Kenyon Sara, Boulvain Michel, Neilson Jim
Department of Obstetrics and Gynaecology, University of Leicester, United Kingdom.
Obstet Gynecol. 2004 Nov;104(5 Pt 1):1051-7. doi: 10.1097/01.AOG.0000143268.36682.21.
We sought to evaluate the administration of antibiotics to pregnant women with preterm rupture of membranes (PROM).
We collected data by using the Cochrane Controlled Trials Register and MEDLINE.
We included randomized controlled comparisons of antibiotic versus placebo (14 trials, 6,559 women).
TABULATION, INTEGRATION, AND RESULTS: Antibiotics were associated with a statistically significant reduction in maternal infection and chorioamnionitis. There also was a reduction in the number of infants born within 48 hours and 7 days and with the following morbidities: neonatal infection (relative risk [RR] 0.67, 95% confidence interval [CI] 0.52-0.85), positive blood culture (RR 0.75, 95% CI 0.60-0.93), use of surfactant (RR 0.83 95% CI 0.72-0.96), oxygen therapy (RR 0.88, 95% CI 0.81-0.96), and abnormal cerebral ultrasound scan before discharge from hospital (RR 0.82, 95% CI 0.68-0.99). Perinatal mortality was not significantly reduced (RR 0.91, 95% CI 0.75-1.11). A benefit was present both in trials where penicillins and erythromycin were used. Amoxicillin/clavulanate was associated with a highly significant increase in the risk of necrotizing enterocolitis (RR 4.60, 95% CI 1.98-10.72).
The administration of antibiotics after PROM is associated with a delay in delivery and a reduction in maternal and neonatal morbidity. These data support the routine use of antibiotics for women with PROM. Penicillins and erythromycin were associated with similar benefits, but erythromycin was used in larger trials and, thus, the results are more robust. Amoxicillin/clavulanate should be avoided in women at risk of preterm delivery because of the increased risk of neonatal necrotizing enterocolitis. Antibiotic administration after PROM is beneficial for both women and neonates.
我们旨在评估对胎膜早破（PROM）孕妇使用抗生素的情况。
我们通过使用Cochrane对照试验注册库和MEDLINE收集数据。
我们纳入了抗生素与安慰剂的随机对照比较（14项试验，6559名女性）。
制表、整合与结果：抗生素与产妇感染和绒毛膜羊膜炎的统计学显著降低相关。48小时内和7天内出生的婴儿数量以及以下疾病的发生率也有所降低：新生儿感染（相对危险度[RR]0.67，95%置信区间[CI]0.52 - 0.85）、血培养阳性（RR 0.75，95%CI 0.60 - 0.93）、使用表面活性剂（RR 0.83，95%CI 0.72 - 0.96）、氧疗（RR 0.88，95%CI 0.81 - 0.96）以及出院前脑超声扫描异常（RR 0.82，95%CI 0.68 - 0.99）。围产期死亡率未显著降低（RR 0.91，95%CI 0.75 - 1.11）。在使用青霉素和红霉素的试验中均有获益。阿莫西林/克拉维酸与坏死性小肠结肠炎风险的高度显著增加相关（RR 4.60，95%CI 1.98 - 10.72）。
胎膜早破后使用抗生素与分娩延迟以及产妇和新生儿发病率降低相关。这些数据支持对胎膜早破女性常规使用抗生素。青霉素和红霉素具有相似的益处，但红霉素用于了更大规模的试验，因此结果更可靠。对于有早产风险的女性应避免使用阿莫西林/克拉维酸，因为其会增加新生儿坏死性小肠结肠炎的风险。胎膜早破后使用抗生素对女性和新生儿均有益。
