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Use of intrapartum prophylactic antibiotics

Bibliographic reference Study type Evidence level Number of patients Patient characteristics Intervention Comparison Length of follow-up Outcome measures Effect size Source of funding Additional comments
Flenady V;King J;

2002450
Systematic review - meta-analysisEvidence level: 1+2 trials
N=733 and N=105
Women in labour at term with pre-labour rupture of membranes.Intervention: 2 RCTs of antibiotic prophylaxisComparison: Placebo or no treatmentFollow-up period: Not clear - but includes length of PN stay for mother and babyOutcome Measures:
Maternal infection (chorioamnionitis and endometritis)
Maternal length of hospital stay
Matrnal adverse drug reaction

Apgar score at 5 min.
Neonatal early onset infection
Neonatal positive blood culture
Length of neonatal stay
Pneumonia
Meningitis
Neonatal mechanical ventilation
Perinatal mortality
Use of antibiotics resulted in a signif. reduction in:
endometritis (RR 0.09, CI 0.01 to 0.73); maternal infectious morbidity 3% vs. 7% (RR 0.43, CI 0.23 to 0.82. NNT 25, CI 14 to 100); and a reduction in the neonatal length of hospital stay (reported by 1 trial) (MD −0.90, CI −1.34 to −0.46).
Not statedCare needed in applying these findings to our population of women in spontaneous labour after term prelabour RoM. Would seem to apply to those women who go into labour withinn 24 hours (which is a large proportion)
Dare MR;Middleton P;Crowther CA;Flenady V;Varatharaju B;

2006442
RCTEvidence level: 1+12 trials involving 6814 women.Women at term with pre-labour rupture of membranes (PRoM)Intervention: Planned early birth (before 24 hours of PRoM) by induction of labour or caesarean section.Comparison: Expectant management for at least 24 hours.Follow-up period: Few days postantally (results from neonatal infection screen)Outcome Measures:
Women’s outcomes:
Maternal mortality
Caesarean section
Chorioamnionitis
Endometritis
Postpartum fever
Operative vaginal birth
Maternal satisfaction
Views of care

Neonatal outcomes:
Mortality
Neontal infection/sepsis
Time from RoM to birth
Apgar scores
Use of mecahical ventilation
Planned vs. expectant

Maternal mortality (1 trial): 0/61 vs. 0/62.
CS (12 trials): 333/3401 vs. 360/3413; RR 0.94 (95% CI 0.82 to 1.08).
Chorioamnionitis (9 trials): 226/3300 vs. 327/3311; RR 0.74 (95% CI 0.56 to 0.97).
Endometritis (4 trials): 5/217 vs. 19/228; RR 0.30 (95% CI 0.12 to 0.74).
Postpartum fever (5 trials): 82/2747 vs. 117/2774; (95% CI 0.69 to 1.17).
Operative vaginal birth (7 trials): 487/2786 vs. 502/2825; RR 0.98 (0.84 to 1.16).
Maternal satisfaction - “nothing liked” (1 trial): 138/2517 vs. 320/2524; RR 0.43 (95% CI 0.36 to 0.52).
Maternal satisfaction - “nothing disliked” (1 trial): 821/2517 vs. 688/2524; RR 1.20 (95% CI 1.10 to 1.30).

Fetal/perinatal mortality (6 trials): 3/2946 vs. 7/2924; RR 0.46 (95% CI 0.13 to 1.66).
Time from RoM to birth (5 trials): WMD -9.53 hours (95% CI −12.96 to −6.10).
Apgar score <7 at 5 mins. (7 trials): 335/3000 vs. 366/3005 (95% CI 0.81 to 1.07).
Mechanical ventilation (3 trials): 25/2566 vs. 28/2592 (95% CI 0.46 to 2.12).
Neonatal infection (10 trials): 74/3210 vs. 93/3196 (95% CI 0.61 to 1.12).
NICU or SCBU admission (6 trials): 356/2825 vs. 484/2854; RR 0.73 (95% CI 0.58 to 0.91).

Sub-group analyses:
Parity - no significant differences found between nulliparous and multiparous women.

Digital vaginal examinations vs. no digital vaginal examinations -
Chorioamnionitis (4 trials vs. 2 trials): RR 1.00 (95% CI 0.43 to 2.33) vs. RR 0.97 (95% CI 0.69 to 1.35).
Neonatal infection (3 trials vs. 2 trials): RR 0.43 (95% CI 0.12 to 1.52) vs. 0.44 (95% CI 0.05 to 3.60).

Maternal antibiotic propylaxis (All women vs. some women):
Chorioamnionitis (1 trial vs. 4 trials): RR 1.02 (95% CI 0.62 to 1.69) vs. RR 0.62 (0.51 to 0.76).
Endometritis (2 trials vs. 2 trials): RR 0.26 (95% CI 0.09 to 0.74) vs. RR 0.44 (95% CI 0.07 to 2.93).
Postpartum fever (1 trials vs. 2 trials): RR 0.42 (95% CI 0.12 to 1.49) vs. RR 0.75 (95% CI 0.55 to 1.02).
Neonatal infection: 1 trial vs. 5 trials): 0.10 (95% CI 0.01 to 1.81) vs. 0.86 (95% CI 0.62 to 1.19).
NHS programme for Research and Development, UK
Dept. of Obstetrics and Gynaecology, The University of Adelaide, Australia.
The 12 included trials all involve women of at least 37 weeks completed pregnancy. 6 trials included induction of labour by oxytocin; 4 trials included induction of labour by prostaglandins, 1 trials included a comparison of induction of labour by oxytocin and prostaglandin; 1 trial involved induction of labour by Caulophyllum.

From: Evidence tables

Cover of Intrapartum Care
Intrapartum Care: Care of Healthy Women and Their Babies During Childbirth.
NICE Clinical Guidelines, No. 55.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2007 Sep.
Copyright © 2007, National Collaborating Centre for Women’s and Children’s Health.

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