J Korean Med Sci.  2005 Feb;20(1):88-92. 10.3346/jkms.2005.20.1.88.

Effect of Antenatal Corticosteroid and Antibiotics in Pregnancies Complicated by Premature Rupture of Membranes between 24 and 28 weeks of Gestation

• Song GA
• Han MS

• KMID: 1781732
• DOI: http://doi.org/10.3346/jkms.2005.20.1.88

Abstract

The aim of this study was to assess the effectiveness of active intervention with antenatal maternal corticosteroid and antibiotics therapy in infants delivered between 24 and 28 weeks of gestation after premature rupture of membrane. This retrospective study included pregnant women complicated by preterm delivery at the Dong-A University Hospital from 1998 to 2002. Patients were divided into labor induction group 1 (n=20), observation group 2 (n=19), and medication group 3 (n=20). We evaluated the effects of prolongation of pregnancy and intervention with maternal corticosteroids and antibiotics therapy on perinatal and neonatal outcomes. Each group did not have a significant difference (p<0.05) in neonatal outcomes, such as respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, pneumonia, bronchopulmonary dysplasia, and sepsis. The mean latency period was 4.7 days and 7.6 days in groups 2 and 3, respectively. Therefore, this study was unable to demonstrate any beneficial effects of corticosteroids in improving neonatal outcomes and prolongation of the latency period with antibiotics.

Keyword

Fetal Membranes, Premature Rupture; Preterm Birth; Anti-Bacterial Agents; Glucocorticoids; Perinatal Morbidity; Pregnancy Outcome

MeSH Terms

Adrenal Cortex Hormones/*pharmacology
Adult
Anti-Bacterial Agents/*pharmacology
Apgar Score
Female
Fetal Membranes, Premature Rupture/*drug therapy
Gestational Age
Humans
Infant, Newborn
Maternal Age
Pregnancy
Pregnancy Outcome
Pregnancy Trimester, Second
Premature Birth/prevention & control
Respiratory Distress Syndrome, Newborn/prevention & control
Retrospective Studies
Time Factors

Reference

1. Parry A, Strauss JF III. Premature rupture of the fetal membranes. N Engl J Med. 1998. 338:663–670.

2. Arias F, Tomich P. Etiology and outcome of low birth weight and preterm infants. Obstet Gynecol. 1982. 60:277–281.

3. Cox SM, Williams ML, Leveno KJ. The natural history of preterm ruptured membranes: What to expect of expectant management. Obstet Gynecol. 1988. 71:558–562.

4. Mercer BM, Miodovnik M, Thurnau GR, Goldenberg RL, Das AF, Ramsey RD, Rabello YA, Meis PJ, Moawad AH, Iams JD, Van Dorsten JP, Paul RH, Bottoms SF, Merenstein G, Thom EA, Roberts JM, McNellis D. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes: randomized controlled trial. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. JAMA. 1997. 278:989–995.

5. Morales WJ, Talley T. Premature rupture of membranes at <25 weeks: A management dilemma. Am J Obstet Gynecol. 1993. 168:503–507.

6. Farooqi A, Holmgren PA, Engberg S, Serenius F. Survival and 2-year outcome with expectant management of second-trimester rupture of membranes. Obstet Gynecol. 1998. 92:895–901.

7. Garite TJ, Rumney PJ, Briggs GG, Harding JA, Nageotte MP, Towers CV, Freeman RK. A randomized, placebo-controlled trial of betamethasone for the prevention of respiratory distress syndrome at 24 to 28 weeks' gestation. Am J Obstet Gynecol. 1992. 166:646–651.

8. Leitich H, Egarter C, Reisenberger K, Kaider A, Berghammer P. Concomitant use of glucocorticoids: a comparison of two metaanalysis on antibiotic treatment in preterm premature rupture of membranes. Am J Obstet Gynecol. 1998. 178:899–908.

9. Collaborative Group on Antenatal Steroid Therapy. Effects of antenatal dexamethasone administration on the prevention of respiratory distress syndrome. Am J Obstet Gynecol. 1981. 141:276–287.

10. Liggins GC. Premature delivery of fetal lambs infused with glucocorticoids. J Endocrinol. 1969. 45:515–523.

11. Linggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome RDS in premature infants. Pediatrics. 1972. 50:515–525.

12. Papageorgiou AN, Desgranges MF, Masson M, Colle E, Shatz R, Gelfand MM. The antenatal use of betamethasone in the prevention of respiratory distress syndrome. A controlled double-blind study. Pediatrics. 1979. 63:73–79.

