Antibiotic therapy in preterm premature rupture of membranes: a randomized, prospective, double-blind trial

Article Abstract:

Preterm, premature rupture of the fetal membranes (rupture of the membranes that surround the fetus before labor begins, and before the baby is full-term) is associated with increased risks for both mother and fetus. The mother may develop an infection, and infants often suffer from respiratory distress syndrome, infections, or hemorrhage. To determine whether administration of antibiotics to women with preterm premature rupture of the membranes might reduce the rate of such complications, a prospective, randomized study of 85 such women (average length of gestation, 34 weeks) was performed. After completing a medical examination and review of medical history, patients who met certain criteria were transferred to the antepartum unit on bed rest, where they were monitored carefully. Subjects were randomly assigned to receive either mezlocillin (an antibiotic, 40 women) for 48 hours followed by oral ampicillin until delivery, or intravenous and oral placebo (inactive) medication (45 women). Results showed that 16 patients (35 percent) in the placebo group developed chorioamnionitis (inflammation of the membranes that surround the fetus), compared with three women (7 percent) in the antibiotic group. Uterine inflammation (endometritis or myometritis) developed in 33 percent of the placebo group and 12 percent of the antibiotic group. The interval between membrane rupture and delivery was shorter for women on the placebo. Finally, the infants born to women who had received the placebo had a greater incidence of clinical sepsis (signs of a systemic infection) and intraventricular hemorrhage (bleeding within the brain ventricles). The antibiotic was administered to cure any infection already present, not to prevent infection, based on the assumption that an infection was likely to be present in patients with premature rupture of membranes. Administration of the antibiotic was clearly beneficial. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Antibiotics, Premature rupture of membranes, Premature rupture of the membrane, Pregnancy, Complications of, Pregnancy complications

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Trial of labor in patients with a previous lower uterine vertical cesarean section

Article Abstract:

Women who have undergone cesarean deliveries with a low vertical incision may safely undergo a trial of labor and vaginal delivery in subsequent pregnancies. Researchers reviewed the outcomes of 77 women with previous low vertical cesarean incisions who were allowed to go through a trial of labor in the next pregnancy. Eleven women had another cesarean, for a rate of 14.3%, as compared to a 9% rate for 154 control group women who did not have low vertical incisions. The 14.3% rate is lower than the hospital's 17% rate of repeat cesarean sections for all previous cesareans. One patient experienced a ruptured uterus during labor or delivery, for a rate of 1.3%. Both mother and infant survived. Women with previous transverse cesarean incisions have been allowed to undergo trials of labor since the early 1980s.

Case studies, Physiological aspects, Labor (Obstetrics), Vaginal birth after cesarean

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Efficacy of maintenance therapy after acute tocolysis: a meta-analysis

Article Abstract:

Continuing tocolytic therapy for pregnant women in premature labor does not seem to help. Tocolytic therapy is used to stop premature labor. It may be successful the first time, but a review of 12 clinical trials revealed it does not prevent recurring premature labor.

Evaluation, Prevention, Premature labor, Tocolytic agents

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