Antibiotics for preterm rupture of membranes

Cochrane Review by Kenyon S, Boulvain M, Neilson J

This record should be cited as: Kenyon S, Boulvain M, Neilson J. Antibiotics for preterm rupture of membranes. Cochrane Database of Systematic Reviews 2010, Issue 8. Art. No.: CD001058. DOI: 10.1002/14651858.CD001058.pub2.

ABSTRACT

Title

Antibiotics for preterm rupture of membranes

Background

Premature birth carries substantial neonatal morbidity and mortality. Subclinical infection is associated with preterm rupture of membranes (PROM). Prophylactic maternal antibiotic therapy might lessen infectious morbidity and delay labour, but could suppress labour without treating underlying infection.

Objectives

To evaluate the immediate and long-term effects of administering antibiotics to women with PROM before 37 weeks, on maternal infectious morbidity, neonatal morbidity and mortality, and longer-term childhood development.

Search strategy

We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (29 April 2010).

Selection criteria

Randomised controlled trials comparing antibiotic administration with placebo that reported clinically relevant outcomes were included as were trials of different antibiotics. Trials in which no placebo was used were included for the outcome of perinatal death alone.

Data collection and analysis

We extracted data fromeach report without blinding of either the results or the treatments that women received.We sought unpublished data from a number of authors.

Main results

We included 22 trials, involving 6800 women and babies.

Authors' conclusions

The decision to prescribe antibiotics for women with PROM is not clearcut. Benefits in some short-term outcomes (prolongation of pregnancy, infection, less abnormal cerebral ultrasound before discharge from hospital) should be balanced against a lack of evidence of benefit for others, including perinatal mortality, and longer term outcomes. If antibiotics are prescribed it is unclear which would be the antibiotic of choice.

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