(902) Is expectant management of late PPROM an option in patients with GBS colonization?

A retrospective cohort study was conducted at a single university-affiliated medical center between 2012 and 2022. Patients who had preterm premature rupture of membranes (PPROM) between 34 to 37 weeks of pregnancy carrying a singleton gestation, with no contraindications to expectant management were included in the study group. According to the department protocol, all patients with PPROM receive 1G of IV Azithromycin once and 4g of IV penicillin every 4 hours. Antibiotics are discontinued in patients negative for GBS and continued for one week in GBS positive patients. Outcomes were compared to those with a negative GBS culture. Baseline demographic characteristics were compared between the groups. The primary outcome was latency from PPROM till delivery.  Secondary outcomes included cesarean delivery, composite adverse maternal outcome (PPH, chorioamnionitis, abruption of placenta) and composite neonatal outcome (NICU admission, respiratory distress syndrome, early onset GBS disease).

Results:

Two hundred and seventeen patients were included in the study. 98(45.2%) were GBS carriers and 119 (54.8%) were noncarriers. There were no significant between group differences in mean maternal age (27.3±6,29.7±6.1;p=0.37) or gestational age at delivery (252 days±5,252 days±6;p=0.4),rate of diabetes (10.1%,10.2%;p=0.97 ) neonatal mean birthweight (2602g,2698g;p=0.32).

There were no significant differences between the groups for the primary outcome of duration from membrane rupture until delivery (2.83 ± 2.9 days,3.03 ± 2.9 days ;P = 0.98) nor  the rate of cesarean delivery (9.8%,10.9% ;p=0.45) or in composite  maternal (2.7%,1.9%;p=0.26) or neonatal outcomes(23%,22%;p=0.34).

Conclusion:

Expectant management of late PPROM in GBS carriers is not associated with an increased risk of adverse maternal or neonatal outcomes.