Antibiotic administration to patients with preterm premature rupture of membranes does not eradicate intra-amniotic infection

Figures & data

Table I.  Clinical characteristics of the study population, according to the inflammatory status of the amniotic cavity at admission.

	Without intra-amniotic inflammation at admission (N = 28)	With intra-amniotic inflammation at admission (N = 18)
Maternal age (years)
Mean ± SD	27 ± 7.2	28 ± 6.8
Median (range)	26.5 (16–42)	29 (17–41)
Parity
Nulliparous (n, %)	8 (29%)	4 (22%)
Multiparous (n, %)	20 (71%)	14 (78%)
GA at 1st AMCT (weeks)
Mean ± SD	28.7 ± 2.8	24.2 ± 3.7
Median (range)	29.5 (22–32)	24 (18–30)*
GA at 2nd AMCT
Mean ± SD	30.4 ± 2.6	26.4 ± 3.5
Median (range)	31 (24–35)	26 (19–32)*
1st AMCT-to-delivery interval (weeks)
Mean ± SD	4.1 ± 2.4	5.1 ± 3.1
Median (range)	3.1 (0.7–10.1)	3.7 (1.4–11.7)
Spontaneous labor	12 (43%)	9 (50%)
GA at delivery (weeks)
Mean ± SD	33.9 ± 3.0	28.9 ± 3
Median (range)	33 (24–39)	28.5 (22–33)*

SD, standard deviation; GA, gestational age; AMCT, amniocentesis. *p < 0.05.

Table II.  Types of microorganisms isolated from amniotic fluid, white blood cell count and glucose concentration in amniotic fluid from both amniocenteses, as well as labor status and gestational age at delivery for patients who had positive amniotic fluid culture for microorganisms from the first amniocentesis.

Case	First amniocentesis				Second amniocentesis				Delivery
	GA at Amniocentesis (weeks)	Microorganism	WBC count (/mm^3)	Glucose concentration (mg/dL)	GA at Amniocentesis (weeks)	Microorganism	WBC count (/mm^3)	Glucose concentration (mg/dL)	Labor status	GA at Delivery (weeks)	Discharge status
1	25.2	Mycoplasma hominis	250	25	27.5	Negative	250	25	Sp labor	28.0	Alive
2	25.5	Ureaplasma urealyticum	8	21	27.0	Ureaplasma urealyticum	700	2	Sp labor	28.0	Alive
3	22.0	Ureaplasma urealyticum	375	16	25.0	Ureaplasma urealyticum	15 040	42	Sp labor	25.3	Alive
4	27.4	Ureaplasma urealyticum	41	67	29.5	Ureaplasma urealyticum	N/A	N/A	No labor C-section	29.5	Alive
5	18.6	Ureaplasma urealyticum	1000	20	21.4	Ureaplasma urealyticum	245	60	Induced for fetal death	22.3	Fetal death due to prolapsed umbilical cord
6	23.1	Ureaplasma urealyticum	47 000	2	25.2	Mycoplasma hominis	20 000	2	Induced for fetal death	25.3	Fetal death due to prolapsed umbilical cord
7	23.3	Ureaplasma urealyticum	260	6	26.4	Ureaplasma urealyticum	6325	10	Sp labor	28.4	Alive

GA, gestational age; WBC, white blood cell; Sp, spontaneous; N/A, not available.

Table III.  Amniotic fluid parameters at the first and second amniocenteses.

Amniotic fluid parameters	First AMCT	Second AMCT	p
Intra-amniotic inflammation (n, %)	18/46 (39%)	24/45 (53%)*	NS
Positive culture (n, %)	7/46 (15%)	13/46 (28%)	NS
White blood cell count (median, range)	45.5 (0–47 000)	115.5 (0–38 000)	NS

AMCT, amniocentesis; GA, gestational age; AF, amniotic fluid; NS, not significant p > 0.05.

*Information on AF WBC count was not available in one patient.

Figure 1 (A) Flow chart showing amniotic fluid inflammatory findings (based on white blood cell count) before and after antibiotic treatment. One patient did not have an amniotic fluid white blood cell count available at the second amniocentesis. (B) Flow chart showing amniotic fluid microbiological findings (based on amniotic fluid culture) before and after antibiotic treatment.