13. Taeusch HW, Frigoletto F, Kitzmiller J, Avery ME, Hehre A, Fromm B, Lawson E, Neff RK. Risk of respiratory distress syndrome after prenatal dexamethasone treatment. Pediatrics. 1979. 63:64–72.

14. Crowley P, Chalmers I, Keirse MJ. The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials. Br J Obstet Gynaecol. 1990. 97:11–25.

15. Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consens Statement. 1994. 12:1–24.

16. Egarter C, Leitich H, Karas H, Weiser F, Husslein P, Kaider A, Schemper M. Antibiotic treatment in preterm premature rupture of membranes and neonatal morbidity: a metaanalysis. Am J Obstet Gynecol. 1996. 174:589–597.

17. Ernest JM, Givner LB. A prospective, randomized placebo-controlled trial of penicillin in preterm premature rupture of membranes. Am J Obstet Gynecol. 1994. 170:516–521.

18. Whang JD, Roh CR, Yang SH, Lee JS, Kim WY, Yoo JD. Perinatal outcome with active expectant management of second-trimester rupture of membranes. Korean J Obstet Gynecol. 2001. 44:348–354.

19. Kenyon SL, Taylor DJ, Tarnow-Mordi W, Group OC. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. ORACLE Collaborative Group. Lancet. 2001. 357:979–988.

20. Lockwood CJ, Costigan K, Ghidini A, Wein R, Chien D, Brown BL, Alvarez M, Cetrulo CL. Double-blind; placebo-controlled trial of piperacillin prophylaxis in preterm membrane rupture. Am J Obstet Gynecol. 1993. 169:970–976.

21. Lovett SM, Weiss JD, Diogo MJ, Williams PT, Garite TJ. A prospective, double-blind, randomized, controlled clinical trial of ampicillinsulbactam for preterm premature rupture of membranes in women receiving antenatal corticosteroid therapy. Am J Obstet Gynecol. 1997. 176:1030–1038.

22. Lee IS, Shin SM, Kang JA, Won HS, Lee PR, Kim A, Nam JH. The effect of antenatal conricosteroid on perinatal outcomes of preterm births. Korean J Obstet Gynecol. 2000. 43:863–870.

23. Mercer BM, Moretti ML, Prevost RR, Sibai BM. Erythromycin therapy in preterm premature rupture of the membranes: a prospective, randomized trial of 220 patients. Am J Obstet Gynecol. 1992. 166:794–802.

24. Mercer BM, Arheart KL. Antimicrobial therapy in expectant management of preterm premature rupture of the membranes. Lancet. 1995. 346:1271–1279.

25. Owen J, Groome LJ, Hauth JC. Randomized trial of prophylactic antibiotic therapy after preterm amnion rupture. Am J Obstet Gynecol. 1993. 169:976–981.

26. Goo BS, Chung JY, Kim JS, Kim SR, Lee SS, Won HS, Suh DS, Lee PR, Kim A. Benefits of antenatal corticosteroid in infants delivered before 33 weeks of gestation after premature rupture of membranes. Korean J Obstet Gynecol. 2004. 47:166–171.

27. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weight less than 1500gm. J Pediatr. 1978. 92:529–534.

28. Spinillo A, Capuzzo E, Ometto A, Stronati M, Baltaro F, Iasci A. Value of antenatal corticosteroid therapy in preterm birth. Early Hum Dev. 1995. 42:37–47.

29. Crowley PA. MRCOG. FRCPI. Antenatal corticosteroid therapy: A meta-analysis of the randomized trials, 1972 to 1994. Am J Obstet Gynecol. 1995. 173:322–335.

30. Silver RK, Vyskocil C, Solomon SL, Ragin A, Neerhof MG, Farrell EE. Randomized trial of antenatal dexamethasone in surfactant-treated infants delivered before 30 weeks' gestation. Obstet Gynecol. 1996. 87:683–691.

31. Chapman SJ, Hauth JC, Bottoms SF, Iams JD, Sibai B, Thom E, Moawad AH, Thurnau GR. Benefits of maternal corticosteroid therapy in infants weighing ≤1,000 grams at birth after preterm rupture of the amnion. Am J Obstet Gynecol. 1999. 180:677–682.

32. Lewis DF, Brody K, Edwards MS, Brouillette RM, Burlison S, Loncon SN. Preterm premature ruptured membranes: A randomized trial of steroids after treatment with antibiotics. Obstet Gynecol. 1996. 88:801–805.

33. Segel SY, Miles AM, Clothier B, Parry S, Macones GA. Duration of antibiotic therapy after preterm premature rupture of fetal membranes. Am J Obstet Gynecol. 2003. 189:799–802.