The Role of Antibiotic Prophylaxis in Preterm Premature Rupture of Membranes
Preterm premature rupture of membranes (PPROM) occurs in 3 percent of all pregnancies and is responsible for, or associated with, approximately one-third of preterm births causing significant perinatal morbidity and fetal death. Preterm infants are very vulnerable to respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), periventricular leucomalacia (PVL), other neurological sequelae, infection and necrotizing enterocolitis (NEC). Chorioamnionitis based on clinical criteria occurs in approximately 3-30% of all PPROM pregnancies. The aim of this study was to analyze the role of antibiotic prophylaxis in delivery delay on neonatal outcome (body weight, Apgar scores, pulmonary complications, neurological complications - abnormal cerebral ultrasound scan prior to hospital discharge, perinatal infections) and to determine the possibility of an optimal antibiotic regimen. Therefore we retrospectively alysed last 5 years of data from patients treated in our center and provided a coherent overview of the clinical course and outcome of patients with PPROM treated with prophylactic antibiotics and antenatal corticosteroids. There were 324 preterm newborns which fulfilled the inclusion criteria for our study; 190 in Study group (received empiric i.v. antibiotics) and 134 in Control group (without antibiotic). We found significant difference in gestational age (p<0.0001), birth weight (p<0.0001), Apgar scores (p<0.0001) maternal C-reactive protein level (p<0.0001) and latency period (5.54days vs.11.33days, p=0.001) between the groups. Histologic chorioamnionitis was significantly more frequent in s Study group (14.2% vs. 36.3%, p<0.0001). We found significant difference in neonatal outcome according the different antibiotic treatment. Antenatal antibiotics and corticosteroid therapies have clear benefits and should be offered to all women without contraindications.