Hernández BA, López FJÁ, Gámez GC

Language: Spanish
References: 10
Page: 403-410
PDF size: 716.88 Kb.

ABSTRACT

Background: premature rupture of membranes occurs between 5 and 15% of pregnancies, of these, 10% occurs at term and preterm 2 to 3.5%.
Objective: To compare maternal and perinatal outcomes from the use of erythromycin or clindamycin in women with preterm premature rupture of membranes with conservative treatment at the Regional General Hospital No. 36.
Patients and methods: comparative, prospective, randomized study conducted at the Regional General Hospital No. 36 of the Instituto Mexicano del Seguro Social, Puebla. The most common risk factors were cervical infections (55%) and urinary tract infection (55%). A history of premature rupture of membranes in pregnancy was reported in 12.5% of patients. Group A was prescribed erythromycin and group B, standard-dose clindamycin, these were the independent variables. Maternal outcomes (deciduoendometritis and chorioamnionitis) and perinatal (respiratory distress syndrome, necrotizing enterocolitis and sepsis) were the dependent variables. Fisher exact test was applied to the results of the study.
Results: about perinatal outcome, sepsis was expressed more frequently in the clindamycin group (60%) compared with erythromycin (35%). The occurrence of respiratory distress syndrome was similar in both groups, 70 and 75% respectively. For necrotizing enterocolitis, 25 and 5%. Maternal alterations as chorioamnionitis occurred in 20% of patients in group A and 5% in group B. Endometritis results were similar in both groups.
Conclusions: comparing the maternal and perinatal outcomes with conservative management of premature rupture of membranes, results were better in the group treated with erythromycin. It is not possible to prove it statistically because of the sample size.

REFERENCES

1. Mercer BM. Preterm premature rupture of the membranes. Obstet Gynecol 2003;101(1):178-193.

2. ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol 2007;109(4):1007-1019.

3. Royal College of Obstetricians and Gynaecologists (RCOG). Preterm prelabour rupture of membranes. London (UK): Royal College of Obstetricians and Gynaecologists (RCOG); 2006;11 (Guideline; no. 44).

4. Canavan TP, Simhan HN, Caritis S. An evidence-based approach to the evaluation and treatment of premature rupture of membranes: Part I. Obstet Gynecol Surv 2004;59(9):669-677.

5. Canavan TP, Simhan HN, Caritis S. An evidence-based approach to the evaluation and treatment of premature rupture of membranes: Part II. Obstet Gynecol Surv 2004;59(9):678-689.

6. Tran SH, Cheng YW, Kaimal AJ, Caughey AB. Length of rupture of membranes in the setting of premature rupture of membranes at term and infectious maternal morbidity. Am J Obstet Gynecol 2008;198(6):700.e1-5.

7. Pristauz G, Bauer M, Maurer-Fellbaum U, Rotky-Fast C, et al. Neonatal outcome and two-year follow-up after expectant management of second trimester rupture of membranes. Int J Gynaecol Obstet 2008;101(3):264-268.

8. Gopalani S, Krohn M, Meyn L, Hitti J, Crombleholme WR. Contemporary management of preterm premature rupture of membranes: determinants of latency and neonatal outcome. Am J Perinatol 2004;21(4):183-190.

9. Kenyon S, Boulvain M, Neilson J. Antibiotics for preterm rupture of the membranes: a systematic review. Obstet Gynecol 2004;104(5 Pt 1):1051-1057.

10. Kenyon SL, Taylor DJ, Tarnow-Mordi W, ORACLE Collaborative Group. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. ORACLE Collaborative Group. Lancet 2001;357(9261):979-988.