Mozurkewich E L, Wolf F M
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, USA.
Obstet Gynecol. 1997 Jun;89(6):1035-43. doi: 10.1016/s0029-7844(97)00094-x.
To compare rates of cesarean birth, endometritis, chorioamnionitis, and serious neonatal infections among pregnancies complicated by premature rupture of membranes (PROM) at term and managed by immediate oxytocin induction, by conservative management (or delayed oxytocin induction), or by vaginal (or endocervical) prostaglandin E2, gel, suppositories, or tablets.
The English-language literature in MLD, LINE and other databases was searched through April 1996 using the terms "fetal membranes," "premature rupture," and "term."
We included randomized trials comparing two or more management schemes for PROM at term.
TABULATION, INTEGRATION, AND RESULTS: Twenty-three studies with a total of 7493 subjects met the inclusion criteria and were included for analysis. Data regarding chorioamnionitis, endometritis, neonatal infections, and cesarean delivery were extracted. Meta-analyses were performed for the three interventions for these outcomes of interest using the Der-Simonian and Laird and Mantel-Haenszel techniques to estimate the pooled odds ratios (ORs). No statistically significant differences in cesarean deliveries or neonatal infections were noted among management schemes. Vaginal prostaglandins resulted in more chorioamnionitis than immediate oxytocin (OR 1.55, 95% confidence interval [CI] 1.09, 2.21), but less chorioamnionitis than conservative management (OR 0.68, 95% CI 0.51, 0.91). Immediate oxytocin induction resulted in fewer cases of chorioamnionitis (OR 0.67, 95% CI 0.52, 0.85) and endometritis (OR 0.71, 95% CI 0.51, 0.99) than conservative management, although these results achieved significance only with the Mantel-Haenszel technique.
Conservative management may result in more maternal infections than immediate induction with oxytocin or prostaglandins.
比较足月胎膜早破（PROM）且采用即刻缩宫素引产、保守治疗（或延迟缩宫素引产）或阴道（或宫颈内）前列腺素E2凝胶、栓剂或片剂治疗的孕妇剖宫产、子宫内膜炎、绒毛膜羊膜炎及严重新生儿感染的发生率。
通过检索MLD、LINE及其他数据库中截至1996年4月的英文文献，检索词为“胎膜”“早破”和“足月”。
我们纳入了比较两种或更多种足月PROM治疗方案的随机试验。
制表、整合与结果：23项研究共7493名受试者符合纳入标准并纳入分析。提取了关于绒毛膜羊膜炎、子宫内膜炎、新生儿感染及剖宫产的数据。使用Der-Simonian和Laird法以及Mantel-Haenszel法对这三种干预措施针对这些感兴趣的结局进行荟萃分析，以估计合并比值比（OR）。各治疗方案在剖宫产或新生儿感染方面未发现统计学显著差异。阴道前列腺素导致的绒毛膜羊膜炎比即刻缩宫素更多（OR 1.55，95%置信区间[CI] 1.09，2.21），但比保守治疗更少（OR 0.68，95% CI 0.51，0.91）。即刻缩宫素引产导致的绒毛膜羊膜炎（OR 0.67，95% CI 0.52，0.85）和子宫内膜炎（OR 0.71，95% CI 0.51，0.99）病例比保守治疗少，尽管这些结果仅在Mantel-Haenszel法中具有统计学意义。
保守治疗可能比即刻缩宫素或前列腺素引产导致更多的母体感染。
