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|Title:||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|
van der Ham, D.
de Groot, C.
|Citation:||BJOG, 2014; 121(10):1263-1272|
|P Tajik, DP van der Ham, MH Zafarmand, MHP Hof, J Morris, MTM Franssen, CJM de Groot, JJ Duvekot, MA Oudijk, C Willekes, KWM Bloemenkamp, M Porath, M Woiski, BM Akerboom, JM Sikkema, B Nij Bijvank, ALM Mulder, PM Bossuyt, BWJ Mol|
|Abstract:||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.|
|Keywords:||Early onset neonatal sepsis; group B streptococcus; preterm premature rupture of membranes; treatment selection marker; vaginal culture|
|Description:||Article first published online: 27 MAY 2014|
|Rights:||© 2014 Royal College of Obstetricians and Gynaecologists|
|Appears in Collections:||Obstetrics and Gynaecology publications|
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