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Updated: May 28, 2025
A Murine Model of Fetal Exposure to Maternal Inflammation to Study the Effects of Acute Chorioamnionitis on Newborn Intestinal Development
Published on: June 24, 2020
Maternal and Neonatal Infectious Outcomes Compared According to Rupture of Membrane Duration and Antibiotic
Raneen Abu Shqara1,2, Daniel Glikman2, Lior Lowenstein1,2
1From the Department of Obstetrics & Gynecology, Galilee Medical Center, Nahariya, Israel.
Background:
Prolonged rupture of membranes (ROM) is associated with peripartum infections; the optimal timing to initiate prophylactic antibiotic treatment is inconclusive. We compared maternal and neonatal infectious morbidity and bacterial distribution in chorioamniotic-membrane cultures according to a ROM-to-delivery interval of 12-18 versus ≥18 hours.
Methods:
This retrospective cohort study was conducted in a single tertiary university-affiliated hospital from January 2020 to January 2023. Labor was induced in term singleton pregnant women with ROM ≥12 hours who did not deliver spontaneously within 12-24 hours. Prophylactic ampicillin was administered based on risk factors. Outcomes were compared between ROM 12-18 hours (n = 683) and >18 hours (n = 1039); the latter uniformly received intrapartum antibiotics. The primary maternal outcome was clinical chorioamnionitis. The secondary outcomes included intrapartum fever, cesarean delivery, puerperal endometritis and hospitalization length. Neonatal outcomes included early-onset sepsis, 5-minute Apgar score <7, length of stay, respiratory distress and ventilation support.
Results:
The clinical chorioamnionitis rate was comparable between the ROM 12- to 18- and the ≥18-hour groups. However, intrapartum fever occurred more frequently in the former (15.5% vs. 11.6%, P = 0.024), and postoperative infections were significantly higher (11.7% vs. 4.5%, P = 0.020). Cesarean deliveries were more common in ROM ≥18 versus 12-18 hours (21.3% vs. 16.3%, P = 0.028). Neonatal outcomes were similar between the groups. The bacterial distributions among chorioamniotic-membrane cultures were similar, the most common isolated pathogens were Enterobacteriaceae.
Conclusions:
Although the risk of chorioamnionitis was similar, the incidence of intrapartum fever and postoperative infections were higher in ROM 12-18 versus ≥18 hours. Initiating antibiotic prophylactic treatment at 12 hours post-prelabor ROM may be beneficial.
