부산대학교 도서관

INTRODUCTION: Periviable rupture of membranes counseling should describe maternal and neonatal outcomes associated with both immediate delivery or expectant management; unfortunately, most published data focuses on neonatal outcomes and maternal risk estimates vary widely. We performed a meta-analysis to describe outcomes associated with expectant management compared to immediate delivery of periviable PROM. METHODS: We performed a systematic review of the literature including published clinical trials and observational cohorts after the year 2000. Publications were selected if they included maternal and neonatal outcomes for both expectant management and immediate delivery. Gestational age range was limited from 14 to 25 weeks. The primary outcome was maternal sepsis. Secondary outcomes included chorioamnionitis, hemorrhage, laparotomy, and neonatal survival. Pooled risk differences were calculated for each outcome using a random effects model. Publication bias was assessed using funnel plots and Harbord test. RESULTS: A total of 2,550 studies were initially screened, and 44 manuscripts were reviewed. Of these, 5 publications met inclusion for analysis: 4 retrospective and 1 prospective. Overall, 61.1% of women chose expectant management. Expectant management was associated with a 4% increased risk of maternal sepsis, 30% increased risk of chorioamnionitis, and 28% increased risk of any laparotomy. Neonatal survival with expectant management was 34% compared to 0% with immediate delivery. CONCLUSION: Women who choose to undergo expectant management experience an increased risk of sepsis, chorioamnionitis, and laparotomy with only one-third of neonates surviving to discharge. Knowledge of these risks is critical to counseling patients with this diagnosis. [ABSTRACT FROM AUTHOR]