MANAGEMENT STRATEGY FOR FULL-TERM LABOR COMPLICATED BY PRELABOR RUPTURE OF MEMBRANES AND GROUP B STREPTOCOCCUS COLONIZATION

Relevance: Group B streptococcus (GBS) is the leading cause of perinatal infections. Despite measures implemented to prevent vertical transmission of GBS from mother to child, not all cases of early neonatal infections caused by GBS have yet been prevented. One of the reasons may be the admission of women to labor with unknown GBS colonization status. Objective: To investigate the management of full-term labor complicated by prelabor rupture of membranes (PROM) and GBS colonization. Materials and methods: The study enrolled 124pregnant women with PROM and unknown GBS colonization status. Of these, 27/124pregnant women were tested positive for GBS by real-time PCR. In this study group, only active management of full-term labor with intrapartum antibiotic prophylaxis for early neonatal GBS infection was included. In the remaining 97/124pregnant women with PROM and negative GBS, two management strategies for full-term labor were used: active (n=39/97) and expectant (n=58/97). Active management approaches were similar in the group with GBS colonization, and expectant management. They consisted of observation of labor progression for 24-72 h and antibiotic prophylaxis of infectious and inflammatory complications when the duration of ruptured membranes reached 18 h. The study analyzed predictors of GBS colonization, pregnancy course characteristics, frequency and nature of labor complications, and perinatal outcomes in the study groups, taking into account the chosen management for full-term labor complicated by PROM. Results: Labor complicated by PROM in women with GBS colonization is associated with the highest risk of chorioamnionitis, even with intrapartum antibiotic prophylaxis, compared with expectant approach to labor management in GBS-negative women. Nevertheless, despite the high risk of chorioamnionitis in the group with active labor management against the background of GBS colonization, no neonates had early neonatal GBS infection according to clinical and laboratory data. Conclusion: Active management strategy for full-term labor complicated by PROM and GBS colonization prevents the development of early neonatal GBS infection.

full-term pregnancy, prelabor rupture of membranes, group B streptococcus, neonatal infections