Transabdominal amnioinfusion in preterm premature rupture of membranes: a randomised controlled trial


Dr A. L. Tranquilli, Department of Obstetrics and Gynaecology, Polytechnic University of Marche at Salesi Hospital, via Corridoni 11, 60123 Ancona, Italy.


Objective  To evaluate the role of transabdominal amnioinfusion in improving the perinatal outcomes of pregnancies complicated by preterm premature rupture of membranes (pPROM).

Design  A randomised controlled trial.

Setting  A teaching hospital in Italy, obstetric unit.

Population  Women with singleton pregnancies complicated by pPROM, between 24 + 0 and 32 + 6 weeks of gestation.

Methods  Patients were randomised 24 hours after admission to our referral hospital, to expectant management with transabdominal amnioinfusion or expectant management only.

Main outcome measures  The effects of transabdominal amnioinfusion on pPROM–delivery interval and on perinatal outcomes.

Results  Of the 65 women with pPROM 34 met the inclusion criteria. Seventeen women were assigned to amnioinfusion (the amnioinfusion group) and the other 17 to expectant management. Compared with the control group (median: 8 days; range: 3–14), the pPROM–delivery period was significantly longer in women who underwent amnioinfusion (median: 21 days; range: 15–29) (P < 0.05). Women with amnioinfusion were less likely to deliver within seven days since pPROM (RR: 0.18; range: 0.04–0.69 95% CI) or within two weeks (RR: 0.46; range: 0.21–1.02 95% CI). In the amnioinfusion group the neonatal survival was significantly higher at each gestational age (P < 0.01, Yates's correction for Log Rank Test) with a reduction in pulmonary hypoplasia.

Conclusions  We demonstrated that compared with standard expectant management the treatment with transabdominal amnioinfusion after pPROM resulted in significant prolongation of pregnancy and better neonatal outcomes.