cochrane collaboration > colloquia > abstracts > adelaide 1996 Oral presentation: Antenatal corticosteroids to prevent adverse perinatal outcomes in the presence of preterm prelabour rupture of the membranes (pPROM). Meta-analyses including unpublished data

Ohlsson A. and Lacy J. University of Toronto Maternal, Infant and Reproductive Health Research Unit, Toronto, Ontario, Canada.

Introduction: Systematic reviews of the effect of antenatal corticosteroids on perinatal outcomes in the presence of pPROM have indicated a need for more precise estimates of the effect size.
Objective: By obtaining additional data from published studies of this intervention in pPROM populations, and thus increasing the statistical power, we intended to confirm/refute the possible benefits of antenatal corticosteroids in reducing adverse perinatal outcomes.
Methods: Medline, Embase, Reference Update, and Cochrane Pregnancy and Childbirth Database were searched. The quality of the studies was assessed using the Jadad method. We contacted 5 primary authors and received unpublished information from two studies, both of high quality (HQ). This included the original data set on tape from one large study. Data was abstracted by two researchers using preset definitions. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using Revman, for all studies (AS) and for HQ studies.
Results: Previous published studies provide information on at least one outcome in 779 infants. We obtained data on an additional 395 mothers (405 infants) from two HQ studies. Inconsistent ascertainment of intraventricular haemorrhage prevents the use of meta-analytic techniques to assess the effect of antenatal corticosteroids on this important outcome.

The summary  ORs and CIs were for:
RDS  (AS)                 0.55   (0.38-0.79)
RDS  (HQ)                 0.67   (0.30-1.48)
Neonatal infection (AS)   1.16   (0.58-2.30)
Neonatal infection (HQ)   0.97   (0.15-6.19)
Neonatal death (AS)       0.69   (0.32-1.49)
Neonatal death (HQ)       0.97   (0.15-6.19)
Endometritis (AS)         1.65   (0.91-2.98)
Endometritis (HQ)         1.21   (0.50-2.91)
Chorioamnionits (AS)      0.88   (0.57-1.36)
Chorioamnionitis (HQ)     0.88   (0.45-1.71)
Cesarean section (AS)     1.04   (0.73-1.49)
Cesarean section (HQ)     0.73   (0.38-1.41)

Discussion: After obtaining unpublished data, we conclude that the benefit (risks) of antenatal corticosteroids in the presence of pPROM, although suggesting a reduction in RDS, remains an enigma.

Adelaide 1996 O2.12