title: Clinical triggers to initiate intrapartum penicillin therapy for prevention of group B streptococcus infection.
abstract: Despite national recommendations for prophylactic group B streptococci intrapartum penicillin therapy (GBS-IPT), there is little guidance for clinicians regarding to how to achieve the recommended 4 hours of therapy. We sought to identify clinical triggers for effective temporal prompts to initiate GBS-IPT to achieve the recommended duration of therapy. GBS-colonized women who delivered between 37 and 42 weeks were analyzed retrospectively. The clinical record was reviewed for clinical events including rupture of membranes, oxytocin therapy, 4-cm dilation, active labor, narcotic analgesia, epidural analgesia. In addition, combinations of these triggers were evaluated using the first appearance of 4-cm dilation or active labor, narcotic analgesia or epidural, and a composite indicator of each of these four triggers. Antibiotic duration and proportion receiving 4 hours of GBS-IPT for each trigger were compared with the conventional penicillin management the patient actually received (CM). Data were analyzed with Z-test for proportions with Bonferroni correction and one-way analysis of variance. Two hundred thirteen women met study criteria and were reviewed. Using CM, 90.8% of nulliparas and 68.7% of parous women achieved adequate GBS-IPT. In nulliparas, each clinical trigger resulted in equivalent rates of adequate GBS-IPT compared with CM. The duration of therapy was less for 4-cm dilation, epidural, epidural or narcotic analgesia, and 4-cm dilation or active labor triggers in nulliparas, suggesting better identification of the period 4 hours prior to delivery. In parous women, clinical triggers did not perform better than CM. In nulliparous women, clinical triggers to initiate therapy may achieve high rates of GBS-IPT, with a significant decrease in the duration of antibiotic therapy. In nulliparous women, clinical triggers better identify the 4-hour window prior to delivery than CM.
authors.affiliation: Yale University School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, New Haven, Connecticut 06520-8063, USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Hamar
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Illuzzi
authors.forename: Edmund F
authors.initials: EF
authors.lastname: Funai
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis / Q000379:methods*; D005260:Female; D006801:Humans; D007747:Labor Stage, First; D007743:Labor, Obstetric / Q000187:drug effects; D010298:Parity / Q000187:drug effects; D010406:Penicillins / Q000008:administration & dosage* / Q000627:therapeutic use; D011247:Pregnancy; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000517:prevention & control*; D013292:Streptococcus agalactiae; D013997:Time Factors
chemical_list: D010406:Penicillins