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Antibiotic prophylaxis for term or near-term premature rupture of membranes: metaanalysis of randomized trials

Published:December 30, 2014DOI:https://doi.org/10.1016/j.ajog.2014.12.034

      Objective

      The objective of the study was to evaluate the efficacy of antibiotic prophylaxis in women with term or near-term premature rupture of membranes.

      Study Design

      Searches were performed in MEDLINE, OVID, Scopus, ClinicalTrials.gov, the PROSPERO International Prospective Register of Systematic Reviews, EMBASE, ScienceDirect.com, MEDSCAPE, and the Cochrane Central Register of Controlled Trials with the use of a combination of key words and text words related to antibiotics, premature rupture of membranes, term, and trials from inception of each database to September 2014. We included all randomized trials of singleton gestations with premature rupture of membranes at 36 weeks or more, who were randomized to antibiotic prophylaxis or control (either placebo or no treatment). The primary outcomes included maternal chorioamnionitis and neonatal sepsis. A subgroup analysis on studies with latency more than 12 hours was planned. Before data extraction, the review was registered with the PROSPERO International Prospective Register of Systematic Reviews (registration number CRD42014013928). The metaanalysis was performed following the Preferred Reporting Item for Systematic Reviews and Meta-analyses statement.

      Results

      Women who received antibiotics had the same rate of chorioamnionitis (2.7% vs 3.7%; relative risk [RR], 0.73, 95% confidence interval [CI], 0.48–1.12), endometritis (0.4% vs 0.9%; RR, 0.44, 95% CI, 0.18–1.10), maternal infection (3.1% vs 4.6%; RR, 0.48, 95% CI, 0.19–1.21), and neonatal sepsis (1.0% vs 1.4%; RR, 0.69, 95% CI, 0.34–1.39). In the planned subgroup analysis, women with latency longer than 12 hours, who received antibiotics, had a lower rate of chorioamnionitis (2.9% vs 6.1%; RR, 0.49, 95% CI, 0.27–0.91) and endometritis (0% vs 2.2%; RR, 0.12, 95% CI, 0.02–0.62) compared with the control group.

      Conclusion

      Antibiotic prophylaxis for term or near-term premature rupture of membranes is not associated with any benefits in either maternal or neonatal outcomes. In women with latency longer than 12 hours, prophylactic antibiotics are associated with significantly lower rates of chorioamnionitis by 51% and endometritis by 88%.

      Key words

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      References

        • Marowitz A.
        • Jordan R.
        Midwifery management of prelabour rupture of membranes at term.
        J Midwifery Womens Health. 2007; 52: 199-206
        • American College of Obstetricians and Gynecologists
        Premature rupture of membranes: clinical management guidelines for obstetrician-gynecologists. ACOG Practice bulletin no. 139.
        Obstet Gynecol. 2013; 122: 918-930
        • Kenyon S.
        • Boulvain M.
        • Neilson J.P.
        Antibiotics for preterm rupture of membranes.
        Cochrane Database Syst Rev. 2013; : CD001058
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        J Clin Epidemiol. 2009; 62: 1006-1012
      1. Higgins JPT, Altman DG, Sterne JAC. Assessing risk of bias in included studies. In: Higgins JPT, Green S, eds. Cochrane handbook for systematic reviews of interventions, version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available at: www.cochrane-handbook.org. Accessed Sept. 15, 2014.

        • Tran S.H.
        • Cheng Y.
        • Kaimal A.
        • Chaughey A.
        Length of rupture of membranes in the setting of premature rupture of membranes at term and infectious maternal morbidity.
        Am J Obstet Gynecol. 2008; 198: 700.e1-700.e5
        • Lebherz T.B.
        • Hellman L.P.
        • Madding R.
        • Anctil A.
        • Arje S.L.
        Double-blind study of premature rupture of the membranes. A report of 1,896 cases.
        Am J Obstet Gynecol. 1963; 87: 218-225
        • Brelije M.C.
        • Kaltreider D.F.
        The use of vaginal antibiotics in premature rupture of the membranes.
        Am J Obstet Gynecol. 1966; 94: 889-897
        • Gordon M.
        • Weingold A.B.
        Treatment of patients with premature rupture of the fetal membranes: a) prior to 32 weeks; b) after 32 weeks. Premature rupture of the membranes—a rational approach to management.
        in: Reid D.E. Christian C.D. Controversy in obstetrics and gynecology II. WB Saunders Co, Philadelphia1974: 42-44
        • Ovalle A.
        • Gomez R.
        • Martinez M.A.
        • et al.
        Antibiotic treatment of patients with term premature rupture of membranes: a randomized clinical trial.
        Prenatal Neonat Med. 1998; 3: 599-606
        • Cararach V.
        • Botet F.
        • Sentis J.
        • Almirali R.
        • Perez-Picanol E.
        Administration of antibiotics to patients with rupture of membranes at term: a prospective, randomized, multicentric study. Collaborative Group on PROM.
        Acta Obstet Gynecol Scand. 1998; 77: 298-302
        • Passos F.
        • Cardoso K.
        • Coelho A.M.
        • Graca A.
        • Clode N.
        • Mendes da Graca
        Antibiotic prophylaxis in premature rupture of membranes at term: a randomized controlled trial.
        Obstet Gynecol. 2012; 120: 1045-1054
        • Nabhan A.F.
        • Elhelaly A.
        • Elkadi M.
        Antibiotic prophylaxis in relabour spontaneous rupture of fetal membranes at or beyond 36 weeks of pregnancy.
        Int J Gynaecol Obstet. 2014; 124: 59-62
        • Walss Rodriguez R.J.
        • Navarro Castanon J.
        Prophylactic antibiotics in premature rupture of the membranes.
        Ginecol Obstet Mexico. 1988; 56: 339-342
        • Shatrov J.
        • Birch S.C.M.
        • Lam L.T.
        • et al.
        Chorioamnionitis and cerebral palsy: a meta-analysis.
        Obestet Gynecol. 2010; 116: 387-392
        • Malloy M.H.
        Chorioamnionitis: epidemiology of newborn management and outcome United States 2008.
        J Perinatol. 2014; 34: 611-615
        • MacDorman M.
        • Menacker F.
        • Declercq E.
        Cesarean birth in the United States: epidemiology, trends, and outcomes.
        Clin Perinatol. 2008; 35: 293-307
        • Flenady V.
        • King J.F.
        Antibiotics for prelabour rupture of membranes at or near term.
        Cochrane Database Syst Rev. 2002; : CD001807