Sperling R S, Ramamurthy R S, Gibbs R S
Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio.
Obstet Gynecol. 1987 Dec;70(6):861-5.
There are no reported randomized trials to determine the ideal timing of antibiotic treatment for intra-amniotic infection. We evaluated the effect of intrapartum versus immediate postpartum treatment of intra-amniotic infection on maternal and neonatal morbidity and mortality. Two hundred fifty-seven women with clinically diagnosed intra-amniotic infection who had amniotic fluid cultures were evaluated. Patients received treatment with penicillin and gentamicin, but the timing of the treatment was determined at the physician's discretion. Most patients (82%) received intrapartum treatment; the remaining women (18%), mainly those with an anticipated short interval before delivery, received the same antibiotics immediately postpartum. As expected, the postpartum treatment group had a significantly shorter diagnosis-to-delivery interval (1.9 +/- 2.1 versus 4.7 +/- 4.3 hours; P less than .001) and a lower maximum temperature during labor (100.8 +/- 0.7 versus 101.0 +/- 0.8F; P = .038). The two treatment groups did not differ in distribution of low birth weight infants, frequency of maternal bacteremia, mode of delivery, or organisms isolated from the amniotic fluid. There were no differences in maternal outcome, but the incidence of neonatal sepsis was significantly lower in the intrapartum treatment group (2.8 versus 19.6%; P less than .001). Neonatal mortality from sepsis was also lower in the intrapartum treatment group (0.9 versus 4.3%), but this difference was not statistically significant. The reduced frequency of neonatal septicemia observed in the intrapartum-treated group might reflect early intrauterine therapy for the infected fetus.
尚无已报道的随机试验来确定羊膜腔内感染抗生素治疗的理想时机。我们评估了产时与产后立即治疗羊膜腔内感染对孕产妇和新生儿发病率及死亡率的影响。对257例临床诊断为羊膜腔内感染且进行了羊水培养的女性进行了评估。患者接受青霉素和庆大霉素治疗，但治疗时机由医生自行决定。大多数患者（82%）接受产时治疗；其余女性（18%），主要是那些预计分娩间隔较短的女性，在产后立即接受相同的抗生素治疗。正如预期的那样，产后治疗组的诊断至分娩间隔明显更短（1.9±2.1小时对4.7±4.3小时；P<0.001），且产时最高体温更低（100.8±0.7华氏度对101.0±0.8华氏度；P = 0.038）。两个治疗组在低出生体重儿分布、孕产妇菌血症发生率、分娩方式或从羊水中分离出的微生物方面没有差异。孕产妇结局没有差异，但产时治疗组新生儿败血症的发生率显著更低（2.8%对19.6%；P<0.001）。产时治疗组败血症导致的新生儿死亡率也更低（0.9%对4.3%），但这一差异无统计学意义。产时治疗组观察到的新生儿败血症发生率降低可能反映了对感染胎儿的早期宫内治疗。
