Prophylactic penicillin during labor in infection-prone patients

Abstract

Although penicillin given during labor should theoretically give protection against infection, there are as yet only a few reports which present reliable data indicating actual results. In the present experiment 100 obstetrical patients with premature rupture of the membranes for at least 20 hours, labor for 20 hours or more, or both were given prophylactic penicillin at regular intervals before delivery; whereas a like number of controls were untreated. Taking into account the differences in the two groups (as shown by comparisons of the length of labor, lapse of time after premature rupture of the membranes, incidence of antepartum fever, inflammation of the placenta, etc.) there was demonstrated a considerable protection against puerperal infection in such patients from the use of penicillin during labor. However, welcome as is this protection, the prevention was so far from complete in these infection-prone patients as to suggest only a very cautious extension of the indications for delivery by cesarean section in such difficult cases. In agreement with Keettel, Scott, and Plass, there was some reason to believe that the use of larger prophylactic doses of penicillin should be expected further to reduce the occurrence of puerperal infection.On theoretical grounds it has been suggested that the fetus should receive some protection against antenatal infection from the penicillin given to the mother before delivery, though factual evidence regarding this seems to be largely lacking. In the present series the gross results, as well as an analysis of the figures, failed to indicate any advantage to the child from prophylactic antepartum treatment of the mother.