Meconium-stained amniotic fluid-associated infectious morbidity: a randomized, double-blind trial of ampicillin-sulbactam prophylaxis.
OBJECTIVE
To evaluate the efficacy of intrapartum prophylactic administration of ampicillin-sulbactam in reducing intraamniotic infection and postpartum endometritis in patients with meconium-stained amniotic fluid (AF).


METHODS
Patients with intrapartum meconium-stained AF were randomized to receive either ampicillin-sulbactam or normal saline (placebo) intravenously at the time of diagnosis of meconium and every 6 hours until delivery. The outcomes of the two groups were compared with respect to intra-amniotic infection and postpartum endometritis.


RESULTS
During the study period, 332 patients with meconium-stained AF were approached for participation, and 120 patients met inclusion criteria and were enrolled. Patient demographics, labor, and delivery characteristics were similar. Ampicillin-sulbactam reduced the incidence of intra-amniotic infection from 23.3 to 6.7%, (P = .02; relative risk [RR] 0.48, 95% confidence interval [CI] 0.22-0.98). The incidence of postpartum endometritis was also reduced, but the difference was statistically nonsignificant (8.3 versus 16.7%, P = .16; RR 0.64, 95% CI 0.30-1.33).


CONCLUSIONS
Prophylactic intravenous ampicillin-sulbactam significantly reduces intra-amniotic infection in patients with meconium-stained AF.
Adair
C D
CD
Department of Obstetrics and Gynecology, Bowman Gray School of Medicine, Winston-Salem, North Carolina, USA.
Ernest
J M
JM
Sanchez-Ramos
L
L
Burrus
D R
DR
Boles
M L
ML
Veille
J C
JC
D000328:Adult; D000653:Amniotic Fluid; D000667:Ampicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000517:prevention & control*; D016001:Confidence Intervals; D004311:Double-Blind Method; D004716:Endometritis / Q000517:prevention & control*; D005260:Female; D005315:Fetal Diseases / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D008470:Meconium; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D010406:Penicillins / Q000627:therapeutic use*; D011247:Pregnancy; D012306:Risk; D013407:Sulbactam / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D010406:Penicillins; D000667:Ampicillin; D013407:Sulbactam