Should preterm labour and preterm premature rupture of membranes be treated with antibiotics?

Abstract

Preterm Labour (PTL) and Preterm Premature Rupture of Membranes (PPROM), both defined as occurring spontaneously before 37 completed weeks of pregnancy, have long been recognized as the major contributor to perinatal mortality and morbidity. The outcome for the baby deteriorates proportionately the earlier the incident occurs. It is estimated that spontaneous preterm birth is responsible for 21.8% of perinatal deaths or 6346 babies per year in South Africa. Preterm birth is less common in first world countries (±12% of deliveries) but in spite of intensive research the figures continue to increase. A disproportionate amount of the costs incurred in managing neonates are caused by preterm delivery. Approximately 30% of preterm deliveries are indicated - the most common reasons being pre-eclampsia, fetal distress, intra-uterine growth restriction and obstetric haemorrhage. This category continues to increase because of the increased in multiple births from assisted reproductive treatment, changes in obstetric management between 34-37 weeks gestation and induction of labour in very preterm infants coupled with the willingness to resuscitate extremely low birth weight infants. Of the remaining two thirds of preterm deliveries approximately 60% are associated with infection and this group is divided equally between PTL and PPROM.