1080 Mechanical cervical ripening after rupture of membranes and risk of chorioamnionitis: systematic review and meta-analysis

Abstract

To evaluate if singleton pregnancies with prelabor rupture of membranes (PROM) or preterm prelabor rupture of membranes (PPROM) undergoing cervical ripening with a Foley balloon catheter (FBC) have an increased risk of chorioamnionitis compared to women using non-mechanical induction methods. PubMed, Embase, Cochrane Clinical Trials, Web of Science and Clinical Trials.gov were systematically searched from 1/1/1984 to 7/7/2020 for full text randomized studies. Studies that involved singleton pregnancies in vertex presentation with PROM or PPROM, reported on maternal infection, and compared groups with a FBC to other cervical ripening methods were included. The primary outcome was chorioamnionitis and secondary outcomes included endometritis, duration of labor and mode of delivery. Articles were screened by 2 independent reviewers with discrepancies addressed by a 3rd. Odds ratio (OR), or weight mean difference (WMD), with 95% confidence intervals (95%CI) were calculated using random effect or fixed effects models for outcomes with and without significant heterogeneity respectively using RevMan v5.4. Overall, 2544 studies were screened with 35 full text studies assessed of which 4 studies met inclusion criteria. Use of mechanical cervical ripening with a FBC was associated with a 4.5 times increased risk of chorioamnionitis (95% CI 1.8, 11.2) (Figure 1) and a 1.6 times increased risk of cesarean section (95%CI 1.09, 2.36) (Table 1). There was no difference between groups for time of induction to delivery (mean difference 1.03, 95% CI -1.59, 3.65) or postpartum endometritis (OR 0.82, 95% CI 0.18, 3.7). Mechanical cervical dilation with a FBC after PROM or PPROM was associated with an increased risk of chorioamnionitis and cesarean section when compared to other cervical ripening methods. These findings should be incorporated into decision making regarding method of induction after PROM or PPROM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)