Expectant management of late preterm prelabor rupture of membranes in GBS carriers.

OBJECTIVE

The impact of maternal group B Streptococcus (GBS) colonization on outcomes of expectant management in late preterm prelabor rupture of membranes (PPROM) is debated. This study examined maternal and neonatal infectious outcomes in women with late PPROM at 34-36.6 weeks of gestation, stratified by GBS colonization status.

METHODS

This retrospective cohort study included 412 women admitted for expectant management of late PPROM. Outcomes were compared between GBS-positive (n = 73) and GBS-negative (n = 339) groups. Co-primary outcomes were clinical chorioamnionitis and latency duration (time from rupture of membranes to delivery). Expectant management consisted of betamethasone administration and 7-day antibiotics regimen. Induction was performed at 37 weeks or earlier if chorioamnionitis or non-reassuring fetal status was suspected. After delivery, chorioamniotic swabs were obtained.

RESULTS

Gestational age at PPROM was similar between the groups. The rates of intrapartum fever, clinical chorioamnionitis, postpartum fever, latency duration, latency >48 h, and delivery week were similar. For the positive versus negative GBS status group, antibiotic administration in the neonatal intensive care unit was more common (8 [11.1%] vs 12 [3.5%], P = 0.013). Rates of neonatal complications, such as early-onset sepsis, respiratory distress syndrome, invasive ventilation, and meconium aspiration syndrome, were similar between the groups. The distributions of pathogens in chorioamniotic swab cultures were similar (P = 0.461).

CONCLUSION

Among GBS carriers with late PPROM, we found similar maternal and neonatal adverse outcomes. The increased neonatal antibiotic administration may be attributed to preventive measures related to the positive GBS status. Expectant management of PPROM in women with GBS colonization is reasonable.