(499) Impact of antibiotic administration before 20 weeks in previable PPROM on neonatal and maternal outcomes

ACOG advises consideration of antibiotics starting at 20 weeks of gestation after periviable preterm prelabor rupture of membranes. It is unclear if antibiotics before 20 weeks are beneficial, thus we compared latency to delivery, maternal, and neonatal outcomes based on antibiotic receipt in patients with PPROM before 20 weeks(pPPROM).  


Study Design:

This retrospective cohort study included patients with ROM < 20wks who opted for expectant management at a single tertiary center from 2013-2022, comparing outcomes based on antibiotic receipt. Antibiotics included 48 hours of IV azithromycin/ampicillin followed by 5 days of oral amoxicillin. Patients who opted for termination were excluded. Primary outcome was achieving viability(23wks). Secondary neonatal outcomes included latency from pPPROM to delivery, NICU admission, and survival to hospital discharge. Maternal outcomes included intraamniotic infection, delivery route, postpartum hemorrhage, ICU admission, hysterectomy, dilation and curettage, endometritis, sepsis and renal failure.


Results:

Of 24 patients with pPPROM, 13 opted for expectant management and were included. 7(54%) received antibiotics and 6 did not. Maternal characteristics, pregnancy comorbidities and gestational age at pPPROM did not differ significantly between groups(Table1). 4(57%) of 7 pPPROM patients administered antibiotics achieved viability versus no patients without antibiotics(p=0.03), with average delivery at 23.3 weeks [21.0,24.3] for those administered antibiotics versus 20.4 weeks [20.1, 20.9](p=0.04) in those who were not. No significant difference in neonatal survival to discharge was noted. Similarly, no significant differences in maternal outcomes other than increased cesarean delivery rate among those administered antibiotics were noted(Table 2).


Conclusion:

Antibiotic receipt at time of pPPROM was associated with longer latency without observed increase in maternal morbidity in this small cohort. Larger, appropriately powered studies are needed to determine if antibiotic receipt prior to 20 weeks improves neonatal outcomes and survival in pPPROM.