[Prolonged membrane rupture at term: Benefits of antibioprophylaxis for reducing intrauterine infection in the absence of streptococcus B].

OBJECTIVE

The primary objective was to evaluate the effectiveness of antibiotic prophylaxis in preventing intrauterine infections in patients with term prelabor rupture of membranes from 37 weeks of gestation, with a negative group B Streptococcus PCR test.

METHODS

This was a retrospective, single-center, before-and-after cohort study conducted in a type 3 French maternity unit. We included women who delivered at ≥37 weeks of gestation with rupture of membranes lasting more than 12hours and a negative PCR screening for vaginal Group B Streptococcus colonization. Patients (n=830) in the "antibiotic prophylaxis protocol" group received prophylactic PENICILLIN G starting 18hours after membrane rupture. Patients (n=682) in the "no antibiotic prophylaxis protocol" group received no antibiotics. Intrauterine infection was defined as a temperature >38°C lasting more than 30minutes or >38.5°C, combined with at least two of the following criteria: fetal tachycardia, meconium-stained amniotic fluid, or pelvic pain under epidural anesthesia.

RESULTS

A total of 1512 patients were included. The rate of intrauterine infection was significantly lower in the "antibiotic prophylaxis protocol" group compared to the "no prophylaxis protocol" group (1.33% vs. 3.96%, P=0.001). No significant differences were observed between the two groups regarding postpartum endometritis or early-onset neonatal bacterial infection.

CONCLUSIONS

Administering antibiotic prophylaxis starting 18hours after membrane rupture in term patients with term prelabor rupture of membranes and a negative Group B Streptococcus screening appears to reduce the rate of intrauterine infection.