526: Transabdominal amnioinfusion in preterm premature rupture of membranes: a systematic review and a metaanalysis

Abstract

premature rupture of membranes: a systematic review and a metaanalysis Shay Porat, Hagai Amsalem, Prakesh S. Shah, Kellie E. Murphy Mount Sinai Hospital, Obstetrics and Gynecology, Toronto, ON, Canada, Hadassah University Hospital, Mount Scopus, Obstetrics and Gynecology, Jerusalem, Israel, Mount Sinai Hospital, Department of Paediatrics, Toronto, ON, Canada OBJECTIVE: Transabdominal amnioinfusion (TA) was investigated in several studies as an intervention for improving neonatal outcomes following second trimester preterm premature rupture of membranes (PPROM). The objective of this study was to systematically review the efficacy and safety of TA in early PPROM. STUDY DESIGN: A comprehensive literature search was performed with no language barrier, using the EMBASE and MEDLINE from 19502011. Observational and randomized controlled trials (RCT) were identified. Only studies with proven PPROM and oligohydramnios were included. Two reviewers independently assessed titles, abstracted data and full text. Quality of the studies was assessed using the Newcastle-Ottawa scale and the Cochrane’s tool for assessing risk of bias for RCTs. Primary outcomes were gestational age at delivery, latency period length, birthweight, perinatal mortality, pulmonary hypoplasia and chorioamnionitis. Secondary outcomes were: early onset neonatal sepsis, neonatal mortality, bronchopulmonary dysplasia, genitourinary infections, cesarean section and post-partum sepsis. Statistical analysis was performed using Review Manager 5 software (RevMan 5.0). RESULTS: Seven studies including two RCTs, one quasi-randomized and four observational studies were eligible. The two RCTs and the quasi-randomized studies were meta-analyzed together and observational studies were meta-analyzed separately. Favorable results for the treatment group were concordant in both meta-analyses with regards to latency period length, perinatal mortality, pulmonary hypoplasia and neonatal mortality (table 1). These results even intensify in face of significantly lower gestational age at rupture of membranes in the observational studies. CONCLUSION: Serial TA for early PPROM may improve early PPROMassociated morbidity and mortality. The possible benefits of this treatment modality warrant additional adequately powered randomized control trials. 527 Maternal IL6 levels: a failed biomarker for preterm birth Sindhu K. Srinivas, Jamie A. Bastek, Markley Foreman, Meghan McShea, Laura Anglim, Anita Weber, Michal A. Elovitz University of Pennsylvania Perelman School of Medicine, Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Philadelphia, PA, University of Pennsylvania Perelman School of Medicine, CCEB, Philadelphia, PA OBJECTIVE: Interleukin 6 (IL6) levels have been investigated as a predictor of preterm birth (PTB) and adverse neonatal outcomes including cerebral palsy. Our objective was to evaluate the association between maternal serum IL6 levels and PTB, interval to delivery, chorioamnionitis, and adverse neonatal outcomes in women with symptoms of preterm labor (PTL). STUDY DESIGN: We performed a cohort study of women with singleton pregnancies who presented at 22-33 6/7 wks with signs/symptoms of PTL from April 2009 to June 2011. Maternal medical, obstetric history, and delivery information were obtained through chart abstraction. Blood was drawn at the time of presentation with PTL. IL6 (pg/ ml) was measured in maternal serum using a high sensitivity ELISA (RD OR 1.00 (0.98-1.04), p 0.7). The mean gestational age at delivery and interval from presentation to delivery did not differ among quartiles of IL6 levels (table). There was no association between IL6 and chorioamnionitis (p 0.83) or adverse neonatal outcome (P 0.2). CONCLUSION: Maternal IL6 levels have been posited as a potential reliable biomarker for PTB. This adequately powered study demonstrates that maternal IL6 levels are not associated with PTB. Additionally, maternal IL6 is not associated with interval to delivery, chorioamnionitis or adverse neonatal outcomes. Maternal IL6 cannot be used clinically to predict PTB or chorioamnionitis in women with PTL symptoms. Further research is needed to evaluate other maternal biomarkers as accurate predictors of PTB and adverse neonatal outcomes. MOD#21FY08-539 (Elovitz) Poster Session III Doppler Assessment, Fetus, Prematurity www.AJOG.org