DiSciullo Alison J, Hand Marissa, Iqbal Sara N, Chornock Rebecca L
Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC (Drs DiSciullo, Iqbal, and Chornock).
Georgetown University School of Medicine, Washington, DC (Dr Hand).
AJOG Glob Rep. 2023 Apr 5;3(2):100206. doi: 10.1016/j.xagr.2023.100206. eCollection 2023 May.
Preterm premature rupture of membranes accounts for approximately one-quarter of all preterm deliveries and occurs in 2% to 3% of all pregnancies. With subclinical infection being a suspected cause of preterm premature rupture of membranes, the administration of prophylactic antibiotics is an accepted standard of care to extend the latency period. Historically, erythromycin was used in the antibiotic regimen recommended for women with preterm premature rupture of membranes during expectant management; however, azithromycin has recently been shown to be a suitable alternative.
This study aimed to evaluate whether extended azithromycin administration affects the latency time in preterm premature rupture of membranes.
This was a retrospective multi-institutional cohort study in Washington, District of Columbia, of patients admitted from January 2012 to December 2019 with preterm premature rupture of membranes of singleton pregnancies between 23 0/7 and 33 6/7 weeks of gestation. Patients were excluded if they had multiple pregnancies, had an allergy to penicillin or macrolides, were in labor, had suspected placental abruptions, had overt chorioamnionitis, or had nonreassuring fetal status on presentation indicating the need for prompt delivery. Patients that received limited azithromycin administration (<2 days) and patients that received extended azithromycin administration (7 days) were compared. All patients otherwise received the institutional standard of 2 days of intravenous ampicillin followed by 5 days of oral amoxicillin. The primary outcome was length of gestational latency, defined as the time from membrane rupture to delivery. The selective secondary outcomes that were evaluated were rates of chorioamnionitis and adverse neonatal outcomes, including sepsis, respiratory distress, necrotizing enterocolitis, intraventricular hemorrhage, and neonatal death.
During the study period, 416 cases of preterm premature rupture of membranes were identified. Of the 287 patients who met the inclusion criteria, 165 (57.5%) received limited azithromycin administration, and 122 (42.5%) received extended azithromycin administration. Adjusted median gestational latency was significantly longer for patients who received extended azithromycin administration, extended by >3 days (2.6 days [interquartile range, 2.2-3.1] for limited azithromycin administration vs 5.8 days [interquartile range, 4.8-6.9] for extended azithromycin administration; <.001). Neonatal secondary outcome evaluation was performed on 216 cases (76%). There was no difference in chorioamnionitis or adverse neonatal outcomes between the 2 groups.
Among patients with preterm premature rupture of membranes, extended azithromycin administration was associated with increased latency, without any effect on other maternal or neonatal outcomes.
胎膜早破约占所有早产的四分之一，在所有妊娠中发生率为2%至3%。由于亚临床感染被怀疑是胎膜早破的原因，预防性使用抗生素是延长潜伏期的公认标准治疗方法。历史上，红霉素曾被用于期待治疗期间胎膜早破女性的抗生素治疗方案中；然而，最近阿奇霉素已被证明是一种合适的替代药物。
本研究旨在评估延长阿奇霉素给药时间是否会影响胎膜早破的潜伏期。
这是一项在华盛顿特区进行的回顾性多机构队列研究，研究对象为2012年1月至2019年12月因单胎妊娠23⁰/₇至33⁶/₇周胎膜早破入院的患者。如果患者为多胎妊娠、对青霉素或大环内酯类过敏、正在分娩、怀疑胎盘早剥、有明显绒毛膜羊膜炎或入院时胎儿状况不佳表明需要立即分娩，则将其排除。比较接受有限阿奇霉素给药（<2天）的患者和接受延长阿奇霉素给药（7天）的患者。所有其他患者均接受机构标准治疗，即静脉注射氨苄西林2天，然后口服阿莫西林5天。主要结局为妊娠潜伏期，定义为从胎膜破裂到分娩的时间。评估的选择性次要结局为绒毛膜羊膜炎发生率和不良新生儿结局，包括败血症、呼吸窘迫、坏死性小肠结肠炎、脑室内出血和新生儿死亡。
在研究期间，共识别出416例胎膜早破病例。在符合纳入标准 的287例患者中，165例（57.5%）接受了有限阿奇霉素给药，122例（42.5%）接受了延长阿奇霉素给药。接受延长阿奇霉素给药的患者调整后的中位妊娠潜伏期明显更长，延长超过3天（有限阿奇霉素给药组为2.6天[四分位间距，2.2 - 3.1]，延长阿奇霉素给药组为5.8天[四分位间距，4.8 - 6.9]；P <.001）。对216例病例（76%）进行了新生儿次要结局评估。两组之间的绒毛膜羊膜炎或不良新生儿结局没有差异。
在胎膜早破患者中，延长阿奇霉素给药时间与潜伏期延长相关，对其他母体或新生儿结局无任何影响。
