Should a positive placental culture after delivery be treated?

From the Research

Treatment of a positive placental culture after delivery is generally not necessary if the mother is asymptomatic, but antibiotic treatment is recommended if the mother shows signs of infection. The decision to treat should consider the specific organism identified, maternal symptoms, and risk factors. According to the most recent study 1, placental cultures may be an essential predictor of neonatal morbidity in preterm premature rupture of membranes (PPROM) and may contribute to the modification of neonatal treatment. Some key points to consider when deciding on treatment include:

• The presence of symptoms such as fever, uterine tenderness, or foul-smelling lochia
• The specific organism identified in the placental culture
• The risk factors for infection, such as preterm labor or rupture of membranes
• The potential benefits and risks of antibiotic treatment, including the risk of antibiotic resistance and side effects. The typical regimen for antibiotic treatment includes broad-spectrum antibiotics like ampicillin 2g IV every 6 hours plus gentamicin 5mg/kg IV daily, with the addition of clindamycin 900mg IV every 8 hours if there's concern for anaerobic infection 1. It's also important to note that treating asymptomatic women with positive cultures unnecessarily exposes them to antibiotics without clear benefit, while failing to treat symptomatic infections can lead to serious complications like endometritis or sepsis 2, 3. In terms of the correlation between placental bacterial culture results and histological chorioamnionitis, a study found that the histological and bacteriological results were concordant in about 70% of the examined placentas 3. Another study found that placental cultures are highly specific but not sensitive, and the value of performing current routine placental cultures appears limited 2. Overall, the decision to treat a positive placental culture after delivery should be based on a careful consideration of the individual patient's risk factors, symptoms, and laboratory results.