Antibiotics for prelabour rupture of membranes at or near term

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.