Pregnancy Outcome

Background PPROM occurs prior to 37 weeks. Compared to term infants, preterm infants are more likely to be affected by early onset GBS disease and when affected have a higher perinatal mortality. Management decisions need to balance risks of prematurity and infection. Objectives To determine the neonatal outcomes when there has been PPROM in the presence of maternal GBS and interventions that may reduce the risk of poor outcome. Methods Retrospective case note review of PPROM at Sunderland Royal Hospital from 1st January 2013 – 31st December 2017. Results Electronic notes of 268 women and their 287 babies were reviewed. The gestation at diagnosis of PPROM ranged from 18– 36 weeks (median 34). GBS was detected in 22 women. In 50% the carriage was known prior to PPROM. In 50% this was known prior to 34 weeks of gestation. Overall perinatal mortality was 4% (12/287). Maternal GBS colonisation was associated with higher perinatal mortality, 13.6% versus 3.4% (3/22 versus 9/265). Active management at 34 weeks where maternal GBS colonisation was known would have prevented one intrauterine death. Conclusion In this sample, perinatal mortality appears to be increased when PPROM occurs in the presence of maternal GBS colonisation. Recent RCOG guidance recommends that it is beneficial to expedite delivery in PPROM from 34 weeks if a woman is a known to be colonised with GBS. Reference 1. Prevention of early onset neonatal GBS disease, RCOG green top guideline 36, RCOG, September 2017 PP.002 The role of a dedicated pre-term surveillance clinic offering cervical cerclage; changing outcomes for women: A five year analysis at the National Maternity Hospital Holles Street Rowan, A; Fee, N; Luethe, L; Higgins, S