Postpartum antibiotics for intrapartum chorioamnionitis : systematic review

Abstract

Background: Chorioamnionitis is associated with maternal morbidity and neonatal sepsis and death. There is no clear consensus on the most appropriate antibiotic to use and how long the treatment should continue. Objective: This review is aimed to systematically assess the effectiveness of different postpartum antibiotic regimens in women diagnosed with intrapartum chorioamnionitis on maternal morbidity and mortality, and their side effects. Method of review: We searched MEDLINE, SCOPUS, and The Cochrane Central Register of Controlled Trials (CENTRAL). Randomized and quasi-randomized trials that compared the effect of postpartum antibiotic with different antibiotic regimen or placebo on maternal morbidity in the women with a diagnosis of intrapartum chorioamnionitis were included. Study eligibility was assessed independently by two reviewers. Trial quality and data were extracted by one reviewer. Data were analyzed using the Review Manager software (RevMan 2004). Main results: Three eligible trials (517 women) were included in this review. Meta-analysis of two trials comparing single-dose antibiotic with multiple-dose antibiotic after delivery showed no statistically significant difference in treatment failure events (RR 1.78, CI 0.72, 4.40). Authors’ conclusions: The conclusions that could be drawn from this review are limited due to small number of studies. No recommendation can be made on the most appropriate antibiotic regimen to choose to treat chorioamnionitis during postpartum period.