Antibiotics for meconium-stained amniotic fluid in labour for preventing maternal and neonatal infections

Cochrane Review by Siriwachirachai T, Sangkomkamhang US, Lumbiganon P, Laopaiboon M

This record should be cited as: Siriwachirachai T, Sangkomkamhang US, Lumbiganon P, Laopaiboon M. Antibiotics for meconium-stained amniotic fluid in labour for preventingmaternal and neonatal infections. Cochrane Database of Systematic Reviews 2010, Issue 12. Art.No.: CD007772. DOI: 10.1002/14651858.CD007772.pub2.

ABSTRACT

Title

Antibiotics for meconium-stained amniotic fluid in labour for preventing maternal and neonatal infections

Background

Chorioamnionitis is more likely to occur when meconium-stained amniotic fluid (MSAF) is present. Meconium may enhance the growth of bacteria in amniotic fluid by serving as a growth factor, inhibiting bacteriostatic properties of amniotic fluid. Many adverse neonatal outcomes related to MSAF result fromMeconium Aspiration Syndrome (MAS). MSAF is associated with both maternal and newborn infections. Antibiotics may be an effective option to reduce such morbidity.

Objectives

The objective of this review is to assess the efficacy and side effects of prophylactic antibiotics for MSAF during labour in preventing maternal and neonatal infections.

Search strategy

We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (30 September 2010).

Selection criteria

Randomized controlled trials (RCTs) comparing prophylactic antibiotics with placebo or no treatment during labour for women with MSAF.

Data collection and analysis

Two review authors independently assessed the results of the only available trial and extracted data on maternal and neonatal outcomes.

Main results

We included one study with 120 pregnant women. It compared ampicillin-salbactam (N = 60) versus normal saline (N = 60) in pregnant women with MSAF. Prophylactic antibiotics appeared to have no statistically significant reduction in the incidence of neonatal sepsis (risk ratio (RR) 1.00, 95% CI 0.21 to 4.76), neonatal intensive care unit (NICU) admission (RR 0.83, 95% CI 0.39 to 1.78) and postpartum endometritis (RR 0.50, 95% CI 0.18 to 1.38). However, significant decrease in the risk of chorioamnionitis (RR 0.29, 95% CI 0.10 to 0.82). No serious adverse effects were reported.

Authors' conclusions

Current evidence indicates that compared to placebo, antibiotics for MSAF in labour may reduce chorioamnionitis. There was no evidence that antibiotics could reduce postpartum endometritis, neonatal sepsis and NICU admission. This systematic review identifies the need for more well-designed, adequately powered RCTs to assess the effect of prophylactic antibiotics in the incidence of maternal and neonatal complications.

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