Rupture of the membranes and amniotic infection. Apropos of 3000 cases

This work shows the effect of a policy of reducing the amounts of antibiotics prescribed, and reports on the effect on the rate of infection in a maternity unit where systematic antibiotic cover for patients with premature rupture of the membranes was stopped. Breaking of the waters with loss of liquor makes infection of the contents of the sac almost inevitable; but we have found over a period of five years that with the exception of certain strains of Group B streptococci infection with bacteria from vaginal flora rarely gives rise to severe infection in the infant. This balance sheet was drawn up: 350 infections of the liquor in 13.540 deliveries, which is 2.5%. Infection of the liquor by definition implies that the infant will be contaminated; but in fact the baby was infected in only 0.6% of births--which figure is no higher than in other series. Bacteria found in the vaginal flora: streptococci and anaerobes are responsible for 92% of amniotic infections, streptococcus B being first in frequency responsible for 41.36% of amniotic infections and 47.5% of neonatal infections. The low percentage, 5.4% of Gram negative Bacilli can be attributed to their absence when antibiotic cover is given. Neonatal infections usually improve quickly with a narrow-spectrum antibiotic and the one we gave most often was penicillin G. Careful watch on women with premature rupture of the membranes, accompanied by repeated bacteriological control makes it possible to avoid systematic antibiotic therapy and to allow the antibiotic sensitive bacteria to return to their primary role, if by chance infection of the amniotic contents, which is usually benign, occurs.