Antibiotics for preterm rupture of membranes

  • Review
  • Intervention

Authors

  • Sara Kenyon,

    Corresponding author
    1. University of Birmingham, School of Health and Population Studies, Edgbaston, UK
    • Sara Kenyon, School of Health and Population Studies, University of Birmingham, Public Health Building, Edgbaston, B15 2TT, UK. s.kenyon@bham.ac.uk.

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  • Michel Boulvain,

    1. Maternité Hôpitaux Universitaires de Genève, Département de Gynécologie et d'Obstétrique, Unité de Développement en Obstétrique, Genève 14, Switzerland
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  • James P Neilson

    1. The University of Liverpool, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, Liverpool, UK
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Abstract

Background

Premature birth carries substantial neonatal morbidity and mortality. One cause, associated with preterm rupture of membranes (pROM), is often subclinical infection. Maternal antibiotic therapy might lessen infectious morbidity and delay labour, but could suppress labour without treating underlying infection.

Objectives

To evaluate the immediate and long-term effects of administering antibiotics to women with pROM before 37 weeks, on maternal infectious morbidity, fetal and neonatal morbidity and mortality, and longer-term childhood development.

Search strategy

We searched the Cochrane Pregnancy and Childbirth Group trials register (August 2004).

Selection criteria

Randomised controlled trials comparing antibiotic administration with placebo that reported clinically relevant outcomes were included. In addition, trials, in which no placebo was used, were included for the outcome of perinatal death alone.

Data collection and analysis

We extracted data from each report without blinding of either the results or the treatments that women received. We sought unpublished data from a number of authors.

Main results

Twenty-two trials involving over 6000 women and their babies were included.

The use of antibiotics following pROM is associated with a statistically significant reduction in chorioamnionitis (relative risk (RR) 0.57, 95% confidence interval (CI) 0.37 to 0.86). There was a reduction in the numbers of babies born within 48 hours (RR 0.71, 95% CI 0.58 to 0.87) and seven days of randomisation (RR 0.80, 95% CI 0.71 to 0.90). The following markers of neonatal morbidity were reduced: neonatal infection (RR 0.68, 95% CI 0.53 to 0.87), use of surfactant (RR 0.83, 95% CI 0.72 to 0.96), oxygen therapy (RR 0.88, 95% CI 0.81 to 0.96), and abnormal cerebral ultrasound scan prior to discharge from hospital (RR 0.82, 95% CI 0.68 to 0.98). Co-amoxiclav was associated with an increased risk of neonatal necrotising enterocolitis (RR 4.60, 95% CI 1.98 to 10.72).

Authors' conclusions

Antibiotic administration following pROM is associated with a delay in delivery and a reduction in major markers of neonatal morbidity. These data support the routine use of antibiotics in pPROM.

The choice as to which antibiotic would be preferred is less clear as, by necessity, fewer data are available. Co-amoxiclav should be avoided in women at risk of preterm delivery because of the increased risk of neonatal necrotising enterocolitis. From the available evidence, erythromycin would seem a better choice.

Plain language summary

Certain antibiotics given to women with early broken waters will improve babies' health

Babies born too soon are more likely to suffer ill health in the early days and sometimes throughout life. Early labour and birth (before 37 weeks) may be due to undetected infection. The review found that certain antibiotics given to women, when their waters break early, increase the time babies stay in the womb. They reduced infection and the number of babies with potential development problems, but did not save more babies. One antibiotic (co-amoxiclav) increased the number of babies with a rare condition of inflammation of the bowel. The antibiotic recommended for women whose waters break early is erythromycin.

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