Antibiotic regimens for management of intraamniotic infection

Antibiotics are used to prevent life-threatening complications for mother and baby when the amniotic fluid is infected, but it is not known which antibiotic is best.

Amniotic fluid is the 'water' surrounding the baby inside the womb. If this fluid becomes infected, it can be life-threatening for the mother and baby, and the baby should be born within 12 hours. Infection can come from bacteria entering the womb from the vagina, or from a medical procedure that penetrates the membranes ('bag' around baby and waters). Antibiotics reduce the risk of dangerous complications for both mother and baby. The review found there is not enough evidence from trials to show which antibiotic is best or whether it should be given before or after the baby is born.

Authors' conclusions: 

The conclusions that can be drawn from this meta-analysis are limited due to the small number of studies. For none of the outcomes was a statistically significant difference seen between the different interventions. Current consensus is for the intrapartum administration of antibiotics when the diagnosis of intraamniotic infection is made; however, the results of this review neither support nor refute this although there was a trend towards improved neonatal outcomes when antibiotics were administered intrapartum. No recommendations can be made on the most appropriate antimicrobial regimen to choose to treat intraamniotic infection.

[Note: The six citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

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Background: 

Intraamniotic infection is associated with maternal morbidity and neonatal sepsis, pneumonia and death. Although antibiotic treatment is accepted as the standard of care, few studies have been conducted to examine the effectiveness of different antibiotic regimens for this infection and whether to administer antibiotics intrapartum or postpartum.

Objectives: 

To study the effects of different maternal antibiotic regimens for intraamniotic infection on maternal and perinatal morbidity and mortality.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2002) and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2002). We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 30 April 2010 and added the results to the awaiting classification section of the review.

Selection criteria: 

Trials where there was a randomized comparison of different antibiotic regimens to treat women with a diagnosis of intraamniotic infection were included. The primary outcome was perinatal morbidity.

Data collection and analysis: 

Data were extracted from each publication independently by the authors.

Main results: 

Two eligible trials (181 women) were included in this review. No trials were identified that compared antibiotic treatment with no treatment. Intrapartum treatment with antibiotics for intraamniotic infection was associated with a reduction in neonatal sepsis (relative risk (RR) 0.08; 95% confidence interval (CI) 0.00, 1.44) and pneumonia (RR 0.15; CI 0.01, 2.92) compared with treatment given immediately postpartum, but these results did not reach statistical significance (number of women studied = 45). There was no difference in the incidence of maternal bacteremia (RR 2.19; CI 0.25, 19.48). There was no difference in the outcomes of neonatal sepsis (RR 2.16; CI 0.20, 23.21) or neonatal death (RR 0.72; CI 0.12, 4.16) between a regimen with and without anaerobic activity (number of women studied = 133). There was a trend towards a decrease in the incidence of post-partum endometritis in women who received treatment with ampicillin, gentamicin and clindamycin compared with ampicillin and gentamicin alone, but this did not reach statistical significance (RR 0.54; CI 0.19, 1.49).

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