Is expectant management of late preterm prelabor rupture of membranes an option in patients with Group B streptococcus colonization?

Objective: To evaluate whether expectant management of late preterm prelabor rupture of membranes (PPROM) in patients colonized with Group B streptococcus (GBS) is associated with an increased risk of adverse maternal and neonatal outcomes. Study Design: This cohort study analyzed data from singleton pregnancies complicated by late PPROM between 34⁺⁰ and 36⁺⁶ weeks of pregnancy, where a documented GBS rectovaginal culture result was available, and who underwent expectant management until 37⁺⁰ weeks. After rectovaginal GBS swabs were taken, patients received an ampicillin-based regimen: this was discontinued if swab results were GBS-negative or continued for 1 week if GBS-positive. Outcomes of patients with a positive GBS culture were compared with those with a negative culture. The primary outcomes were chorioamnionitis and neonatal fever. Secondary outcomes included the mode of delivery, latency from PPROM to delivery, placental abruption, neonatal intensive care unit admission, and early-onset neonatal GBS bacteremia, as well as composite adverse maternal and neonatal outcomes. Results: A total of 217 patients met the inclusion criteria for this study. Among these, 98 (45.2%) were identified as GBS carriers, and 119 (54.8%) were noncarriers. Baseline characteristics were comparable between the two groups. There was no significant difference in the rates of chorioamnionitis (2.1% versus 0.5% P = 0.23), neonatal fever (2.1% versus 1.7% P = 0.42) latency from PPROM to delivery and adverse maternal or neonatal outcomes between GBS carriers and noncarriers. Conclusion: Expectant management of GBS-colonized women with late PPROM, when accompanied by appropriate antibiotic prophylaxis and close maternal-fetal surveillance is not significantly associated with adverse outcomes and appears to be a safe option. These findings reinforce the need for evidence-based, individualized management strategies for GBS colonization in late PPROM.