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 230/7 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
