Antibiotics for prelabour rupture of membranes at or near term

[Intervention Review]
Antibiotics for prelabour rupture of membranes at or near term

Vicki Flenady1, James F King2

1Mater Mother's Research Centre, Mater Health Services, Wooloongabba, Australia. 2Department of Perinatal Medicine, Royal Women's Hospital, Carlton, Australia

Contact address: Vicki Flenady, Mater Mother's Research Centre, Mater Health Services, Level 2 Quarters Building, Annerley Road, Wooloongabba, Queensland, 4102, Australia. vicki.flenady@mater.org.au. (Editorial group: Cochrane Pregnancy and Childbirth Group.)

Cochrane Database of Systematic Reviews, Issue 2, 2009 (Status in this issue: New search for studies completed, conclusions not changed)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
DOI: 10.1002/14651858.CD001807
This version first published online: 22 July 2002 in Issue 3, 2002. Last assessed as up-to-date: 22 December 2008. (Help document - Dates and Statuses explained).

This record should be cited as: Flenady V, King JF. Antibiotics for prelabour rupture of membranes at or near term. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD001807. DOI: 10.1002/14651858.CD001807.
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Abstract


Background
Prelabour rupture of the membranes at or near term (term PROM) increases the risk of infection for the woman and her baby. The routine use of antibiotics for women at the time of term PROM may reduce this risk. However, due to increasing problems with bacterial resistance and the risk of maternal anaphylaxis with antibiotic use, it is important to assess the evidence addressing risks and benefits in order to ensure judicious use of antibiotics. This review was undertaken to assess the balance of risks and benefits to the mother and infant of antibiotic prophylaxis for prelabour rupture of the membranes at or near term.


Objectives
To assess the effects of antibiotics administered prophylactically to women with prelabour rupture of the membranes at 36 weeks or beyond, on maternal, fetal and neonatal outcomes.


Search strategy
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2008).


Selection criteria
All randomised trials which compared outcomes for women and infants when antibiotics were administered prophylactically for prelabour rupture of the membranes at or near term, with outcomes for controls (placebo or no treatment).


Data collection and analysis
Two authors independently extracted the data and assessed trial quality. Additional data were received from the investigators of included trials.


Main results
The results of two trials, involving a total of 838 women, are included in this review. The use of antibiotics resulted in a statistically significant reduction in maternal infectious morbidity (chorioamnionitis or endometritis): (risk ratio (RR) 0.43; 95% confidence interval (CI) 0.23 to 0.82); (risk difference (RD) -4%; 95% CI -7% to -1%); (number needed to treat (NNT) 25; 95% CI 14 to100). No statistically significant differences were shown for outcomes of neonatal morbidity. However, one study of 105 women showed a reduction in neonatal length of stay (mean difference -0.90; 95% CI -1.34 to -0.46).


Authors' conclusions
No clear practice recommendations can be drawn from the results of this review on this clinically important question, related to a paucity of reliable data. Further well-designed randomised controlled trials are needed to assess the effects of routine use of maternal antibiotics for women with prelabour rupture of the membranes at or near term.


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Plain language summary

Antibiotics for prelabour rupture of membranes at or near term
Giving pregnant women antibiotics when their membranes rupture at or near term without the onset of labour may reduce the risk of infections for the women. More research is needed on the safety and impact of the antibiotics on their babies. Sometimes the membranes (creating a bag of liquid around the unborn baby) break when the baby is due without the onset of regular uterine contractions. This is called PROM (prelabour rupture of membranes). When this happens, there is a risk of infection entering the womb (uterus) and affecting the mother and her baby. Most of the women spontaneously start regular uterine contractions within 24 hours, although some do not. The women are often given antibiotics to prevent infection but there are concerns about possible adverse effects of antibiotic use. The other main management strategy is to induce labour with oxytocin.

The review of trials found that routine antibiotics for term PROM reduced the risk of infection of the uterus for the pregnant woman. There was not enough strong evidence about other outcomes, including infections and complications for the baby. Only two trials involving a total of 838 women with PROM were identified. The conclusions from this review are limited by the small numbers of women enrolled in the identified trials and the low rate of maternal infection in the control groups. There is insufficient information in this review to assess possible adverse effects from the use of antibiotics for women or their infants.






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