Using vaginal Group B Streptococcus colonisation in women with preterm premature rupture of membranes to guide the decision for immediate delivery: a secondary analysis of the PPROMEXIL trials

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 121; no. 10; pp. 1263 - 1272
• Main Authors: Tajik, P, Ham, DP, Zafarmand, MH, Hof, MHP, Morris, J, Franssen, MTM, Groot, CJM, Duvekot, JJ, Oudijk, MA, Willekes, C, Bloemenkamp, KWM, Porath, M, Woiski, M, Akerboom, BM, Sikkema, JM, Bijvank, B Nij, Mulder, ALM, Bossuyt, PM, Mol, BWJ
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-09-2014
• Subjects: Decision Making; Delivery, Obstetric; Early onset neonatal sepsis; Female; Fetal Membranes, Premature Rupture - microbiology; Fetal Membranes, Premature Rupture - therapy; group B streptococcus; Humans; Induced labor; Netherlands; Newborn babies; Pregnancy; Pregnancy Complications, Infectious - microbiology; Pregnancy Complications, Infectious - therapy; preterm premature rupture of membranes; Risk Factors; Sepsis; Streptococcal Infections - diagnosis; Streptococcus agalactiae - isolation & purification; Streptococcus infections; Treatment Outcome; treatment selection marker; Vagina - microbiology; vaginal culture; Netherlands; preterm premature rupture of membranes; Early onset neonatal sepsis; group B streptococcus; treatment selection marker; vaginal culture
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.12889

Objective
To investigate whether vaginal Group B Streptococcus (GBS) colonisation or other baseline characteristics of women with preterm premature rupture of membranes (PPROM) can help in identifying subgroups of women who would benefit from immediate delivery.
Design
Secondary analysis of the PPROMEXIL trials.
Setting
Sixty hospitals in the Netherlands.
Population
Women with PPROM between 34 and 37 weeks of gestation.
Methods
Random assignment of 723 women to immediate delivery or expectant management.
Main outcome measures
Early onset neonatal sepsis.
Results
Vaginal GBS colonisation status was the only marker which was significantly associated with the benefit of immediate delivery (P for interaction: 0.04). GBS colonisation was observed in 14% of women. The risk of early onset neonatal sepsis in GBS‐positive women was high (15.2%) when they were managed expectantly but this risk was reduced to 1.8% with immediate delivery. The early onset neonatal sepsis risk was much lower in neonates of GBS‐negative women: 2.6% after expectant management and 2.9% with immediate delivery. We estimated that by inducing labour only in GBS‐positive women, there would be a 10.4% increase in term delivery rate, while keeping neonatal sepsis and caesarean delivery rates comparable to a strategy of labour induction for all.
Conclusions
Our post hoc findings suggest that women with PROM between 34 and 37 weeks might benefit from immediate delivery if they have GBS vaginal colonisation, while in GBS‐negative women labour induction could be delayed until 37 weeks.