No benefit to antibiotics for term rupture of membranes

1. Overall, antibiotic prophylaxis following term or near-term premature rupture of membranes was not associated with maternal or neonatal benefit.

2. In women with latency >12 hours from rupture of membranes to delivery, prophylactic antibiotics were associated with a significantly decreased rate of maternal infection.

Evidence Rating Level: 1 (Excellent)  

Study Rundown: Premature, or pre-labor, rupture of membranes (PROM) occurs when a woman’s water breaks the onset of labor. It is common and occurs in approximately 1 in 10 full-term pregnancies. The amniotic sac, or the membrane that ruptures when a woman’s water breaks, holds the amniotic fluid and forms a protective barrier for the baby from the outside world. When the amniotic sac ruptures prior to labor, it allows bacteria to enter the uterus and is associated with an increased risk of infections in both the mother (e.g. chorioamnionitis, endometritis) and the baby (e.g. neonatal sepsis). While PROM in preterm pregnancies (<34 weeks gestation) is treated with antibiotics, PROM in term pregnancies (≥37 weeks gestation) is typically treated with induction of labor and no prophylactic antibiotics. In this study, researchers performed a meta-analysis of randomized trials to determine whether antibiotic prophylaxis in cases of term or near-term premature rupture of membranes reduced rates of infection.

Overall, there was no difference in maternal or neonatal infection rates between those who did or did not get antibiotics. However, in a subgroup of women with >12 hour latency period from PROM to delivery, prophylactic antibiotics were associated with a significantly decreased rate of maternal infection. This is the most up-to-date, comprehensive meta-analysis of its kind. Strengths of this study were inclusion of only randomized controlled trials and large sample size, permitting powered subgroup analyses. Limitations included moderate-high risk of bias in all but one of the included RCTs in the meta-analysis. Future studies might employ a larger sample size to evaluate the benefit of latency antibiotics for women at various durations of rupture of membranes prior to delivery to determine if there is a latency duration after which prophylactic antibiotics provide maternal or fetal benefit.

Click to read the study in AJOG

Relevant Reading: ACOG Practice Bulletin No. 139–Premature Rupture of Membranes

In-Depth [meta-analysis]: Researchers included 5 randomized trials of singleton pregnancies with premature rupture of membranes at 36 weeks gestation or later in a meta-analysis. All participants were randomized to either antibiotic prophylaxis (n=1354) or a control of placebo or no treatment (n=1345). Primary outcomes were maternal chorioamnionitis and neonatal sepsis. A subgroup analysis of studies with latency of >12 hours was planned.

In the primary analysis there was no difference in frequency of chorioamnionitis, endometritis, maternal infection, or neonatal sepsis between the two groups. In the subgroup of women with latency longer than 12 hours, antibiotics were associated with lower rates of chorioamnionitis (RR=0.49, 95% CI=0.27-0.91) and endometritis (RR=0.12, 95% CI=0.02-0.62).

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