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Type: Journal article
Title: Midtrimester preterm prelabour rupture of membranes (PPROM): expectant management or amnioinfusion for improving perinatal outcomes (PPROMEXIL - III trial)
Author: van Teeffelen, A.
van der Ham, D.
Willekes, C.
Al Nasiry, S.
Nijhuis, J.
van Kuijk, S.
Schuyt, E.
Mulder, T.
Franssen, M.
Oepkes, D.
Jansen, F.
Woiski, M.
Bekker, M.
Bax, C.
Porath, M.
de Laat, M.
Mol, B.
Pajkrt, E.
Citation: BMC Pregnancy and Childbirth, 2014; 14(1):128-1-128-7
Publisher: BioMed Central
Issue Date: 2014
ISSN: 1471-2393
Statement of
Augustinus S P van Teeffelen, David P van der Ham, Christine Willekes, Salwan Al Nasiry, Jan G Nijhuis, Sander van Kuijk, Ewoud Schuyt, Twan L M Mulder, Maureen T M Franssen, Dick Oepkes, Fenna A R Jansen, Mallory D Woiski, Mireille N Bekker, Caroline J Bax, Martina M Porath, Monique W M de Laat, Ben W Mol and Eva Pajkrt
Abstract: BACKGROUND: Babies born after midtrimester preterm prelabour rupture of membranes (PPROM) are at risk to develop neonatal pulmonary hypoplasia. Perinatal mortality and morbidity after this complication is high. Oligohydramnios in the midtrimester following PPROM is considered to cause a delay in lung development. Repeated transabdominal amnioinfusion with the objective to alleviate oligohydramnios might prevent this complication and might improve neonatal outcome. METHODS/DESIGN: Women with PPROM and persisting oligohydramnios between 16 and 24 weeks gestational age will be asked to participate in a multi-centre randomised controlled trial. INTERVENTION: random allocation to (repeated) abdominal amnioinfusion (intervention) or expectant management (control). The primary outcome is perinatal mortality. Secondary outcomes are lethal pulmonary hypoplasia, non-lethal pulmonary hypoplasia, survival till discharge from NICU, neonatal mortality, chronic lung disease (CLD), number of days ventilatory support, necrotizing enterocolitis (NEC), periventricular leucomalacia (PVL) more than grade I, severe intraventricular hemorrhage (IVH) more than grade II, proven neonatal sepsis, gestational age at delivery, time to delivery, indication for delivery, successful amnioinfusion, placental abruption, cord prolapse, chorioamnionitis, fetal trauma due to puncture. The study will be evaluated according to intention to treat. To show a decrease in perinatal mortality from 70% to 35%, we need to randomise two groups of 28 women (two sided test, β-error 0.2 and α-error 0.05). DISCUSSION: This study will answer the question if (repeated) abdominal amnioinfusion after midtrimester PPROM with associated oligohydramnios improves perinatal survival and prevents pulmonary hypoplasia and other neonatal morbidities. Moreover, it will assess the risks associated with this procedure.
Keywords: PPROM; Oligohydramnios; Amnioinfusion; Perinatal mortality; Pulmonary hypoplasia
Description: Published: 4 April 2014
Rights: © 2014 van Teeffelen et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
RMID: 0030017777
DOI: 10.1186/1471-2393-14-128
Appears in Collections:Obstetrics and Gynaecology publications

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