not included in the retrospective analysis [43].

Table 4. Details of the studies reporting complications.

Study	PPROM/PTL/both	Number	Complications
Angus et al. [32]	PTL (n = 66) PPROM (n = 11)	77	0
Leaños-Miranda et al. [37]	PTL (intact membrane)	452	0
Musilova et al. [44]	PPROM	590	4 (0.6%)

Table 5. Summary characteristics of the studies with details of uptake rates, success rates, safety data and complications.

Study ID	Date range	Selection	Approached	Eligible	Declined	Accepted	Consented	Amniocentesis	Complications
Angus et al. [32]	NI	NI	NI	NI	NI	77	77	77	0
Cobo et al. [33]	2012–2018	Consecutive	531	446	88	358	358	358	NI
Combs et al. [34]	Sept 2007–Nov 2009	NI	338	338	NI	320	320	305	NI
Ferrazzi et al. [35]	Nov 2009–Oct 2011	NI	40	40	17	23	23	23	NI
Fulova et al. [45]	May 2015–Sept 18	NI	67	67	0	67	67	62	NI
Jacobsson et al. [36]	1996–2001	NI	58	58	0	58	58	53	NI
Kacerovsky et al. [37]	July 2008–Oct 2010	Consecutive	174	153	1	152	152	145	NI
Kacerovsky et al. [38]	January 2014–May 2019	Retrospective analysis	317	315	0	315	315	312	NI
Kacerovsky et al. [40](Lactobacilli)	Aug 2015–Dec 2018	Retrospective analysis	356	311	0	311	311	309	NI
Leaños-Miranda et al. [37]	Jan 2016–July 2019	Consecutive	452	452	0	452	452	452	0
Musilova et al. [43] (WCC)	Feb 2012–June 2017	Consecutive	526	526 (479) − 42 excluded after amnio	1	525	525	523	NI
Musilova et al. [44]	May 2008–July 2016	Retrospective analysis	595	595	5	590	590	567	4
Musilova et al. [41]	NI	Retrospective analysis	159	159	0	159	159	158	NI
Ovalle et al. [31]	Oct 1991–Jan 1996	Consecutive	NI	100	NI	100	100	99	NI

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Data availability statement

The data that support the findings of this study are available from the corresponding author, DS, upon reasonable request.