title: Rapid identification of group B streptococcus carriage by PCR to assist in the management of women with prelabour rupture of membranes in term pregnancy.
abstract: BACKGROUND
  Management of prelabour rupture of membranes at term (37 weeks gestation or later) (TPROM) remains complicated in the absence of a rapid assay for group B streptococcus (GBS) colonisation.
  
  
  OBJECTIVE
  To evaluate the accuracy and clinical utility of a commercial PCR assay, compared with culture, for detection of GBS colonisation in pregnant women presenting with TPROM.
  
  
  METHODS
  A prospective study of women presenting with TPROM conducted in a large tertiary hospital (Westmead Hospital, Australia). Five hundred and seventy-four consecutive women with TPROM were enrolled between July 2006 and November 2007. Paired low vaginal and anal swabs were collected from women presenting with TPROM for PCR and culture on GBS selective agar following broth enrichment. Primary outcomes were sensitivity and specificity of PCR compared with GBS selective enrichment culture. Secondary analyses included comparison with a historical but otherwise similar cohort regarding clinical utility, maternal and neonatal outcomes.
  
  
  RESULTS
  PCR sensitivity and specificity were 89.0% (95% CI - 82.8-93.6%) and 97.9% (95% CI - 96.0-99.0%), respectively, compared with culture. 72.3% of women were aware of their GBS PCR status within 3 h of presentation. Compared with the historical cohort, PCR reduced the requirement for intrapartum antibiotics by 25.6% (P < 0.001). There were no significant differences in maternal outcomes or combined rates of admissions to neonatal intensive care or special care nursery.
  
  
  CONCLUSIONS
  Group B streptococcus PCR is an accurate, rapid, safe and practical alternative to culture for detection of GBS colonisation in pregnant women at the time of TPROM. This method has the potential advantage to reduce costs associated with length of hospital stay.
authors.affiliation: Department of Obstetrics & Gynaecology, Westmead Hospital, Westmead, New South Wales, Australia.
authors.forename: Warren S W
authors.initials: WS
authors.lastname: Chan
authors.forename: Seng C
authors.initials: SC
authors.lastname: Chua
authors.forename: Heather F
authors.initials: HF
authors.lastname: Gidding
authors.forename: Don
authors.initials: D
authors.lastname: Ramjan
authors.forename: May Y W
authors.initials: MY
authors.lastname: Wong
authors.forename: Tom
authors.initials: T
authors.lastname: Olma
authors.forename: Lee
authors.initials: L
authors.lastname: Thomas
authors.forename: Gwendolyn L
authors.initials: GL
authors.lastname: Gilbert
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000382:microbiology; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000382:microbiology; D006801:Humans; D007231:Infant, Newborn; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D013290:Streptococcal Infections / Q000175:diagnosis*; D013292:Streptococcus agalactiae / Q000235:genetics / Q000302:isolation & purification*; D014621:Vagina / Q000382:microbiology; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial
keywords: PCR; group B streptococcus carriage; prelabour rupture of membranes in term pregnancy