Antibiotic use before amniotomy (artificially rupturing the membranes) for reducing infections in mother and infant

The artificial rupture of the membranes (amniotomy) is a common obstetrical procedure. It may be done to either initiate or to augment labour, with or without oxytocin. This invasive procedure allows vaginal micro-organisms access into the uterine cavity, which can in turn lead to infections in both the mother and the infant. A greater time interval between rupture of membranes and delivery, as with induction of labour, increases the chances of an infection.

The purpose of this review was to evaluate the routine use of antibiotics immediately prior to amniotomy for both initiation and augmentation of labour using randomised controlled trials. However, our search only identified one trial which did not meet the inclusion criteria for this review.

Consequently, there is no evidence to support or refute the routine use of antibiotics prior to amniotomy. Randomised controlled trials on this topic are needed, especially in resource-constrained settings where amniotomy is still used as a means of inducing labour, to evaluate the routine use of antibiotics at amniotomy in such settings. Future research in this area should also consider cost effectiveness and side effects of antibiotic use including the emergence of antibiotic-resistant strains.

Authors' conclusions: 

High-quality trials are needed to justify or refute the routine use of antibiotics at amniotomy for prevention of infection in the mother and infant.

Future studies should be conducted, especially in resource-constrained settings where amniotomy is still used as a means of induction of labour, in order to evaluate the routine use of antibiotics at amniotomy in these settings. Future research in this area should include important maternal and infant outcomes listed in this review and also consider cost effectiveness and side effects of antibiotic use, including the emergence of antibiotic-resistant strains.

Read the full abstract...
Background: 

Amniotomy (the deliberate rupture of membranes) was described almost two centuries ago and since then has been used both for induction and augmentation of labour - which are common obstetric practices. Trends have shown a rise in the induction rates over the last decade and data suggest that the rate of labour inductions is increasing faster than the rate of pregnancy complications. Recent years have seen the emergence of a variety of other methods of induction of labour but amniotomy combined with oxytocin infusion remains the most commonly used method of augmentation of labour. The newer agents for induction are expensive and in resource-poor settings amniotomy is still the chosen method for both induction and augmentation.

As with any invasive procedure amniotomy can lead to infection, ascending from the vagina into the uterine cavity and can contribute significantly to both maternal and neonatal infectious morbidity.

Objectives: 

The objective of this review was to evaluate the prophylactic use of antibiotics versus placebo or no treatment prior to amniotomy on maternal and neonatal infectious morbidity and mortality.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2014), the International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov (12 September 2014).

Selection criteria: 

Randomised controlled trials or cluster-randomised trials comparing antibiotics prior to amniotomy versus placebo (or no treatment) were eligible for inclusion in this review but none were identified. Quasi-randomised trials or cross-over trials were not eligible for inclusion.

Data collection and analysis: 

Two review authors independently assessed one trial report for inclusion. In future updates of this review, two review authors will independently assess risk of bias and carry out data extraction. Data will be checked for accuracy.

Main results: 

We identified one trial report but this was excluded. No studies met the inclusion criteria for this review.

Share/Save