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Review
. 2014 Oct 3;2014(10):CD010209.
doi: 10.1002/14651858.CD010209.pub2.

Fetal assessment methods for improving neonatal and maternal outcomes in preterm prelabour rupture of membranes

Gemma C Sharp  1 , Sarah J Stock, Jane E Norman
Affiliations
Review

Fetal assessment methods for improving neonatal and maternal outcomes in preterm prelabour rupture of membranes

Gemma C Sharp et al. Cochrane Database Syst Rev. .

Abstract

Background: Fetal assessment following preterm prelabour rupture of membranes (PPROM) may result in earlier delivery due to earlier detection of fetal compromise. However, early delivery may not always be in the fetal or maternal interest, and the effectiveness of different fetal assessment methods in improving neonatal and maternal outcomes is uncertain.

Objectives: To study the effectiveness of fetal assessment methods for improving neonatal and maternal outcomes in PPROM. Examples of fetal assessment methods that would be eligible for inclusion in this review include fetal cardiotocography, fetal movement counting and Doppler ultrasound.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2014) and reference lists of retrieved studies.

Selection criteria: Randomised controlled trials comparing any fetal assessment methods, or comparing one fetal assessment method to no assessment.

Data collection and analysis: Two review authors independently assessed trials for inclusion into the review. The same two review authors independently assessed trial quality and independently extracted data. Data were checked for accuracy.

Main results: We included three studies involving 275 women (data reported for 271) with PPROM at up to 34 weeks' gestation. All three studies were conducted in the United States. Each study investigated different methods of fetal assessment. One study compared weekly endovaginal ultrasound scans with no assessment (n = 93), one compared amniocentesis with no assessment (n = 47), and one compared daily nonstress testing with daily modified biophysical profiling (n = 135). We were unable to perform a meta-analysis, but were able to report data from individual studies.There was no convincing evidence of increased risk of neonatal death in the group receiving endovaginal ultrasound scans compared with the group receiving no assessment (risk ratio (RR) 7.30, 95% confidence interval (CI) 0.39 to 137.54; one study, 92 women), or in the group receiving amniocentesis compared with the group receiving no amniocentesis (RR 1.00, 95% CI 0.07 to 15.00; one study, 44 women). For both these interventions, we inferred that there were no fetal deaths in the intervention or control groups. The study comparing daily nonstress testing with daily modified biophysical profiling did not report fetal or neonatal death. Primary outcomes of maternal death and serious maternal morbidity were not reported in any study. Overall, there were few statistically significant differences in outcomes between the comparisons.The overall quality of evidence is poor, because participant blinding was not possible for any study.

Authors' conclusions: There is insufficient evidence on the benefits and harms of fetal assessment methods for improving neonatal and maternal outcomes in women with PPROM to draw firm conclusions. The overall quality of evidence that does exist is poor.Further high-quality randomised controlled trials are required to guide clinical practice.

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Conflict of interest statement

Gemma Sharp and Sarah Stock: none known.

Jane Norman has research grants from (non commercial) funding agencies for pregnancy related conditions (full list available on request), consultancy funds from UK government agencies for providing reports on maternal deaths (less than £5000), honoraria for book chapters and books in obstetrics and gynaecology. She has provided paid consultancy to a small drug company (Preglem) with an interest in obstetric/gynaecological drugs (less than £5000; 2010 to 2012) and unpaid consultancy to Hologic (who manufacture fibronectin amongst others).

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Weekly endovaginal ultrasound scan versus no scan, Outcome 1 Fetal death (antenatal).
1.2
1.2. Analysis
Comparison 1 Weekly endovaginal ultrasound scan versus no scan, Outcome 2 Neonatal death (in the first 28 days of life).
1.3
1.3. Analysis
Comparison 1 Weekly endovaginal ultrasound scan versus no scan, Outcome 3 Maternal chorioamnionitis.
1.4
1.4. Analysis
Comparison 1 Weekly endovaginal ultrasound scan versus no scan, Outcome 4 Maternal endometritis.
1.5
1.5. Analysis
Comparison 1 Weekly endovaginal ultrasound scan versus no scan, Outcome 5 Caesarean delivery.
1.6
1.6. Analysis
Comparison 1 Weekly endovaginal ultrasound scan versus no scan, Outcome 6 Days of postnatal hospitalisation (mother).
1.7
1.7. Analysis
Comparison 1 Weekly endovaginal ultrasound scan versus no scan, Outcome 7 Days from randomisation to birth.
1.8
1.8. Analysis
Comparison 1 Weekly endovaginal ultrasound scan versus no scan, Outcome 8 Respiratory distress syndrome.
1.9
1.9. Analysis
Comparison 1 Weekly endovaginal ultrasound scan versus no scan, Outcome 9 Birthweight.
1.10
1.10. Analysis
Comparison 1 Weekly endovaginal ultrasound scan versus no scan, Outcome 10 Days from birth to discharge home (neonate).
2.1
2.1. Analysis
Comparison 2 Amniocentesis versus no amniocentesis, Outcome 1 Fetal death (antenatal).
2.2
2.2. Analysis
Comparison 2 Amniocentesis versus no amniocentesis, Outcome 2 Neonatal death (in the first 28 days of life).
2.3
2.3. Analysis
Comparison 2 Amniocentesis versus no amniocentesis, Outcome 3 Maternal chorioamnionitis.
2.4
2.4. Analysis
Comparison 2 Amniocentesis versus no amniocentesis, Outcome 4 Birth within 48 hours after rupture of membranes.
2.5
2.5. Analysis
Comparison 2 Amniocentesis versus no amniocentesis, Outcome 5 Respiratory distress syndrome.
2.6
2.6. Analysis
Comparison 2 Amniocentesis versus no amniocentesis, Outcome 6 Cardiotocographic abnormality in labour.
3.1
3.1. Analysis
Comparison 3 Daily nonstress test versus daily modified biophysical profiling, Outcome 1 Maternal chorioamnionitis.
3.2
3.2. Analysis
Comparison 3 Daily nonstress test versus daily modified biophysical profiling, Outcome 2 Maternal endometritis.
3.3
3.3. Analysis
Comparison 3 Daily nonstress test versus daily modified biophysical profiling, Outcome 3 Caesarean delivery.
3.4
3.4. Analysis
Comparison 3 Daily nonstress test versus daily modified biophysical profiling, Outcome 4 Days from randomisation to birth.
3.5
3.5. Analysis
Comparison 3 Daily nonstress test versus daily modified biophysical profiling, Outcome 5 Respiratory distress syndrome.
3.6
3.6. Analysis
Comparison 3 Daily nonstress test versus daily modified biophysical profiling, Outcome 6 Oxygen therapy after 36 + 0 weeks.
3.7
3.7. Analysis
Comparison 3 Daily nonstress test versus daily modified biophysical profiling, Outcome 7 Birthweight.
3.8
3.8. Analysis
Comparison 3 Daily nonstress test versus daily modified biophysical profiling, Outcome 8 Days from birth to discharge home.
3.9
3.9. Analysis
Comparison 3 Daily nonstress test versus daily modified biophysical profiling, Outcome 9 Necrotising entercolitis.
3.10
3.10. Analysis
Comparison 3 Daily nonstress test versus daily modified biophysical profiling, Outcome 10 Apgar scores less than 7 at 5 minutes.
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References

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