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Effectiveness of Intrapartum Antibiotics for Meconium-Stained Amniotic Fluid

 

Am Fam Physician. 2018 Nov 1;98(9):online.

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INTRAPARTUM ANTIBIOTICS IN WOMEN WITH MECONIUM-STAINED AMNIOTIC FLUID

BenefitsHarms

1 in 7 women had intrapartum chorioamnionitis prevented

None

INTRAPARTUM ANTIBIOTICS IN WOMEN WITH MECONIUM-STAINED AMNIOTIC FLUID

BenefitsHarms

1 in 7 women had intrapartum chorioamnionitis prevented

None

Details for This Review

Study Population: Women at more than 24 weeks' gestation in active labor with meconium-stained amniotic fluid

Efficacy End Points: Neonatal sepsis avoided, intrapartum chorioamnionitis avoided, postpartum endometritis avoided, or neonatal intensive care admission avoided

Harm End Points: None measured

Narrative: Meconium-stained amniotic fluid occurs in approximately 12% of all deliveries and increases the risk of maternal complications (e.g., dystocia, operative delivery, and postpartum endometritis) and neonatal complications (e.g., sepsis, admission to the neonatal intensive care unit [NICU], and meconium aspiration syndrome). This review sought to determine if intrapartum antibiotics, specifically ampicillinsulbactam (Unasyn), given to women in labor with meconium-stained amniotic fluid could limit these complications.1

Two randomized controlled trials2,3 involving 362 pregnant women in labor with meconium-stained amniotic fluid were included in this analysis. Both compared administration of ampicillin-sulbactam intravenously with normal saline. In this analysis,1 there was no significant reduction in the primary outcome of neonatal sepsis (5% in both groups; risk ratio [RR] = 1.00; 95% confidence interval [CI], 0.21 to 4.76) or the secondary outcomes of postpartum endometritis and NICU admissions. No serious adverse effects were reported.1

For the secondary outcome of chorioamnionitis, there was a significant reduction (RR = 0.36; 95% CI, 0.21 to 0.62) with the use of intrapartum antibiotics compared with placebo. This corresponds to a number needed to treat of 7 to

Author disclosure: No relevant financial affiliations.


Copyright © 2018 MD Aware, LLC (theNNT.com). Used with permission.

This series is coordinated by Dean A. Seehusen, MD, MPH, AFP Assistant Medical Editor, and Daniel Runde, MD, from the NNT Group.

A collection of Medicine by the Numbers published in AFP is available at https://www.aafp.org/afp/mbtn.

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Army Medical Department or the U.S. Army Service at large.

References

1. Siriwachirachai T, Sangkomkamhang US, Lumbiganon P, Laopaiboon M. Antibiotics for meconium-stained amniotic fluid in labour for preventing maternal and neonatal infections. Cochrane Database Syst Rev. 2014;(11):CD007772.

2. Adair CD, Ernest JM, Sanchez-Ramos L, Burrus DR, Boles ML, Veille J. Meconium-stained amniotic fluid-associated infectious morbidity: a randomized, double-blind trial of ampicillin-sulbactam prophylaxis. Obstet Gynecol. 1996;88(2):216–220.

3. Adair CD, Lewis D, Weeks J, et al. Is meconium-stained amniotic fluid infectious morbidity reduced by prophylactic ampicillin sulbactam? Am J Obstet Gynecol. 1999;180:s22.

 

 

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