Abstract: Objective: To assess whether earlier administration of antibiotic prophylaxis after prelabor rupture of membranes (PROM) at term would decrease the incidence of maternal and neonatal infections.
Methods: This is a retrospective cohort study comparing women with term PROM who were initiated antibiotic prophylaxis within or after 6 h, and within or after 12 h from PROM to delivery during January 2019 to December 2021. Women with term PROM receiving cephalosporin and without contraindications to vaginal delivery or confirmed or suspected infection were included in the study. The primary outcome was puerperal infection, which refers to the reproductive tract infection occurring within 42 days of delivery. The type of pharmacoeconomic evaluation was selected based on the results of compared effectiveness between the early group and the late group. Propensity-score matching (PSM) was used to adjust confounding. Subgroup and sensitivity analyses were used to verify the robustness of results.
Results: We enrolled 5353 women with term PROM, including 4331 initiated with antibiotic within 6 h, 1022 after 6 h, 5077 within 12 h, and 276 after 12 h. After PSM, no significant difference was observed in the baseline characteristics of the groups. There was no statistical difference between antibiotic use within 6 h and after 6 h, or within 12 h and after 12 h, in puerperal infection (4.6% vs. 4.3%, P = 0.826; 2.9% vs. 4.6%, P = 0.471, respectively), total maternal infection, neonatal sepsis, and total neonatal infection. Cost-minimization analysis showed there was no significant difference between antibiotic use within 6 h and after 6 h, or within 12 h and after 12 h, in direct medical costs.
Conclusion: This study showed that there was no statistical difference in the efficacy and economy of antibiotic prophylaxis used within 6-12 h after rupture of membranes versus after 6-12 h in women with term PROM.
(© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)
References: Prelabor Rupture of Membranes: ACOG practice bulletin, number 217. Obstet Gynecol. 2020;135(3):e80-e97. doi:10.1097/AOG.0000000000003700.
Zhuang L, Li ZK, Zhu YF, et al. The correlation between prelabour rupture of the membranes and neonatal infectious diseases, and the evaluation of guideline implementation in China: a multi-Centre prospective cohort study. Lancet Reg Health West Pac. 2020;3:100029. doi:10.1016/j.lanwpc.2020.100029.
Bond DM, Middleton P, Levett KM, et al. Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome. Cochrane Database Syst Rev. 2017;3(3):CD004735. doi:10.1002/14651858.CD004735.
Hannah ME, Ohlsson A, Farine D, et al. Induction of labor compared with expectant management for prelabor rupture of the membranes at term. TERMPROM Study Group. N Engl J Med. 1996;334(16):1005-1010.
Tran SH, Cheng YW, Kaimal AJ, Caughey AB. Length of rupture of membranes in the setting of premature rupture of membranes at term and infectious maternal morbidity. Am J Obstet Gynecol. 2008;198(6):700.e1-700.e5. doi:10.1016/j.ajog.2008.03.031.
Herbst A, Källén K. Time between membrane rupture and delivery and septicemia in term neonates. Obstet Gynecol. 2007;110(3):612-618. doi:10.1097/01.AOG.0000277632.36186.84.
Saccone G, Berghella V. Antibiotic prophylaxis for term or near-term premature rupture of membranes: metaanalysis of randomized trials. Am J Obstet Gynecol. 2015;212(5):627.e1-627.e9. doi:10.1016/j.ajog.2014.12.034.
Queensland Clinical Guideline Supplement: Early onset Group B Streptococcal disease (EOGBSD). https://www.health.qld.gov.au/__data/assets/pdf_file/0027/626733/s-gbs.pdf.
Chinese Medical Association. Guidelines for diagnosis and management of premature rupture of membranes (2015). Chin J Obstet Gynecol Pediatr. 2015;50(1):3-8. doi:10.3760/cma.j.issn.0529-567x.2015.01.002.
Bellussi F, Livi A, Diglio J, Lenzi J, Magnani L, Pilu G. Timing of induction for term prelabor rupture of membranes and intravenous antibiotics. Am J Obstet Gynecol MFM. 2021;3(1):100245. doi:10.1016/j.ajogmf.2020.100245.
Barišić T, Mandić V, Tomić V, Zovko A, Novaković G. Antibiotic prophylaxis for premature rupture of membranes and perinatal outcome. J Matern Fetal Neonatal Med. 2017;30(5):580-584. doi:10.1080/14767058.2016.1178228.
Yin Z, Yan M. Application time and clinical effect of antibiotics for premature rupture of membranes at term. China Prac Med. 2022;17(14):121-123. doi:10.14163/j.cnki.11-5547/r.2022.14.039.
Wen C. Timing and clinical effect of antibiotics for premature rupture of membranes at term. Contemporary Med. 2020;26(2):129-130.
Liu X, Deng Y, Zhong Q. Application time and clinical effect of antibiotics for premature rupture of membranes at term. Strait Pharmaceutical J. 2018;30(8):184-185.
Mingyu Z, Lili C, Shuhua Y, et al. Influence of timing of prophylactic antibiotics for premature rupture of membranes on maternal and infant outcomes. J Third Military Med Univ. 2020;42(2):197-201. doi:10.16016/j.1000-5404.201908053.
Liu D, Wu L, Luo J, et al. Developing a core outcome set for the evaluation of antibiotic use in prelabor rupture of membranes: a systematic review and semi-structured interview. Front Pharmacol. 2022;13:915698. doi:10.3389/fphar.2022.915698.
Xie X, Kong B, Duan T. Obstetrics and Gynecology [M]. 9th ed. People's Medical Publishing House; 2018.
Chinese pharmaceutical association. China Guidelines for Pharmacoeconomic Evaluations. 2020. https://www.cpa.org.cn/cpadmn/attached/file/20201203/1606977380634185.pdf.
Chaim W, Bashiri A, Bar-David J, Shoham-Vardi I, Mazor M. Prevalence and clinical significance of postpartum endometritis and wound infection. Infect Dis Obstet Gynecol. 2000;8(2):77-82. doi:10.1https://002/(SICI)1098-0997(2000)8:2<77::AID-IDOG3>3.0.CO;2-6.
Soper DE, Mayhall CG, Dalton HP. Risk factors for intraamniotic infection: a prospective epidemiologic study. Am J Obstet Gynecol. 1989;161(3):562-566; discussion 566-8. doi:10.1016/0002-9378(89)90356-6.
Prevention of group B streptococcal early-onset disease in newborns: ACOG committee opinion, number 782. Obstet Gynecol. 2020;134(1):1.
Sénat MV, Schmitz T, Bouchghoul H, et al. Term prelabor rupture of membranes: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). J Matern Fetal Neonatal Med. 2022;35(16):3105-3109. doi:10.1080/14767058.2020.1810230.
Williamson PR, Altman DG, Blazeby JM, et al. Developing core outcome sets for clinical trials: issues to consider. Trials. 2012;13:132. doi:10.1186/1745-6215-13-132.
Zeng LN, Zhang LL, Shi J, et al. The primary microbial pathogens associated with premature rupture of the membranes in China: a systematic review. Taiwan J Obstet Gynecol. 2014;53(4):443-451. doi:10.1016/j.tjog.2014.02.003.
CHINET. Results of annual bacterial resistance surveillance in 2021. 2023. https://www.chinets.com.
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