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Preterm premature ruptured membranes: a randomized trial of steroids after treatment with antibiotics
D F Lewis1, K Brody, M S Edwards
1Department of Obstetrics and Gynecology, Louisiana State University Medical Center, Shreveport, USA.
Insights
Corticosteroids after ampicillin-sulbactam treatment significantly reduced respiratory distress syndrome (RDS) in preterm premature rupture of membranes (PROM) patients. This approach improved infant outcomes without increasing maternal or neonatal infections.
Area of Science:
- Obstetrics and Gynecology
- Neonatology
- Pharmacology
Background:
- Preterm premature rupture of membranes (PROM) poses significant risks to neonates, including respiratory distress syndrome (RDS).
- Corticosteroid administration is a standard treatment to promote fetal lung maturation, but its use in conjunction with antibiotics requires careful evaluation.
Purpose of the Study:
- To evaluate the efficacy of corticosteroids in patients with preterm PROM following a minimum 12-hour treatment with ampicillin-sulbactam.
- To determine the impact of this combined treatment on neonatal respiratory distress syndrome (RDS) and infectious morbidity.
Main Methods:
- A randomized clinical trial was conducted involving patients with preterm PROM.
- Patients received ampicillin-sulbactam for at least 12 hours before corticosteroid administration. Digital vaginal examinations were avoided.
- The study monitored the incidence of RDS, latency period, and maternal/neonatal infectious morbidity.
Main Results:
- A significant reduction in the incidence of RDS was observed in the corticosteroid group (18.4% vs. 43.6%, P = .03).
- No statistically significant difference in the latency period was found between the steroid and no-steroid groups.
- Neonatal and maternal infectious morbidity rates were similar in both groups.
Conclusions:
- Preterm PROM patients treated with a broad-spectrum antibiotic prior to corticosteroids demonstrated a decreased incidence of RDS.
- This therapeutic strategy appears safe, with no apparent adverse sequelae regarding infectious complications.
Objective:
To assess the effectiveness of corticosteroids in patients with preterm premature rupture of membranes (PROM) after treatment with a broad-spectrum antibiotic, ampicillin-sulbactam.
Methods:
A randomized clinical trial of corticosteroids in patients with preterm PROM was undertaken after treating these patients for a minimum of 12 hours with ampicillin-sulbactam. No digital vaginal examinations were performed on these patients. Antibiotics were continued for 7 days and the steroids were repeated weekly. No tocolytics were used. The primary outcome measure was the incidence of respiratory distress syndrome (RDS). Secondary outcome measures included latency period and neonatal and maternal infectious morbidity.
Results:
Seventy-seven patients were enrolled and data about their pregnancies were analyzed. No statistically significant difference in latency period was noted (14.7 days in the steroid group, 15.8 days in the no-steroid group). Both neonatal and maternal infectious morbidity were similar. A significant reduction in the incidence of RDS (18.4 versus 43.6%, P = .03) were observed in the steroid group.
Conclusion:
These data suggest that treating preterm PROM patients with a broad-spectrum antibiotic before corticosteroids decreases RDS without apparent adverse sequelae.