Preterm Premature Rupture of Membrane Clinical Trial
Official title:
A Pilot Randomized Controlled Trial On Complete Bed Rest Versus Activity Restriction After Preterm Premature Rupture of the Membranes
Antepartum bed rest is widely prescribed after preterm premature rupture of the membranes (PPROM), although its effectiveness to prevent preterm birth has not been demonstrated. This pilot randomized controled trial (RCT) aims to access the impact of bed rest in maternal and neonatal outcomes in pregnancies complicated by premature rupture of the membranes.
Aims - To access the impact of bed rest in latency time to delivery, chorioamnionitis
incidence and other maternal and neonatal outcomes in pregnancies complicated by PPROM, thus
enabling proper sample size calculation for future powered RCT.
Study population and Sample size - Eligible patients included those with single pregnancies
with PPROM at 24+0-33+6 weeks of gestation who were admitted to and delivering at our
tertiary center. PPROM was diagnosed on the basis of patient's history and sterile speculum
examination with visualization of amniotic fluid pooling in the vagina and/or leaking from
the cervical canal. Exclusion criteria included indication for immediate delivery on
admission (chorioamnionitis, placenta abruption, cord prolapse, signs of fetal
hypoxia/distress), fetal malformations, multiple gestation, and maternal immunosuppressive
disease. Considering future sample size calculation based upon assumed differences between
groups regarding latency and infection, we aimed a sample of 30 participants.
Randomization - A pilot unblinded randomized controlled trial (RCT) in a 1:1 allocation ratio
between two groups (complete bed rest versus activity restriction after PPROM). Simple random
allocation sequence was generated by the investigators and implemented by sequentially
numbered sealed envelopes. Participants were enrolled by physicians after hospital admission
and written informed consent was obtained before randomization. The trial was conducted in a
single tertiary center of the Portuguese national health system after approval by its ethical
committee.
Statistical analysis - An intention-to-treat analysis was performed with a significance level
of 5%.
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