Preterm premature ruptured membranes: a randomized trial of steroids after treatment with antibiotics.
OBJECTIVE
To assess the effectiveness of corticosteroids in patients with preterm premature rupture of membranes (PROM) after treatment with a broad-spectrum antibiotic, ampicillin-sulbactam.


METHODS
A randomized clinical trial of corticosteroids in patients with preterm PROM was undertaken after treating these patients for a minimum of 12 hours with ampicillin-sulbactam. No digital vaginal examinations were performed on these patients. Antibiotics were continued for 7 days and the steroids were repeated weekly. No tocolytics were used. The primary outcome measure was the incidence of respiratory distress syndrome (RDS). Secondary outcome measures included latency period and neonatal and maternal infectious morbidity.


RESULTS
Seventy-seven patients were enrolled and data about their pregnancies were analyzed. No statistically significant difference in latency period was noted (14.7 days in the steroid group, 15.8 days in the no-steroid group). Both neonatal and maternal infectious morbidity were similar. A significant reduction in the incidence of RDS (18.4 versus 43.6%, P = .03) were observed in the steroid group.


CONCLUSIONS
These data suggest that treating preterm PROM patients with a broad-spectrum antibiotic before corticosteroids decreases RDS without apparent adverse sequelae.
Lewis
D F
DF
Department of Obstetrics and Gynecology, Louisiana State University Medical Center, Shreveport, USA.
Brody
K
K
Edwards
M S
MS
Brouillette
R M
RM
Burlison
S
S
London
S N
SN
D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001623:Betamethasone / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000150:complications / Q000188:drug therapy*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011645:Puerperal Infection / Q000517:prevention & control*; D012127:Respiratory Distress Syndrome, Newborn / Q000209:etiology / Q000517:prevention & control*; D013407:Sulbactam / Q000627:therapeutic use
D005938:Glucocorticoids; C035444:sultamicillin; D000667:Ampicillin; D001623:Betamethasone; D013407:Sulbactam