Imperial College NHS Trust, St. Mary's Hospital, Praed Street, W2 1NY, London, UK.
Department of Midwifery, University of Central Lancashire, Brook Building, PR1 2HE, Preston, UK.
BMC Pregnancy Childbirth. 2023 Sep 8;23(1):650. doi: 10.1186/s12884-023-05878-x.
Prelabour rupture of membranes at term affects approximately 10% of women during pregnancy, and it is often associated with a higher risk of infection than when the membranes are intact. In an attempt to control the risk of infection, two main approaches have been used most widely in clinical practice: induction of labour (IOL) soon after the rupture of membranes, also called active management (AM), and watchful waiting for the spontaneous onset of labour, also called expectant management (EM). In addition, previous studies have demonstrated that vaginal examinations increase the risk of chorioamnionitis. However, the effect of vaginal examinations in the context of prelabour rupture of membranes have not been researched to the same extent.
This systematic review analyses and critiques the latest research on the management of term prelabour rupture of membranes, including the effect of vaginal examinations during labour, with a focus on the outcomes of both normal birth, and chorioamnionitis. Due to its complexity, three research questions were identified using the PICO diagram, and subsequently, the results from these searches were combined. The systematic review aimed to identify randomised controlled trials (RCTs) and observational studies that compared active vs expectant management, included number of vaginal examinations and had chorioamnionitis and/or normal birth as outcomes. The following databases were used: MEDLINE, EMBASE, Maternity and Infant care, LILACS, CINAHL and the Cochrane Central Register of Controlled trials. Quality was assessed using a tool developed especifically for this study that included questions from CASP and the Cochrane risk of bias tool. Due to the high degree of heterogeneity meta-analysis was not deemed appropriate. Therefore, simple narrative analysis was carried out.
Thirty-two studies met the inclusion criteria, of which 27 were RCTs and 5 observational studies. The overall quality of the studies wasn't high, 15 out of the 32 studies were deemed to be low quality and only 17 out of 32 studies were deemed to be of intermediate quality. The systematic review revealed that the management of term prelabour rupture of membranes continues to be controversial. Previous research has compared active management (Induction of labour shortly after the rupture of membrane) against expectant management (watchful waiting for the spontaneous onset of labour). Although previous studies have demonstrated that vaginal examinations increase the risk of chorioamnionitis, no prospective studies have included an intervention to reduce the number of vaginal examinations.
A RCT assessing the consequences of active management and expectant management as well as the effect of vaginal examinations during labour for term prelabour rupture of membranes is necessary.
足月胎膜早破影响约 10%的孕妇，与胎膜完整时相比，常伴有更高的感染风险。为了控制感染风险，临床实践中广泛采用了两种主要方法：胎膜早破后尽快引产（也称为主动管理，AM）和期待自然分娩（也称为期待管理，EM）。此外，先前的研究表明阴道检查会增加绒毛膜羊膜炎的风险。然而，对于足月胎膜早破，阴道检查的效果尚未得到同等程度的研究。
本系统评价分析和批判了最新的足月胎膜早破管理研究，包括分娩时阴道检查的效果，重点关注正常分娩和绒毛膜羊膜炎的结果。由于其复杂性，使用 PICO 图确定了三个研究问题，然后合并这些搜索的结果。系统评价旨在确定比较主动管理与期待管理、包括阴道检查次数以及绒毛膜羊膜炎和/或正常分娩作为结局的随机对照试验（RCT）和观察性研究。使用了以下数据库：MEDLINE、EMBASE、孕产妇和婴儿护理、LILACS、CINAHL 和 Cochrane 对照试验中心注册库。使用专门为此研究开发的工具评估质量，该工具包括来自 CASP 和 Cochrane 偏倚风险工具的问题。由于高度异质性，不认为适合进行荟萃分析。因此，进行了简单的叙述性分析。
符合纳入标准的研究有 32 项，其中 27 项为 RCT，5 项为观察性研究。研究的整体质量不高，32 项研究中有 15 项被认为质量较低，只有 17 项被认为质量中等。系统评价表明，足月胎膜早破的管理仍然存在争议。先前的研究比较了主动管理（胎膜早破后不久引产）与期待管理（等待自然分娩）。尽管先前的研究表明阴道检查会增加绒毛膜羊膜炎的风险，但没有前瞻性研究包括减少阴道检查次数的干预措施。
需要进行一项评估主动管理和期待管理的后果以及足月胎膜早破时阴道检查效果的 RCT。
