MECONIUM-STAINED AMNIOTIC FLUID-ASSOCIATED INFECTIOUS MORBIDITY - A RANDOMIZED, DOUBLE-BLIND TRIAL OF AMPICILLIN-SULBACTAM PROPHYLAXIS

Objective: To evaluate the efficacy of intrapartum prophylactic admini stration of ampicillin-sulbactam in reducing intraamniotic infection a nd postpartum endometritis in patients with meconium-stained amniotic fluid (AF). Methods: Patients with intrapartum meconium-stained AF wer e randomized to receive either ampicillin-sulbactam or normal saline ( placebo) intravenously at the time of diagnosis of meconium and every 6 hours until delivery. The outcomes of the two groups were compared w ith respect to intra-amniotic infection and postpartum endometritis. R esults: During the study period, 332 patients with meconium-stained AF were approached for participation, and 120 patients met inclusion cri teria and were enrolled. Patient demographics, labor, and delivery cha racteristics were similar. Ampicillin-sulbactam reduced the incidence of intraamniotic infection from 23.3 to 6.7%, (P =.02; relative risk [ RR] 0.48, 95% confidence interval [CI] 0.22-8.98). The incidence of po stpartum endometritis was also reduced, but the difference was statist ically nonsignificant (8.3 versus 16.7%, P =.16; RR 0.64, 95% CI 0.30- 1.33). Conclusion: Prophylactic intravenous ampicillin-sulbactam signi ficantly reduces intra-amniotic infection in patients with meconium-st ained AF.