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Meta-Analysis
. 2014 Nov 6;2014(11):CD007772.
doi: 10.1002/14651858.CD007772.pub3.

Antibiotics for meconium-stained amniotic fluid in labour for preventing maternal and neonatal infections

Thitiporn Siriwachirachai  1 , Ussanee S Sangkomkamhang, Pisake Lumbiganon, Malinee Laopaiboon
Affiliations
Meta-Analysis

Antibiotics for meconium-stained amniotic fluid in labour for preventing maternal and neonatal infections

Thitiporn Siriwachirachai et al. Cochrane Database Syst Rev. .

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 2014).

Selection criteria: Randomised 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 trials for inclusion and risk of bias, extracted data and checked them for accuracy.

Main results: We included two studies with 362 pregnant women. Both studies compared ampicillin-sulbactam (N = 183) versus normal saline (N = 179) 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, there was a significant decrease in the risk of chorioamnionitis (RR 0.36, 95% CI 0.21 to 0.62). No serious adverse effects were reported. Drug resistance, duration of mechanical ventilation and duration of admission to NICU/hospital were not reported. Most of the domains for risk of bias were at low risk of bias for one study and at unclear risk of bias for the other study. The quality of the evidence using GRADE was low for neonatal sepsis, postpartum endometritis, and neonatal mortality and morbidity prior to discharge (Neonatal intensive care admissions) and of moderate quality for chorioamnionitis.

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.

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Conflict of interest statement

None known.

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Antibiotic versus placebo, Outcome 1 Neonatal sepsis.
1.2
1.2. Analysis
Comparison 1 Antibiotic versus placebo, Outcome 2 Chorioamnionitis.
1.3
1.3. Analysis
Comparison 1 Antibiotic versus placebo, Outcome 3 Postpartum endometritis.
1.4
1.4. Analysis
Comparison 1 Antibiotic versus placebo, Outcome 4 Neonatal intensive care admissions.
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References

References to studies included in this review

Adair 1996 {published data only}
    1. Adair CD, Ernest JM, Sanchez‐Ramos L, Burrus DR, Boles ML, Veille J. Meconium‐stained amniotic fluid‐associated infectious morbidity: a randomized, double‐blind trial of ampicillin‐sulbactam prophylaxis. Obstetrics & Gynecology 1996;88(2):216‐20. - PubMed
Adair 1999 {published data only}
    1. Adair CD, Lewis D, Weeks J, Vandenberg T, Barrilleaux S, Philibert L, et al. Is meconium‐stained amniotic fluid infectious morbidity reduced by prophylactic ampicillin sulbactam?. American Journal of Obstetrics and Gynecology 1999;180:s22.

References to studies excluded from this review

Adair 1998 {published data only}
    1. Adair CD, Ernest JM, Sanchez‐Ramos L, Burrus DR, Boles ML, Veille JC. The utility of amnioinfusion in the prophylaxis of meconium‐stained amniotic fluid infectious morbidity. Infectious Diseases in Obstetrics and Gynecology 1998;5:366‐9. - PMC - PubMed
Edwards 1999 {published data only}
    1. Edwards RK, Duff P. Prophylactic cefazolin in amnioinfusions administered for meconium‐stained amniotic fluid. Infectious Diseases in Obstetrics and Gynecology 1999;7(3):153‐7. - PMC - PubMed

