Maternal and Neonatal Outcomes Following Antibiotic Prophylaxis in Term Prelabor Rupture of Membranes (PROM): Evidence From a Systematic Review

Term prelabor rupture of membranes (PROM) is a common obstetric event associated with an increased risk of maternal and neonatal infectious morbidity. The use of antibiotic prophylaxis to prevent these complications is widespread, yet its efficacy remains debated due to conflicting evidence and concerns regarding antimicrobial resistance. This systematic review aimed to synthesize the existing evidence on the impact of antibiotic prophylaxis on maternal and neonatal outcomes in term PROM. A systematic literature search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across PubMed/MEDLINE, Web of Science, Embase, and ClinicalTrials.gov from inception. Studies including pregnant women with term PROM (≥37 weeks) comparing antibiotic prophylaxis to placebo, no treatment, or different timing strategies were eligible. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool for randomized controlled trials (RCTs) and the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool for non-randomized studies. A narrative synthesis was performed due to significant clinical and methodological heterogeneity. Six studies (four RCTs and two retrospective cohorts) were included. The findings were inconsistent. Three studies reported a significant reduction in maternal infections (chorioamnionitis, endometritis) with antibiotic prophylaxis, while two large studies found no significant benefit. For neonatal outcomes, two studies reported a significant reduction in neonatal sepsis, whereas three others found no statistically significant difference. Evidence regarding the optimal timing of antibiotic administration was also conflicting, with one high-quality study finding no benefit for administration within 6-12 hours versus later, while others suggested earlier administration was associated with better outcomes. The overall risk of bias was low for the majority of the included studies. The evidence supporting the routine use of antibiotic prophylaxis for all women with term PROM was inconclusive. While a reduction in maternal infection was observed in some studies, this benefit was not universal, and the effect on neonatal sepsis remains uncertain. A targeted approach, considering individual risk factors such as prolonged membrane rupture or Group B Streptococcus colonization, may be more appropriate than universal prophylaxis. Further high-quality research is needed to define the optimal timing and candidate population for this intervention.