Transabdominal amnioinfusion for preterm premature rupture of membranes: a systematic review and metaanalysis of randomized and observational studies Porat S, Amsalem H, Shah PS, Murphy KE CRD summary This review concluded that serial transabdominal amnioinfusion for pregnant women with preterm premature rupture of their membrane, could improve morbidity and mortality. The authors' cautious conclusions reflected the evidence presented, but they were based on small observational studies, and caution is advised when interpreting the results. Their recommendation for further research was appropriate. Authors' objectives To assess the efficacy and safety of transabdominal amnioinfusion for pregnant women with preterm (before 37 weeks gestation) premature rupture of their membranes. Searching Articles in MEDLINE from 1950 to December 2011 and EMBASE from 1980 to December 2011 were searched, with no language restriction. Search terms were reported. ClinicalTrials.gov was searched for ongoing trials. Bibliographies of identified studies was checked for further studies. Study selection Observational studies or randomised controlled trials (RCTs) of transabdominal amnioinfusion plus conventional treatment compared with conventional treatment alone, were eligible for inclusion. Studies that included patients with a confirmed diagnosis of oligohydramnios (low amount of amniotic fluid), associated with preterm premature rupture of membranes, were included. Studies that included patients with oligohydramnios associated with other causes, such as intrauterine growth restriction or renal anomalies, were excluded. In the included studies, the primary outcomes of interest were the latency period (interval from preterm premature rupture of membrane to birth) and perinatal deaths. Secondary outcomes were pulmonary hypoplasia, neonatal deaths, gestational age at birth, birth weight, chorioamnionitis, early onset (less than 72 hours from delivery) neonatal sepsis, bronchopulmonary dysplasia, and caesarean delivery. Conventional care included bed rest in the hospital and prophylactic antibiotics. Across the studies, the foetal gestational age varied from 16 to 33 weeks. In most studies, the average number of amnioinfusions per patient ranged from 1.23 to four, and the infused volume ranged from 140 to 350mL per infusion. Two reviewers independently evaluated studies for inclusion; disagreements were resolved through consensus. Assessment of study quality Study quality was assessed using the Newcastle-Ottawa Scale, for observational studies, and the Cochrane Collaboration's risk of bias tool, for RCTs. The Newcastle-Ottawa Scale assessed selection, comparability and outcome biases. The risk of bias tool assessed selection, performance, detection, attrition, reporting, and other biases. Two reviewers independently assessed quality, and any discrepancies were resolved through discussion, with a third reviewer. Data extraction The data were extracted to calculate the mean difference for continuous data or the odds ratio for dichotomous data, with their 95% confidence intervals. Study authors were not contacted for missing information. Two reviewers independently extracted the data. Any disagreements were resolved through consensus, with a third reviewer. Methods of synthesis Database of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright © 2019 University of York Page: 1 / 3