Mercer B M, Arheart K L
Department of Obstetrics and Gynecology, University of Tennessee, Memphis, USA.
Lancet. 1995 Nov 11;346(8985):1271-9. doi: 10.1016/s0140-6736(95)91868-x.
We review the impact of antimicrobial treatment on maternal and fetal outcome during expectant management of preterm premature rupture of the membranes. Relevant studies were retrieved from Medline (1966 to August, 1994) with the search term fetal-membrane-premature-rupture and antibiotics or antimicrobial, Excerpta Medica (1972 to August, 1994) with the search term premature fetus, membrane rupture, and antibiotic or antimicrobial therapy, and the Cochrane database of systemic reviews with the criterion antibiotics and prelabour rupture of membranes. We also obtained unpublished data from a randomised clinical trial of ceftizoxime versus placebo. The selected studies were randomised controlled trials of systemic antimicrobial therapy for prolongation of gestation in non-labouring women after preterm premature rupture of the membranes. Data extraction was done by a single reviewer. Studies were evaluated for post-randomisation exclusion and other confounding variables that might introduce analytical bias. Analysis was done with SAS statistical software by a blinded investigator. Antimicrobial therapy after preterm premature rupture of the membranes is associated with a reduced number of women delivering within 1 week (62 vs 76%; OR 0.51, 95% CI 0.41-0.68), and reduced diagnosis of maternal morbidity including chorioamnionitis (12 vs 23%; 0.45, 0.33-0.60) and postpartum infection (8 vs 12%; 0.63, 0.41-0.97). Fetal morbidity, including confirmed sepsis (5 vs 9%; 0.57, 0.36-0.88), pneumonia (1 vs 3%; 0.32, 0.11-0.96), and intraventricular haemorrhage (9 vs 14%; 0.65, 0.45-0.92) were less often diagnosed after antimicrobial therapy. Separate analysis of the six placebo-controlled trials revealed similar or improved odds of pregnancy prolongation, chorioamnionitis, neonatal sepsis, postpartum infection, positive infant blood cultures, and pneumonia. Antimicrobial therapy, when used in the expectant management of preterm premature rupture of the membranes is associated with prolongation of pregnancy and a reduction in the diagnosis of maternal and infant morbidity. Further study should be directed towards determination of optimal antimicrobial therapy, increasing pregnancy prolongation, and enhancement of corticosteroid therapy for induction of pulmonary maturity after preterm premature rupture of the membranes.
我们回顾了在胎膜早破期待治疗期间抗菌治疗对母婴结局的影响。通过检索医学文献数据库（1966年至1994年8月），使用检索词“胎膜-早产-破裂”和“抗生素”或“抗菌药物”；检索医学文摘数据库（1972年至1994年8月），使用检索词“早产胎儿”“胎膜破裂”和“抗生素或抗菌药物治疗”；以及检索Cochrane系统评价数据库，使用标准“抗生素”和“胎膜早破”，获取相关研究。我们还从头孢唑肟与安慰剂的随机临床试验中获得了未发表的数据。所选研究为系统性抗菌治疗在胎膜早破后未临产妇女中延长孕周的随机对照试验。数据提取由一名审阅者完成。对研究进行了随机化后排除及其他可能引入分析偏倚的混杂变量的评估。由一名盲态研究者使用SAS统计软件进行分析。胎膜早破后进行抗菌治疗与1周内分娩女性数量减少相关（62%对76%；比值比0.51，95%可信区间0.41 - 0.68），且产妇发病率诊断减少，包括绒毛膜羊膜炎（12%对23%；0.45，0.33 - 0.60）和产后感染（8%对12%；0.63，0.41 - 0.97）。抗菌治疗后胎儿发病率，包括确诊败血症（5%对9%；0.57，0.36 - 0.88）、肺炎（1%对3%；0.32，0.11 - 0.96）和脑室内出血（9%对14%；0.65，0.45 - 0.92）的诊断较少。对六项安慰剂对照试验的单独分析显示，在延长妊娠、绒毛膜羊膜炎、新生儿败血症、产后感染、婴儿血培养阳性和肺炎方面，有相似或改善的优势比。在胎膜早破的期待治疗中使用抗菌治疗与延长妊娠以及减少母婴发病率的诊断相关。进一步的研究应致力于确定最佳抗菌治疗方案、增加妊娠延长时间以及加强胎膜早破后促进肺成熟的皮质类固醇治疗。
