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• W1853732507 abstract "Linked Comment: Ultrasound Obstet Gynecol 2014; 43: 490–499 In their important paper, Roberts et al. randomized 58 women with preterm prelabor rupture of membranes (PPROM) before 24 + 0 weeks and deepest amniotic fluid pool < 2 cm to either expectant management or serial weekly amnioinfusions. There was no significant difference in any of the predefined outcomes. Serial amnioinfusions were associated with a 14% chance of the infant being alive and well vs 0% in the expectant management group; the risk for placental abruption was 15% in the amnioinfusion vs 0% in the expectant management group. While this study, being a pilot study, did not show any major differences in outcome, the authors concluded that the results justify a larger definitive study to evaluate amnioinfusion for improvement in healthy survival. Very early PPROM can be a devastating complication of pregnancy, associated with a high risk of perinatal death, sepsis and pulmonary hypoplasia1, 2. Several studies have shown that the main prognostic factors for an adverse outcome are early gestational age at rupture, prolonged rupture and severity of oligohydramnios3, 4. Serial transabdominal amnioinfusions have been tried as a means to prevent pulmonary hypoplasia and improve perinatal outcome, with mostly good results. There have been three recent meta-analyses attempting to pool published evidence; two reported an improvement in perinatal morbidity and mortality following amnioinfusion5, 6, whereas the other, focusing on cases occurring before 26 weeks, did not identify any suitable published studies7. The randomized controlled trial by Roberts et al. aims to fill precisely this void by investigating management of PPROM before and at the threshold of viability, which is the most clinically relevant period. The limitations of the study arise from the challenging topic itself and, pragmatically speaking, relate mainly to the unavoidably small sample size, which produces wide confidence intervals for effects on both favorable (e.g. survivor, healthy survivor) and unfavorable (e.g. placental abruption) outcomes. Everything else in this well-designed study can be regarded as a strength, including the data on long-term prognosis after expectant management. More importantly, so far there have been no studies publishing high-quality data from cases of very early PPROM in which the parents opted to continue the pregnancy with active management, and this study takes the first step in this direction. Notwithstanding the limitations due to the small sample size, the results of this study indicate that amnioinfusion after PPROM before 24 weeks may improve the rate of healthy survival. Certainly, this rate is still very low in absolute numbers, and the matter of potential adverse maternal or fetal effects of amnioinfusion is still unresolved. Further research could be based on the protocol of Roberts et al.'s study, with the current work serving either as a pilot study or as part of a future meta-analysis." @default.
• W1853732507 created "2016-06-24" @default.
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• W1853732507 date "2014-05-01" @default.
• W1853732507 modified "2023-09-25" @default.
• W1853732507 title "Re: Amnioinfusion in very early preterm prelabor rupture of membranes (AMIPROM): pregnancy, neonatal and maternal outcomes in a randomized controlled pilot study. D. Roberts, S. Vause, W. Martin, P. Green, S. Walkinshaw, L. Bricker, C. Beardsmore, N. Shaw" @default.
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• W1853732507 doi "https://doi.org/10.1002/uog.13372" @default.
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