Antibiotics delay delivery and reduce pregnancy complications during pPROM

In women with preterm premature rupture of membranes, antibiotics may prolong pregnancy and reduce neonatal morbidity. But antibiotic use in women with preterm labor who have intact membranes does not appear to have the same benefits, according to the results of a study published in the December issue of the American Journal of Obstetrics & Gynecology.

Carolyn E. Hutzal, MD, of McMaster University in Hamilton, Ontario, Canada, and colleagues conducted a meta-analysis of 21 studies in which women with either preterm premature rupture of membranes or preterm labor at 34 weeks or less of gestation were randomly assigned to receive either antibiotics or placebo.

The researchers found that antibiotics delayed delivery, and reduced chorioamnionitis, neonatal infection and intraventricular hemorrhage in women with preterm premature rupture of membranes. But they found that the only benefit of antibiotics for women with preterm labor was a reduction in clinically diagnosed infection, leading them to conclude that there isn't enough evidence to recommend administration of antibiotics to this group.

"All studies defined preterm labor as some clinical variation of contractions with cervical dilatation, or requiring tocolytics," the authors write. "Perhaps more refined testing for preterm labor, such as fetal fibronectin, might improve outcomes of antibiotic use by more appropriate patient selection."

Hutzal CE, Boyle EM, Kenyon SL et al. Use of antibiotics for the treatment of preterm parturition and prevention of neonatal morbidity: a metaanalysis. Am J Obstet Gynecol. 2008;199:620.e1-620.e8.