Professor University of Alabama at Birmingham Birmingham, AL, United States
Objective: A single oral dose of azithromycin (AZI) given during labor in women planning a vaginal delivery reduced maternal infections including sepsis and the effect was stronger in Africa than Asia. Since maternal infection contributes to labor dysfunction and postpartum hemorrhage (PPH), we evaluated the association between AZI and PPH.
Study Design: Secondary analysis of the A-PLUS trial in which women in labor at ≥28 weeks’ gestation were randomized to either 2g AZI or placebo at 8 sites in 7 low- and middle-income countries (LMICs). The outcomes were: 1) PPH based on clinician diagnoses, and 2) postpartum blood transfusion, prior to hospital discharge. We compared rates of the outcomes and computed RR (95% CI) using Poisson regression as relevant. We also implemented sub-group analyses by Africa vs. Asia.
Results: Of 29,278 participants randomized, 14590 to AZI and 14688 to placebo, 99.6% were followed to 42 days postpartum. Baseline characteristics were balanced between groups including overall from Africa (40%), Asia (55%) and Latin America (5%), nulliparous (43%) and labor induction (18%). PPH and blood transfusion did not differ significantly between groups (Table). The effect on blood transfusion appeared to be beneficial in Africa (RR=0.2; 0.07-0.59) but not in Asia (RR=1.22; 0.72-1.78); p-value for interaction = 0.002.
Conclusion: A single intrapartum oral dose of AZI did not significantly reduce the risk of PPH or blood transfusion. Further studies are needed to confirm whether there are benefits in Africa where use of antibiotics in routine clinical care is less prevalent.
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