Abstract
Background: Evidence for the benefits of antibiotics in prelabour rupture of membranes (PROM) at term is limited. Aim: To evaluate the effectiveness of Cefuroxime in mothers with PROM at term undergoing induction of labour after 12 hours, in reducing feto-maternal and neonatal infections compared to a group without antibiotics. Methods: We conducted a single centre randomized controlled trial involving 118 participants presented to professorial Obstetric unit at Teaching Hospital Peradeniya, Sri Lanka. Women with live singleton pregnancies at term (37-42 weeks of gestation) with PROM for less than 12 hours without uterine activity on admission were recruited. Participants were randomly allocated to two groups, one with antibiotic coverage (Cefuroxime) and the other without. All mothers were induced with oxytocin, if labour was not started spontaneously by 12 hours of PROM. Primary study outcomes were development of chorioamnionitis, postpartum endometritis and neonatal infection. Results: One mother in the intervention arm (n=60) and two in the control arm (n=58) developed chorioamnionitis. There were no cases of post-partum endometritis in the intervention arm, but two were noted in the control arm. One neonate in the intervention arm and three in the control arm had sepsis. None of these three outcome measures; chorioamnionitis (OR-0.5, 95% CI 0-5.3), neonatal sepsis (OR-0.3, 95% CI 0.0-3.0) and post-partum endometritis (OR - 0.2, 95% CI 0.0-3.9) showed any significant difference between the two groups. Post-partum sepsis was not reported in both arms. Altogether, there was no statistically significant difference in maternal infection related morbidities in the intervention (n=60, 1.66%) or the control group (n=58, 6.89%) (OR-0.3, 95% CI 0.0-2.2). Conclusions: Use of antibiotics in mothers with term PROM does not provide any significant effect on any of its outcome measures with induction of labour after 12 hours of membrane rupture, particularly in terms of maternal and neonatal infection related morbidities.
Highlights
Prelabour rupture of membranes (PROM) is generally considered as spontaneous membrane rupture with leakage of amniotic fluid prior to onset of labour. When this occurs between 37 to 42 weeks of gestation, it is termed as “Term prelabour rupture of membranes (PROM)”1. It is seen in 10% of all pregnancies and 84% occurs at term[2,3,4]
Whenever the history is suggestive of membrane rupture, its confirmation can be done by visual inspection of leaking of liquor through the “cervical os” using a sterile speculum[3,6]
It compared the outcomes of mothers with term PROM and their infants who had antibiotic, with outcomes of control group; those without antibiotic
Summary
Prelabour rupture of membranes (PROM) is generally considered as spontaneous membrane rupture with leakage of amniotic fluid prior to onset of labour When this occurs between 37 to 42 weeks of gestation, it is termed as “Term PROM”1. One neonate in the intervention arm and three in the control arm had sepsis None of these three outcome measures; chorioamnionitis (OR-0.5, 95% CI 0-5.3), neonatal sepsis (OR-0.3, 95% CI 0.0-3.0) and post-partum endometritis (OR - 0.2, 95% CI 0.0-3.9) showed any significant difference between the two groups. Conclusions: Use of antibiotics in mothers with term PROM does not provide any significant effect on any of its outcome measures with induction of labour after 12 hours of membrane rupture, in terms of maternal and neonatal infection related morbidities
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