Association between antibiotic prophylaxis and adverse perinatal outcomes in premature rupture of membranes

Lima, Thaísa de Souza; Pagani, Flávia Mariane; Borges, Carolina Bianchini; Petrini, Caetano Galvão; Paschoini, Marina Carvalho; Araújo Júnior, Edward; Peixoto, Alberto Borges

doi:10.1590/1806-9282.20211299

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 69 (1) • 2023 • https://doi.org/10.1590/1806-9282.20211299 copy

Association between antibiotic prophylaxis and adverse perinatal outcomes in premature rupture of membranes

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The aim of this study was to evaluate the association between antibiotic prophylaxis and adverse perinatal outcomes in premature rupture of membranes.

METHODS:

This retrospective cohort included pregnant women with premature rupture of membranes (between 24 and 33+6 weeks) who used or did not use prophylactic antibiotics. Pearson's chi-square (χ^²) test, Student's t-test, and binary logistic regression were used for statistical analysis.

RESULTS:

A significant effect was observed in patients with premature rupture of membranes using prophylactic antibiotics regarding amniotic fluid index (p=0.007), deepest vertical pocket (p=0.049), duration of antibiotic therapy (p≤0.001), C-reactive protein level upon admission (p≤0.001), leukocyte count upon admission (p=0.007), and length of stay in neonatal intensive care (p=0.047). A significant association was observed between the abovementioned patients and surfactant use during the neonatal period (p=0.04). A higher prevalence of surfactant use was noted in these patients (20.0 vs. 8.7%; p=0.04).

CONCLUSION:

No association was found between antibiotic prophylaxis and the presence of adverse perinatal outcomes in pregnant women with premature rupture of membranes between 24 and 33+6 weeks of gestation.

KEYWORDS:
Pregnancy; Premature rupture of membrane (pregnancy); Antibiotic prophylaxis; Morbidity

		Group I (n=58) median (min–max)	Group II (n=106) median (min–max)	χ^²	p-value
Maternal age (years)		26 (15–41)	25 (14–43)	0.26	0.608^† † Mann-Whitney: median (minimum–maximum); χ²: chi-square
GA at delivery (weeks)		32 (24.8–35.5)	32.4 (24.3–34.3)	0.03	0.859^† † Mann-Whitney: median (minimum–maximum); χ²: chi-square
Number of pregnancies		1 (1–6)	2 (1–9)	5.60	0.018^† † Mann-Whitney: median (minimum–maximum); χ²: chi-square
Parity		0 (0–5)	1 (0–7)	4.l3	0.038^† † Mann-Whitney: median (minimum–maximum); χ²: chi-square
AFI (cm)		5 (0–18.7)	2.5 (0–18)	7.18	0.007^† † Mann-Whitney: median (minimum–maximum); χ²: chi-square
LVP (cm)		3.6 (0–7.6)	1.95 (0–6)	3.88	0.049^† † Mann-Whitney: median (minimum–maximum); χ²: chi-square
Antibiotic prophylaxis time (hours)		72 (1–240)	6.5 (1–72)	34.6	<0.001^† † Mann-Whitney: median (minimum–maximum); χ²: chi-square
PCR level on admission (mg/dL)		1.95 (0.5–23.2)	0.8 (0–36.7)	24.6	<0.001^† † Mann-Whitney: median (minimum–maximum); χ²: chi-square
PCR level last (mg/dL)		2.2 (1.1–20.9)	0.4 (0–7.1)	21.2	<0.001^† † Mann-Whitney: median (minimum–maximum); χ²: chi-square
Leukocyte count on admission (cells/mm³)		10,050 (4910–21,940)	11,800 (5,980–28,700)	7.20	0.007^† † Mann-Whitney: median (minimum–maximum); χ²: chi-square
Leukocyte count last (cells/mm³)		12,055 (5,250–21,660)	13920 (3257–23,140)	0.78	0.376^† † Mann-Whitney: median (minimum–maximum); χ²: chi-square
Birth weight (grams)		1,890 (940–3,570)	1,775 (630–2,955)	2.60	0.107^† † Mann-Whitney: median (minimum–maximum); χ²: chi-square
Apgar score at 1st min		8 (1–10)	8 (0–9)	0.40	0.527^† † Mann-Whitney: median (minimum–maximum); χ²: chi-square
Apgar score at 5th min		9 (3–10)	9 (1–10)	0.74	0.389^† † Mann-Whitney: median (minimum–maximum); χ²: chi-square
Length of stay in the neonatal ICU (hours)		504 (10–2,208)	768 (3–5,520)	3.95	0.047^† † Mann-Whitney: median (minimum–maximum); χ²: chi-square
Latency period (hours)		48 (4–1,560)	48 (3–620)	0.19	0.659^† † Mann-Whitney: median (minimum–maximum); χ²: chi-square
Ethnicity				0.308	0.857^§ §: percentage (absolute number/total number of cases per group); p-value: p<0.05.
	White	53.6 (30/56)	49.21 (52/106)
	Black	12.5 (7/56)	13.2 (14/106)
	Mixed	33.9 (19/56)	33.7 (40/106)
Smoking		13 (7/54)	18.1 (17/94)	0.662	0.416^§ §: percentage (absolute number/total number of cases per group); p-value: p<0.05.
Alcoholism		5.6 (3/54)	6.4 (6/94)	0.041	0.839^§ §: percentage (absolute number/total number of cases per group); p-value: p<0.05.
Type of delivery				2.45	0.180^§ §: percentage (absolute number/total number of cases per group); p-value: p<0.05.
	Cesarean	44.6 (25/56)	57.5 (61/106)
	Vaginal	55.4 (31/56)	42.5 (45/106)

	Group I (n=58)			Group II (n=106)			χ^²	p-value
	n	N	%	n	N	%	χ^²	p-value
Apgar score at 1st minute <7	8	57	14	27	102	26.5	3.3	0.070
Admission at neonatal ICU	41	57	71.9	59	104	56.7	3.61	0.057
Surfactant use	11	55	20	9	104	8.7	4.21	0.040
Oxygen use	39	57	68.4	67	104	64.4	0.26	0.609
Fetal death	0	55	0	5	106	4.7	2.68	0.102
Neonatal death	5	55	9.1	12	106	11.3	0.19	0.662
Maternal death	0	0	0	0	0	0
Neonatal sepsis	17	55	30.9	21	105	20	2.37	0.124
Maternal sepsis	0	0	0	0	0	0
Chorioamnionitis	13	56	23.2	39	105	37.1	3.24	0.072
Composite perinatal outcomes	38	56	67.9	86	106	81.1	3.60	0.058

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[1] *Corresponding author: araujojred@terra.com.br