Antibiotics for prelabour rupture of membranes at or near term

It is not known whether routine use of antibiotic treatment for prelabour rupture of membranes at or near term is beneficial. More research is needed.

RHL Commentary by Gülmezoglu AM

1. EVIDENCE SUMMARY

The review evaluated the benefits and potential harms of administering antibiotics to women with prelabour rupture of the membranes at or near term.

Two trials with a total of 838 women were included. Both trials showed potential benefits in terms of reducing maternal infectious morbidity defined as chorioamnionitis and/or endometritis (relative risk [RR]: 0.43; 95% confidence interval [CI]: 0.23–0.82). There was inadequate evidence to reliably assess the effects on newborn outcomes particularly perinatal mortality (RR: 0.98; 95% CI: 0.14–6.89).

The trials used different parenteral antibiotic regimens (ampicillin + gentamycin and cefuroxime + clindamycin) and had different time thresholds for labour induction (12 hours and 24 hours).

Neither trial had allocation concealment. Newborn outcome assessment was blinded in one. The trials and the meta-analysis did not have sufficient statistical power to evaluate substantive outcomes reliably. The reviewers were appropriately cautious in their interpretation of the results and recommended more research.

2. RELEVANCE TO UNDER-RESOURCED SETTINGS

2.1. Magnitude of the problem

Prelabour rupture of the membranes occurs in about 8% of pregnant women and more than 90% of these women go into spontaneous labour within 24 hours (1). For women whose labour does not start spontaneously or whose deliveries are not expedited through labour induction, infectious morbidity and mortality become a serious problem. It is estimated that 36% of newborn deaths are due to infections with the majority of those being due to sepsis and pneumonia (2). Since ascending infections are implicated in prelabour rupture of the membranes it is important to be vigilant for any potential infectious consequence for the mother and/or the baby.

2.2. Applicability of the results

Evidence is insufficient to make a recommendation for or against the use of antibiotics for prelabour rupture of the membranes, which renders the applicability of results irrelevant.

2.3. Implementation of the intervention

A combined antibiotic regimen covering Gram-positive and Gram-negative organisms would be feasible to implement in many second-level care settings. However, the interventions researched to date are fairly invasive parenteral regimens and without clear evidence of benefit it is not possible to make any recommendation for implementation.

3. RESEARCH

The main message of the Cochrane review is the need for more research. These trials should be conducted in settings where neonatal and maternal infectious morbidity is a significant burden and should be designed to address substantive outcomes such as newborn death, sepsis, intensive care admission and severe maternal infections.

References

  • Cammu H, Verlaenen H, Derde M. Premature rupture of membranes at term in nulliparous women: a hazard. Obstetrics and Gynecology 1990;76:671–674.
  • Lawn JE, Cousens S, Zupan J, for the Lancet Neonatal Survival Steering Team. 4 million deaths: When? Where? Why. Lancet 2005;364:S9–S19.

This document should be cited as: Gülmezoglu AM. Antibiotics for prelabour rupture of membranes at or near term: RHL commentary (last revised: 8 June 2009). The WHO Reproductive Health Library; Geneva: World Health Organization.

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