Additional references

Alexander 1999
    1. Alexander JM, McIntire DM, Leveno KJ. Chorioamnionitis and the prognosis for term infants. Obstetrics & Gynecology 1999;94:274‐8. - PubMed
Berkus 1994
    1. Berkus MD, Langer O, Samueloff A. Meconium‐stained amniotic fluid: increased risk for adverse neonatal outcome. Obstetrics & Gynecology 1994;84:115‐20. - PubMed
Casey 1997
    1. Casey BM, Cox SM. Chorioamnionitis and endomyometritis. Infectious Disease Clinics of North America 1997;11:203‐22. - PubMed
Clark 1995
    1. Clark P, Duff P. Inhibition of neutrophil oxidative burst and phagocytosis by meconium. American Journal of Obstetrics and Gynecology 1995;173:1301‐5. - PubMed
Cleary 1998
    1. Cleary GM, Wiswell TE. Meconium‐stained amniotic fluid and the meconium aspiration syndrome. An update. Pediatric Clinics of North America 1998;45:511‐29. - PubMed
Florman 1969
    1. Florman AL, Teubner D. Enhancement of bacterial growth in amniotic fluid by meconium. Journal of Pediatrics 1969;74:111‐4. - PubMed
GRADE 2008 [Computer program]
    1. Brozek J, Oxman A, Schünemann H. GRADEpro. Version 3.6. The Cochrane Collaboration, 2008.
Halliday 2001
    1. Halliday HL, Sweet D. Endotracheal intubation at birth for preventing morbidity and mortality in vigorous, meconium‐stained infants born at term. Cochrane Database of Systematic Reviews 2001, Issue 1. [DOI: 10.1002/14651858.CD000500] - DOI - PubMed
Heizmann 2007
    1. Heizmann P, Heizmann WR. Bacteriostatic ‐ bactericidal [Bakteriostase ‐ Bakterizidie]. Medizinische Klinik 2007;102(9):720‐6. - PubMed
Higgins 2009
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2009. Available from www.cochrane‐handbook.org.
Higgins 2011
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hofmeyr 2014
    1. Hofmeyr GJ. Amnioinfusion for meconium‐stained liquor in labour. Cochrane Database of Systematic Reviews 2014, Issue 1. [DOI: 10.1002/14651858.CD000014] - DOI - PMC - PubMed
Hoskins 1987
    1. Hoskins AI, Hemming VG, Johnson TRB, Winkel CA. Effects of alterations of zinc‐to‐phosphorus ratios and meconium content on group B Streptococcus growth in human amniotic fluid in vitro. American Journal of Obstetrics and Gynecology 1987;157(3):770‐3. - PubMed
Josephson 1984
    1. Josephson A. An epidemiologic study of postcesarean infection. American Journal of Infection Control 1984;12:19‐25. - PubMed
Katz 1992
    1. Katz VL, Bowes WA. Meconium aspiration syndrome: reflection on a musky subject. American Journal of Obstetrics and Gynecology 1992;166:171‐83. - PubMed
Mark 2000
    1. Mark SP, Croughan‐Minihane MS, Kilpatrick SJ. Chorioamnionitis and uterine dysfunction. Obstetrics & Gynecology 2000;95:909‐12. - PubMed
Markovitch 1993
    1. Markovitch O, Mazor M, Shoham‐Vardi I, Chaim W Jr. Meconium stained amniotic fluid is associated with maternal infectious morbidity in preterm delivery. Acta Obstetricia et Gynecologica Scandinavica 1993;72:538‐42. - PubMed
Mazor 1995
    1. Mazor M, Furman B, Wiznitzer A, Shoham‐Vardi I, Cohen J, Ghezzi F. Maternal and perinatal outcome of patients with preterm labor and meconium‐stained amniotic fluid. Obstetrics & Gynecology 1995;86:830‐3. - PubMed
Nathan 1994
    1. Nathan L, Leveno KJ, Carmody TJ, Kelly MA, Sherman ML. Meconium: a 1990s perspective on an old obstetric hazard. Obstetrics & Gynecology 1994;83:329‐32. - PubMed
Piper 1998
    1. Piper JM, Newton ER, Berkus MD, Peairs WA. Meconium: a marker for peripartum infection. Obstetrics & Gynecology 1998;91:741‐5. - PubMed
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Romero 1991
    1. Romero R, Hanaoka S, Mazor M, Athanassiadis AP, Callaghan R, Hsu YC, et al. Meconium‐stained amniotic fluid: a risk factor for microbial invasion of the amniotic cavity. American Journal of Obstetrics and Gynecology 1991;164(3):859‐62. - PubMed
Schunemann 2009
    1. Schunemann HJ. GRADE: from grading the evidence to developing recommendations. A description of the system and a proposal regarding the transferability of the results of clinical research to clinical practice [GRADE: Von der Evidenz zur Empfehlung. Beschreibung des Systems und Losungsbeitrag zur Ubertragbarkeit von Studienergebnissen]. Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen 2009;103(6):391‐400. [PubMed: 19839216] - PubMed
Shivananda 2006
    1. Shivananda S, Murthy P, Shah PS. Antibiotics for neonates born through meconium stained amniotic fluid. Cochrane Database of Systematic Reviews 2006, Issue 4. [DOI: 10.1002/14651858.CD006183] - DOI - PMC - PubMed
Tran 2003
    1. Tran SH, Caughey AB, Musci TJ. Meconium‐stained amniotic fluid is associated with puerperal infections. American Journal of Obstetrics and Gynecology 2003;189(3):746‐50. - PubMed
Usta 2000
    1. Usta IM, Sibai BM, Mercer BM. Use of maternal plasma level of zinc‐coproporphyrin in the prediction of intrauterine passage of meconium: a pilot study. Journal of Maternal‐Fetal Medicine 2000;9:201‐3. - PubMed
Ward 2003
    1. Ward M, Sinn J. Steroid therapy for meconium aspiration syndrome in newborn infants. Cochrane Database of Systematic Reviews 2003, Issue 4. [DOI: 10.1002/14651858.CD003485] - DOI - PMC - PubMed
Ward 2008
    1. Ward K, Theiler RN. Once‐daily dosing of gentamicin in obstetrics and gynecology. Clinical Obstetrics and Gynecology 2008;51(3):498‐506. - PMC - PubMed
Wiswell 1990
    1. Wiswell TE, Tuggle JM, Tumer BS. Meconium aspiration syndrome: have we made a difference?. Pediatrics 1990;85:715‐21. - PubMed

References to other published versions of this review

Siriwachirachai 2010
    1. Siriwachirachai T, Sangkomkamhang US, Lumbiganon P, Laopaiboon M. Antibiotics for meconium‐stained amniotic fluid in labour for preventing maternal and neonatal infections. Cochrane Database of Systematic Reviews 2010, Issue 12. [DOI: 10.1002/14651858.CD007772.pub2] - DOI - PubMed

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