The Relationship between Preterm Premature Rupture of Membranes and Colonization of GBS - A Review

Abstract

Purpose: Group B streptococcus (GBS) is the leading cause of newborn infection. The most important risk factor for this debilitating infection in newborns is maternal colonization of the genitourinary and gastrointestinal tracts. This review investigates three main questions and what answers exist in the current literature. The first question seeks to investigate whether there is a causal relationship between GBS infection and Preterm Premature Rupture of Membranes (PPROM). The remaining questions in this review investigate the management of PPROM pertaining to the optimal time of delivery and the antibiotic treatment best suited for GBS colonized women. Methods: A Pubmed www.pubmed.orgsearch was performed (1996-2020), using preterm rupture of membranes and GBS as the primary medical subject heading, reporting randomized clinical trials, quasi-experimental trials, and analytic studies) including retrospective and prospective cohort studies). We also searched Google for preterm rupture of membrane intervention programs and prenatal care clinics published online. Results: We found 39 studies in our search that investigated the relationship between GBS colonization and PPROM. Of these studies, 5 were randomized control trials (RCT), 8 were retrospective, and 4 were systematic reviews. Most of the studies did not show an association between GBS and PPROM. All the studies showed a benefit in antibiotic treatment however none considered specific treatment in the setting of GBS and PPROM. As for management, most of the studies did not show a benefit of expectant management or immediate delivery for these women. Conclusion: There is no clear-cut association between PPROM and GBS. Many studies have sought out to find a significant association, but the more studies exist, the more answers exist to the question being investigated. Practices involving prophylactic antibiotic treatment at the time of PPROM and again at the time of delivery is the most beneficial management which decreases intraamniotic infection, vertical transmission, and risks of neonatal sepsis after birth. Expectant management of delivery was not found to be more effective than active management in women with PPROM and GBS colonization.