Antibiotics for meconium‐stained amniotic fluid in labour for preventing maternal and neonatal infections
Abstract
Background
Chorioamnionitis is more likely to occur when meconium‐stained amniotic fluid (MSAF) is present. Meconium may enhance the growth of bacteria in amniotic fluid by serving as a growth factor, inhibiting bacteriostatic properties of amniotic fluid. Many adverse neonatal outcomes related to MSAF result from Meconium Aspiration Syndrome (MAS). MSAF is associated with both maternal and newborn infections. Antibiotics may be an effective option to reduce such morbidity.
Objectives
The objective of this review is to assess the efficacy and side effects of prophylactic antibiotics for MSAF during labour in preventing maternal and neonatal infections.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (30 September 2010).
Selection criteria
Randomized controlled trials (RCTs) comparing prophylactic antibiotics with placebo or no treatment during labour for women with MSAF.
Data collection and analysis
Two review authors independently assessed the results of the only available trial and extracted data on maternal and neonatal outcomes.
Main results
We included one study with 120 pregnant women. It compared ampicillin‐salbactam (N = 60) versus normal saline (N = 60) in pregnant women with MSAF. Prophylactic antibiotics appeared to have no statistically significant reduction in the incidence of neonatal sepsis (risk ratio (RR) 1.00, 95% CI 0.21 to 4.76), neonatal intensive care unit (NICU) admission (RR 0.83, 95% CI 0.39 to 1.78) and postpartum endometritis (RR 0.50, 95% CI 0.18 to 1.38). However, significant decrease in the risk of chorioamnionitis (RR 0.29, 95% CI 0.10 to 0.82). No serious adverse effects were reported.
Authors' conclusions
Current evidence indicates that compared to placebo, antibiotics for MSAF in labour may reduce chorioamnionitis. There was no evidence that antibiotics could reduce postpartum endometritis, neonatal sepsis and NICU admission. This systematic review identifies the need for more well‐designed, adequately powered RCTs to assess the effect of prophylactic antibiotics in the incidence of maternal and neonatal complications.
PICOs
Plain language summary
Antibiotics for meconium‐stained amniotic fluid in labour for preventing maternal and neonatal infections
Meconium‐stained amniotic fluid (MSAF) is the result of waste maternal from the fetal colon passing into the mother's amniotic cavity. Its incidence increases in post‐term pregnancies. Pregnant women with MSAF are more likely to develop maternal complications including inflammation of the fetal membranes caused by a bacterial infection (chorioamnionitis), postpartum inflammation of the lining of the uterus (endometritis) and neonatal complications such as neonatal sepsis and need for admission to a neonatal intensive care unit (NICU) . Fetal stress or hypoxia may trigger gasping fetal respirations, which results in the aspiration of meconium.
Our review was based on one identified randomized controlled study (involving 120 women) and found that prophylactic antibiotics may reduce the risk of intra‐amniotic infection in women with MSAF. Antibiotics use did not clearly reduce neonatal sepsis, NICU admission or postpartum endometritis. Studies with much larger numbers of pregnant women with MSAF would be needed to examine these issues.
