title: Antibiotics for preterm labour with intact membranes.
abstract: BACKGROUND
  There may be a link between infection and preterm birth.
  
  
  OBJECTIVE
  Since rupture of the membranes is an important factor in the progression of preterm labour, it is important to see if antibiotics are of any benefit prior to membrane rupture. The objective of this review was to assess the effects of antibiotics administered to women in preterm labour with intact membranes, on maternal and neonatal outcomes.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group trials register and reference lists of articles. We contacted experts in the field.
  
  
  METHODS
  Randomised trials which compared antibiotic treatment with placebo or no treatment for women in preterm labour (between 20 and 36 weeks gestation) with intact membranes.
  
  
  METHODS
  Trial quality was assessed and data were extracted independently by two reviewers. Study authors were contacted for missing data.
  
  
  RESULTS
  Meta-analysis of the ten included trials demonstrated a statistically significant prolongation of pregnancy associated with the use of antibiotics (5. 4 days, 95% confidence interval (CI) 0.9- 9.8 days). Antibiotic treatment was also associated with a statistically significant reduction in maternal infection (odds ratio (OR) 0.59, 95% CI 0.36, 0.97) and neonatal necrotising enterocolitis (OR 0.33, 95% CI 0.13, 0.88). No statistically significant effect was detected on the neonatal outcomes of respiratory distress syndrome and neonatal sepsis, although there was a trend towards the latter (OR 0.67, 95% CI 0.42, 1.07). An increase in perinatal mortality was observed in the group receiving antibiotics (OR 3.36, 95% CI 1.21, 9.32).
  
  
  CONCLUSIONS
  Although a prolongation in time to delivery and a trend towards a reduction in neonatal sepsis was detected, this review fails to demonstrate a clear overall benefit from antibiotic treatment for preterm labour with intact membranes on neonatal outcomes and raises concerns about increased perinatal mortality for those who received antibiotics. This treatment cannot therefore be currently recommended for routine practice. Further research is required to identify a subgroup of women (and their babies) who are more likely to experience benefit from antibiotic treatment for preterm labour prior to membrane rupture, and to identify which antibiotic or combination of antibiotics is most effective. The results of the ongoing ORACLE trial should help resolve some of the uncertainties revealed by this review.
authors.affiliation: Perinatal Epidemiology Unit, Mater Hospital, Raymond Tce, South Brisbane, Queensland, Australia, 4101. jking@mater.org.au
authors.forename: J
authors.initials: J
authors.lastname: King
authors.forename: V
authors.initials: V
authors.lastname: Flenady
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007752:Obstetric Labor, Premature / Q000188:drug therapy*; D011247:Pregnancy
chemical_list: D000900:Anti-Bacterial Agents