Dupuis O, Audibert F, Vincent Y, Vial M, Frydman R, Fernandez H
Maternité Hôpital Antoine Béclère, 157, rue de la Porte de Trivaux, 92141 Clamart Cedex.
J Gynecol Obstet Biol Reprod (Paris). 2000 Oct;29(6):588-98.
This study attempts to answer the following question: is systematic amniocentesis an efficient tool for adjusting an antibiotic treatment in case of preterm premature rupture of membranes?
Retrospective study of 76 cases of preterm premature rupture of membranes that occurred between January 1994 and February 1997 in a French teaching hospital.
Amniocentesis was impossible for 28 patients (Group I). In this group there was a 46% rate of neonatal sepsis (n=13). Amniocentesis was successful in 48 patients. 24 delivered within 48 hours after amniocentesis (Group IIa). In this group there was a 29% rate of neonatal sepsis (n=7), and amniotic fluid culture was positive in 33% of the cases. 24 delivered beyond 48 hours after amniocentesis (Group IIb). In this group there was a 21% rate of neonatal sepsis (n=5) and amniotic fluid culture was positive in 12.5% of the cases. Group I and IIa had a high risk of neonatal sepsis and could not benefit from amniocentesis culture results.
Group IIa and IIb cannot be distinguished a priori, therefore systematic amniocentesis can only have a restricted impact on the management of antibiotic therapy. Even in the case of a negative amniotic fluid culture, antibiotic therapy is mandatory. If a systematic amniocentesis policy is used, one hundred amniocentesis have to be performed in order to adapt six antibiotic therapies. In the group with the highest risk of neonatal sepsis (severe oligohydramnios), amniocentesis cannot be performed. A policy of systematic amniocentesis restricted to the cases that are not delivered within the first 48 hours could be evaluated in a prospective randomized trial. Such a policy could help in deciding whether to stop, adapt, or continue the antibiotic therapy, or to induce the delivery in case of an asymptomatic chorioamniotitis.
本研究试图回答以下问题：对于胎膜早破病例，系统性羊膜腔穿刺术是否是调整抗生素治疗的有效工具？
对1994年1月至1997年2月间在一家法国教学医院发生的76例胎膜早破病例进行回顾性研究。
28例患者（第一组）无法进行羊膜腔穿刺术。该组新生儿败血症发生率为46%（n = 13）。48例患者羊膜腔穿刺术成功。24例在羊膜腔穿刺术后48小时内分娩（第二组a）。该组新生儿败血症发生率为29%（n = 7），33%的病例羊水培养呈阳性。24例在羊膜腔穿刺术后48小时后分娩（第二组b）。该组新生儿败血症发生率为21%（n = 5），12.5%的病例羊水培养呈阳性。第一组和第二组a有较高的新生儿败血症风险，无法从羊膜腔穿刺培养结果中获益。
第二组a和第二组b无法预先区分，因此系统性羊膜腔穿刺术对抗生素治疗管理的影响有限。即使羊水培养结果为阴性，抗生素治疗也是必要的。如果采用系统性羊膜腔穿刺术策略，为了调整六种抗生素治疗方案，必须进行100次羊膜腔穿刺术。在新生儿败血症风险最高的组（严重羊水过少）中，无法进行羊膜腔穿刺术。可以在前瞻性随机试验中评估将系统性羊膜腔穿刺术策略限制在最初48小时内未分娩的病例的方案。这样的方案有助于决定是否停止、调整或继续抗生素治疗，或者在无症状绒毛膜羊膜炎的情况下引产。
