How baby is born
The update of this review included 23 studies with a total of 8,615 women and their newborns. Ten studies examined intravenous oxytocin administration, twelve studies examined prostaglandins (six studies in the form of vaginal prostaglandin E2 and six as oral, sublingual or vaginal misoprostol) and one study each examined caulophyllum and acupuncture. A total of three studies were rated as having a low risk of bias, while the other 20 had an unclear or high risk of bias.
Primary endpoints: Women who planned to give birth prematurely had a reduced risk of maternal infectious morbidity (chorioamnionitis and / or endometritis) compared with women who were treated with wait-and-see management after premature rupture of the skin (mean relative risk (RR) 0.49; 95% confidence interval (CI) 0.33 to 0.72; eight studies, 6864 women, Tau² = 0.19; I² = 72%, low quality evidence), and their newborns were less likely to have clear or probable early neonatal sepsis (RR 0.73; 95% CI 0.58 to 0.92; 16 studies, 7,314 infants, low-quality evidence). No clear differences were observed between the group with planned premature birth and expectant care with regard to the risk of a caesarean section (average RR 0.84; 95% CI 0.69 to 1.04; 23 studies, 8576 women, Tau² = 0 , 10; I² = 55%; low quality of evidence), serious maternal morbidity or mortality (no events, three studies, 425 women, very low quality of evidence), clearer early neonatal sepsis (RR 0.57; 95% CI 0, 24 to 1.33; six studies, 1303 infants, very low quality evidence) or perinatal mortality (RR 0.47; 95% CI 0.13 to 1.66; eight studies, 6392 infants; moderate quality of evidence).
Secondary endpoints: women who planned to give birth prematurely had a reduced risk of chorioamnionitis (mean RR 0.55; 95% CI 0.37 to 0.82; eight studies, 6874 women; Tau² = 0.19; I² = 73%), and postpartum septicemia (RR 0.26; 95% CI 0.07 to 0.96; three studies, 263 women), and their newborns were given antibiotics less frequently (mean RR 0.61; 95% CI 0.44 to 0, 84; 10 studies, 6427 infants; Tau² = 0.06; I² = 32%). Women in the group with premature birth were more likely to induce labor (average RR 3.41, 95% CI 2.87 to 4.06; 12 studies, 6945 women, Tau² = 0.05; I² = 71%), had a shorter one Time from premature rupture of the bladder to birth (mean difference (MD) -10.10 hours; 95% CI -12.15 to -8.06; nine studies, 1484 women, Tau² = 5.81; I² = 60%), and their infants had lower birth weights (MD -79.25g, 95% CI -124.96 to -33.55, five studies, 1043 infants). Women who planned to give birth prematurely had a shorter length of hospital stay (MD -0.79 days; 95% CI -1.20 to -0.38; two studies, 748 women Tau² = 0.05; I² = 59%), and their infants were admitted to a special neonatal unit less frequently (RR 0.75; 95% CI 0.66-0.85; eight studies, 6179 infants), and had a shorter duration of hospitalization (-11.00 hours; 95 % CI -21.96 to -0.04; one study, 182 infants) or special or intensive care unit stay (RR 0.72; 95% CI 0.61 to 0.85; four studies, 5691 infants). Women in the planned premature birth group had more positive experiences compared to women in the expectant management group.
No clear differences between the groups were observed for endometritis, postpartum pyrexia, postpartum use of antibiotics, caesarean section for fetal distress, surgical vaginal birth, uterine rupture, epidural anesthesia, postpartum bleeding, adverse effects, umbilical cord prolapse, stillbirth, neonatal mortality, pneumonia, apgarity lower than seven to five minutes, use of mechanical ventilation, or cerebral ultrasound abnormality (no events).
None of the studies reported breastfeeding, postnatal depression, gestational age at birth, meningitis, respiratory distress syndrome, necrotizing enterocolitis, neonatal encephalopathy, or post-natal abnormalities.
In the subgroup analyzes, there were no clear patterns for different effects in methods of induction, parity, use of maternal antibiotic prophylaxis or digital vaginal examination. Results of the sensitivity analyzes based on study quality were consistent with those of the main analysis, with the exception of definite or probable early neonatal sepsis, where no definite differences were observed.
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