The Impact of Antibiotics on Latency When Given at the Time of Membrane Rupture before Viability

Abstract

Objective

It is well established that antibiotics administered in preterm prelabor rupture of membranes increase latency to delivery. While data are limited for membrane rupture prior to viability, antibiotics may also increase latency in this population. This study aimed to assess the effect of prophylactic antibiotics on the duration of latency in individuals with previable prelabor rupture of membranes.

Study Design

Retrospective cohort of pregnancies with previable prelabor rupture of membranes prior to 23^0/7 weeks in a single health system (2013–2022). Patients opting for termination or with a contraindication to expectant management were excluded. The primary outcome was latency from previable prelabor rupture of membranes diagnosis to delivery. Secondary outcomes included subanalysis by gestational age as well as maternal and neonatal morbidity and mortality. Bivariate statistics compared patients who did and did not receive antibiotics (ampicillin, gentamicin). Kaplan-Meier/Cox proportional hazards ratios using significant covariates (p < 0.1) in bivariate analysis models examined antibiotic impact on latency.

Results

Of 115 patients, 46 (40%) met inclusion criteria, of whom 34 (74%) received latency antibiotics. Median latency did not differ with antibiotic receipt (1 [0.4, 2.6] vs. 0.6 weeks [0.3, 0.9], p = 0.27). When adjusted for gestational age at rupture of membranes, antibiotics were not associated with longer latency (hazard ratio = 1.33 [0.91, 1.93]). Antibiotic receipt was associated with lower rates of previable delivery (23.0, [22.7, 24.0] vs. 21.3 weeks [20.5, 23.1], p = 0.006). Adjusted odds of previable delivery remained lower with receipt of antibiotics (adjusted odds ratio = 0.20, [0.04, 0.90]). Antibiotics were associated with longer latency in patients with rupture of membranes at less than 22 weeks gestation (2.4 [1.3,4.4] vs. 0.6 weeks [0.1,0.9], p = 0.02).

Conclusion

Antibiotic administration at the time of previable prelabor rupture of membranes was associated with longer latency prior to 22 weeks gestation. Antibiotic administration increased the odds of delivering after viability. Further study should address optimal antibiotic strategies for this unique population.

Key Points

• No significant increase in latency after antibiotics with rupture of membranes prior to 23 weeks.

• Significantly longer latency after antibiotics with rupture of membranes before 22 weeks.

• Antibiotic receipt associated with increased likelihood of delivering after viability.

Keywords

previable prelabor rupture of membranes - rupture of membranes - latency antibiotics - antibiotic prophylaxis - gestational latency - gestational viability - previable delivery

Publication History

Received: 12 April 2024

Accepted: 12 January 2025

Accepted Manuscript online:
15 January 2025

Article published online:
10 February 2025

• References

• 1 Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: final data for 2003. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System 2005; 54 (02) 1-116
• 2 Middleton P, Shepherd E, Flenady V, McBain RD, Crowther CA. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database Syst Rev 2017; 1 (01) CD005302
• 3 Mercer BM. Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am 2005; 32 (03) 411-428
• 4 Waters TP, Mercer BM. The management of preterm premature rupture of the membranes near the limit of fetal viability. Am J Obstet Gynecol 2009; 201 (03) 230-240
• 5 Manuck TA, Varner MW. Neonatal and early childhood outcomes following early vs later preterm premature rupture of membranes. Am J Obstet Gynecol 2014; 211 (03) 308.e1-308.e6
• 6 Linehan LA, Walsh J, Morris A. et al. Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study. BMC Pregnancy Childbirth 2016; 16 (01) 25
• 7 Kibel M, Asztalos E, Barrett J. et al. Outcomes of pregnancies complicated by preterm premature rupture of membranes between 20 and 24 weeks of gestation. Obstet Gynecol 2016; 128 (02) 313-320
• 8 Dotters-Katz SK, Myrick O, Smid M, Manuck TA, Boggess KA, Goodnight W. Use of prophylactic antibiotics in women with previable prelabor rupture of membranes. J Neonatal Perinatal Med 2017; 10 (04) 431-437
• 9 Anderson JG, Baer RJ, Partridge JC. et al. Survival and major morbidity of extremely preterm infants: a population-based study. Pediatrics 2016; 138 (01) e20154434
• 10 LeMoine F, Moore RC, Chapple A, Moore FA, Sutton E. Neonatal survivability following previable PPROM after hospital readmission for intervention. AJP Rep 2020; 10 (04) e395-e402
• 11 Stoll BJ, Hansen NI, Bell EF. et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (03) 443-456
• 12 Ehret DEY, Edwards EM, Greenberg LT. et al. Association of antenatal steroid exposure with survival among infants receiving postnatal life support at 22 to 25 weeks' gestation. JAMA Netw Open 2018; 1 (06) e183235
• 13 American College of Obstetricians and Gynecologists. Prelabor rupture of membranes. ACOG practice bulletin no. 217. Obstet Gynecol 2020; 135 (03) e80-e97
• 14 Grisaru-Granovsky S, Eitan R, Kaplan M, Samueloff A. Expectant management of midtrimester premature rupture of membranes: a plea for limits. J Perinatol 2003; 23 (03) 235-239