Preterm prelabour rupture of membranes (PPROM) is the spontaneous rupture of membranes prior to 37 weeks gestation, with prolonged onset of labour. The exact mechanism of early membrane rupture is not fully understood, however a significant risk of chorioamonionitis, possibly associated with vaginal group B streptococcus (GBS) colonisation. There is no consensus for the management of women with PPROM. Clinicians continue to debate immediate delivery or expectant management.Method
Retrospective data was collected from all women presenting with singleton pregnancy PPROM to the Gold Coast District hospital from 2011–2. Blood investigations, high vaginal swab result including group B-streptococcus (GBS) status, placental histology and microbiological evidence of maternal and neonatal sepsis post-delivery were recorded. Timing of delivery was recorded, as well as the antibiotics administered.Results
Data was recorded for 63 women from 2011–12 with PPROM. 90% (57/63) of women had their GBS status checked via vaginal swab on admission of which 18% (10/63) were found to be GBS positive. 97% (61/63) women received either prophylactic or treatment-dose antibiotics however, no consensus was reached for the most appropriate antibiotic regimen. Placental analysis was conducted for 44% (28/63) of women, of which 9 showed evidence chorioamnionitis; none were found to be positive for GBS.Conclusion
PPROM presents a significant management challenge; a balance must be achieved between the risk of maternal and foetal sepsis versus foetal morbidity and mortality associated with early delivery. Vaginal colonisation with GBS has been implicated in chorionamnionitis and PPROM, however our study didn’t support these findings.