Supplementary Material for: Amnioinfusion versus usual care in women with prelabour rupture of membranes in midtrimester: a systematic review and meta-analysis of short and long-term outcomes

Introduction: Midtrimester prelabour rupture of membranes (PROM) between 16 and 24 weeks’ gestational age is a major obstetric complication with high rates of perinatal morbidity and mortality. Amnioinfusion has been proposed in women with midtrimester PROM to target oligohydramnios and subsequently enhance pulmonary development and perinatal outcomes.
Material and methods: The purpose of this study was to perform a systematic review and meta-analysis including all randomized clinical trials investigating amnioinfusion versus no intervention in women with PROM between 16+0 and 24+0 weeks gestational age. Databases Central, Embase, Medline, ClinicalTrials.gov and references of identified articles were searched from inception of database to December 2021. The primary outcome was perinatal mortality. Secondary outcomes included neonatal, maternal and long-term developmental outcomes as defined in the core outcome set for preterm birth studies. Summary measures were reported as pooled relative risk (RR) or mean difference (MD) with corresponding 95% of confidence interval (CI).
Results: Two studies (112 patients, 56 in the amnioinfusion group and 56 in the no intervention group) were included in this review. Pooled perinatal mortality was 66.1% (37/56) in the amnioinfusion group compared with 71.4% (40/56) in no intervention group (RR 0.92, 95% CI 0.72 - 1.19). Other neonatal and maternal core outcomes were similar in both groups although, due the relatively small number of events and wide confidence intervals, there is possibility that amnioinfusion can be associated with clinically important benefits and harms. Long-term healthy survival was seen in 35.7% (10/28) of children assessed for follow-up and treated with amnioinfusion versus 28.6% (8/28) after no intervention (RR 1.30, 95% CI 0.47 - 3.60, ‘best case scenario’).
Conclusions: Based on these findings the benefits of amnioinfusion for midtrimester PROM

引言：介于16至24周孕龄期间的中间妊娠期膜破裂（PROM）是一种严重的产科并发症，具有较高的围产期发病率和死亡率。对于中间妊娠期PROM的女性，已提出进行羊水灌注以针对羊水过少并随后增强肺发育及围产期结局。研究材料与方法：本研究旨在进行一项系统评价和荟萃分析，纳入所有16+0至24+0周孕龄PROM女性关于羊水灌注与无干预措施的随机临床试验。检索数据库Central、Embase、Medline、ClinicalTrials.gov以及已识别文章的参考文献，时间范围为数据库创建至2021年12月。主要结局为围产期死亡率。次要结局包括新生儿、母亲及长期发育结局，如早产研究核心结局集所述。汇总指标以汇总相对风险（RR）或平均差异（MD）报告，并附带相应的95%置信区间（CI）。结果：本综述纳入了两项研究（112名患者，其中羊水灌注组56例，无干预组56例）。羊水灌注组的汇总围产期死亡率为66.1%（37/56），与无干预组的71.4%（40/56）相比（RR 0.92，95% CI 0.72 - 1.19）。两组的其他新生儿和母亲核心结局相似，尽管由于事件数量相对较少且置信区间较宽，存在羊水灌注可能带来临床重要益处和危害的可能性。对于接受羊水灌注并接受随访评估的儿童，长期健康存活率为35.7%（10/28），而在无干预措施后为28.6%（8/28）（RR 1.30，95% CI 0.47 - 3.60，最佳情况）。结论：基于这些发现，羊水灌注对于中间妊娠期PROM的益处