Abstract
Prediction of pulmonary hypoplasia after midtrimester preterm prelabour rupture of
membranes (PPROM) is important for optimal management. We performed a systematic review
to assess the capacity of clinical parameters to predict pulmonary hypoplasia. A systematic
literature search in EMBASE and MEDLINE was performed to identify articles published
on pulmonary hypoplasia in relation to midtrimester PPROM. Articles were selected
when they reported on one of the following clinical parameters – gestational age at
PPROM, latency period and degree of oligohydramnios – and when they allowed the construction
of a two-by-two table comparing at least one of three clinical parameters to the occurrence
of pulmonary hypoplasia. The selected studies were scored on methodological quality,
and sensitivity and specificity of the tests in the prediction of pulmonary hypoplasia
and lethal pulmonary hypoplasia were calculated. Overall performance was assessed
by summary receiver operating characteristic (sROC) curves that were constructed with
bivariate meta-analysis. We detected 28 studies that reported on the prediction of
pulmonary hypoplasia. Prediction of lethal pulmonary hypoplasia could be analysed
separately in 21 of these studies. The quality of the included studies was poor. The
estimated sROC-curves showed that gestational age at PPROM performed significantly
better than the two other parameters in the prediction of pulmonary hypoplasia. The
accuracy in the prediction of lethal pulmonary hypoplasia was similar. In women with
midtrimester PPROM, pulmonary hypoplasia can be predicted from the gestational age
at PPROM. This information should be used in the management of women with early PPROM.
Keywords
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Article info
Publication history
Published online: October 26, 2009
Accepted:
October 6,
2009
Received in revised form:
August 29,
2009
Received:
December 18,
2008
Identification
Copyright
© 2009 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
