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Antibiotic therapy for preterm premature rupture of the membranes
1Department of Obstetrics and Gynecology, University of Tennessee, Memphis 38103, USA.
Abstract:
Amniotic fluid studies and placental histopathological evaluation have confirmed the association between intrauterine infection and preterm premature rupture of the membranes (pPROM). This association is increasingly strong with pPROM at early gestational ages. The organisms associated with pPROM include a broad spectrum of aerobic and anaerobic gram-positive and gram-negative bacteria. In many cases, the patient presenting with pPROM will have overt intrauterine infection necessitating delivery. For those amenable to expectant management, the clinical course is usually of brief latency between membrane rupture and delivery. A number of well-designed prospective clinical trials have evaluated the utility of antibiotic treatment during the expectant management of pPROM. Taken together, these studies suggest broad spectrum antibiotic treatment of this population to enhance pregnancy prolongation, and to reduce maternal and neonatal infectious morbidity. There are some data suggesting the potential for a reduction in neonatal gestational age-dependent morbidity. We recommend aggressive adjunctive antibiotic treatment to prolong pregnancy and reduce morbidity in patients with pPROM, at gestations remote from term, when a significant improvement in neonatal outcome can anticipated with expectant management.
Insights
Intrauterine infection is linked to preterm premature rupture of membranes (pPROM). Antibiotic treatment during expectant management can prolong pregnancy and reduce maternal and neonatal infections in pPROM cases.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Infectious Diseases
Background:
- Intrauterine infection is a known cause of preterm premature rupture of membranes (pPROM), particularly at earlier gestational ages.
- A wide range of bacteria, both aerobic and anaerobic, gram-positive and gram-negative, have been implicated in pPROM.
- Patients with pPROM may present with overt intrauterine infection requiring delivery, or may be candidates for expectant management.
Purpose of the Study:
- To evaluate the efficacy of antibiotic treatment in prolonging pregnancy and reducing maternal and neonatal morbidity in patients with pPROM undergoing expectant management.
- To assess the impact of antibiotic therapy on gestational age-dependent neonatal morbidity.
Main Methods:
- Review of well-designed prospective clinical trials evaluating antibiotic treatment during expectant management of pPROM.
- Analysis of data correlating antibiotic use with pregnancy prolongation and infectious morbidity outcomes.
Main Results:
- Broad-spectrum antibiotic treatment during expectant management of pPROM is associated with enhanced pregnancy prolongation.
- Antibiotic therapy significantly reduces maternal and neonatal infectious morbidity in this patient population.
- Evidence suggests a potential reduction in neonatal gestational age-dependent morbidity with antibiotic treatment.
Conclusions:
- Aggressive adjunctive antibiotic treatment is recommended for patients with pPROM at gestations remote from term.
- Antibiotic therapy can prolong pregnancy and decrease infectious morbidity, leading to improved neonatal outcomes when expectant management is anticipated.
- The benefits of antibiotic treatment are most pronounced when significant improvements in neonatal outcomes can be expected.