Antibacterial therapy in pregnancy complicated by pre-labour rupture of membranes
DOI:
https://doi.org/10.15574/HW.2025.5(180).6875Keywords:
pre-labour rupture of membranes (PROM), preterm birth, antibacterial therapy, antibiotic prophylaxis, gestational age, chorioamnionitis, β-hemolytic streptococcus, antimicrobial resistance, pregnancy management strategyAbstract
Aim - to summarize current evidence on pre-labour rupture of membranes (PROM), with particular emphasis on the impact of gestational age on the choice of pregnancy management strategy and the appropriateness of antibacterial therapy, as well as to analyze the evolution of clinical guidelines in the context of the growing problem of antimicrobial resistance.
Рre-labour rupture of membranes remains one of the leading complications of pregnancy, associated with high perinatal morbidity and mortality, the incidence and outcomes of which largely depend on gestational age. The review addresses the contemporary classification of PROM, associated risk factors, and the pathogenetic role of infection, which may act both as a cause and a consequence of membrane rupture. Maternal and neonatal complications, including chorioamnionitis, neonatal sepsis, respiratory distress syndrome, and other severe conditions, are analyzed. Gestational age is shown to be the key determinant in selecting either active or expectant management and in defining the need for antibacterial therapy. Current recommendations from leading obstetrical societies regarding indications, timing, and antibiotic regimens for PROM are summarized, with particular attention to the role of macrolides and the clinical significance of maternal colonization with β-hemolytic streptococcus.
Conclusions. Rational management of pregnancy complicated by PROM should be based on gestational age, clinical context, and up-to-date evidence-based guidelines. Antibacterial therapy is justified in cases of expectant management before 37 weeks of gestation, in women with positive or unknown β-hemolytic streptococcus status, and in the presence of clinical signs of infection. An individualized approach combined with the principles of antimicrobial stewardship allows minimization of infectious complications and reduction of antimicrobial resistance risks.
The authors declare no conflict of interest.
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