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.
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.
  
  
  METHODS
  Secondary analysis of the PPROMEXIL trials.
  
  
  METHODS
  Sixty hospitals in the Netherlands.
  
  
  METHODS
  Women with PPROM between 34 and 37 weeks of gestation.
  
  
  METHODS
  Random assignment of 723 women to immediate delivery or expectant management.
  
  
  METHODS
  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.
authors.affiliation: Department of Obstetrics & Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands; Department of Epidemiology, Biostatistics & Bioinformatics, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Tajik
authors.forename: D P
authors.initials: DP
authors.lastname: van der Ham
authors.forename: M H
authors.initials: MH
authors.lastname: Zafarmand
authors.forename: M H P
authors.initials: MH
authors.lastname: Hof
authors.forename: J
authors.initials: J
authors.lastname: Morris
authors.forename: M T M
authors.initials: MT
authors.lastname: Franssen
authors.forename: C J M
authors.initials: CJ
authors.lastname: de Groot
authors.forename: J J
authors.initials: JJ
authors.lastname: Duvekot
authors.forename: M A
authors.initials: MA
authors.lastname: Oudijk
authors.forename: C
authors.initials: C
authors.lastname: Willekes
authors.forename: K W M
authors.initials: KW
authors.lastname: Bloemenkamp
authors.forename: M
authors.initials: M
authors.lastname: Porath
authors.forename: M
authors.initials: M
authors.lastname: Woiski
authors.forename: B M
authors.initials: BM
authors.lastname: Akerboom
authors.forename: J M
authors.initials: JM
authors.lastname: Sikkema
authors.forename: B
authors.initials: B
authors.lastname: Nij Bijvank
authors.forename: A L M
authors.initials: AL
authors.lastname: Mulder
authors.forename: P M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
mesh_terms: D003657:Decision Making; D036861:Delivery, Obstetric; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D009426:Netherlands; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000382:microbiology* / Q000628:therapy; D012307:Risk Factors; D013290:Streptococcal Infections / Q000175:diagnosis*; D013292:Streptococcus agalactiae / Q000302:isolation & purification*; D016896:Treatment Outcome; D014621:Vagina / Q000382:microbiology*
keywords: Early onset neonatal sepsis; group B streptococcus; preterm premature rupture of membranes; treatment selection marker; vaginal culture