Abstract
Objective: The purpose of this study was to determine the compliance rate with a maternal risk-factor-based guideline for the prevention of neonatal group B streptococcal (GBS) sepsis.
Methods: In August 1994, a risk-factor-based guideline for selective intrapartum prophylaxis against neonatal GBS was adopted by a group model health maintenance organization. This guideline identified the following maternal risk factors for neonatal GBS sepsis: preterm delivery, rupture of membranes for >18 h, fever/chorioamnionitis, and history of a previous GBS-affected child. Patients with one or more risk factors were to receive intrapartum antibiotic prophylaxis consisting of either ampicillin, erythromycin, or clindamycin. We conducted a retrospective chart review to record risk factors and use of antibiotics. We hypothesized that >90% of patients with risk factors would receive intrapartum chemoprophylaxis.
Results: A total of 805 maternal charts were reviewed. Of these, 105 (13%) were candidates for intrapartum prophylaxis. We found an overall compliance rate of 65%. Compliance rates by risk factor were preterm delivery (51%), prolonged rupture of membranes (73%), fever/chorioamnionitis (87%), and previous affected child (100%).
Conclusions: Our results show unexpectedly low compliance rates with a risk-factor-based guideline for the prevention of neonatal GBS sepsis. Only 65% of women with any risk factor for neonatal GBS sepsis received intrapartum antibiotic prophylaxis appropriately. Educational efforts to improve compliance with a risk-factor-based guideline should specifically address mothers delivering at 34–36 weeks gestation and mothers with prolonged rupture of membranes.
Full Text
The Full Text of this article is available as a PDF (347.3 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Allardice J. G., Baskett T. F., Seshia M. M., Bowman N., Malazdrewicz R. Perinatal group B streptococcal colonization and infection. Am J Obstet Gynecol. 1982 Mar 15;142(6 Pt 1):617–620. doi: 10.1016/s0002-9378(16)32429-2. [DOI] [PubMed] [Google Scholar]
- Anthony B. F., Eisenstadt R., Carter J., Kim K. S., Hobel C. J. Genital and intestinal carriage of group B streptococci during pregnancy. J Infect Dis. 1981 Jun;143(6):761–766. doi: 10.1093/infdis/143.6.761. [DOI] [PubMed] [Google Scholar]
- Boyer K. M., Gadzala C. A., Kelly P. D., Gotoff S. P. Selective intrapartum chemoprophylaxis of neonatal group B streptococcal early-onset disease. III. Interruption of mother-to-infant transmission. J Infect Dis. 1983 Nov;148(5):810–816. doi: 10.1093/infdis/148.5.810. [DOI] [PubMed] [Google Scholar]
- Easmon C. S., Hastings M. J., Deeley J., Bloxham B., Rivers R. P., Marwood R. The effect of intrapartum chemoprophylaxis on the vertical transmission of group B streptococci. Br J Obstet Gynaecol. 1983 Jul;90(7):633–635. doi: 10.1111/j.1471-0528.1983.tb09280.x. [DOI] [PubMed] [Google Scholar]
- Garland S. M., Fliegner J. R. Group B streptococcus (GBS) and neonatal infections: the case for intrapartum chemoprophylaxis. Aust N Z J Obstet Gynaecol. 1991 May;31(2):119–122. doi: 10.1111/j.1479-828x.1991.tb01797.x. [DOI] [PubMed] [Google Scholar]
- Gibbs R. S., McDuffie R. S., Jr, McNabb F., Fryer G. E., Miyoshi T., Merenstein G. Neonatal group B streptococcal sepsis during 2 years of a universal screening program. Obstet Gynecol. 1994 Oct;84(4):496–500. [PubMed] [Google Scholar]
- Lim D. V., Morales W. J., Walsh A. F., Kazanis D. Reduction of morbidity and mortality rates for neonatal group B streptococcal disease through early diagnosis and chemoprophylaxis. J Clin Microbiol. 1986 Mar;23(3):489–492. doi: 10.1128/jcm.23.3.489-492.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Matorras R., García-Perea A., Omeñaca F., Diez-Enciso M., Madero R., Usandizaga J. A. Intrapartum chemoprophylaxis of early-onset group B streptococcal disease. Eur J Obstet Gynecol Reprod Biol. 1991 Jun 5;40(1):57–62. doi: 10.1016/0028-2243(91)90045-m. [DOI] [PubMed] [Google Scholar]
- Rouse D. J., Goldenberg R. L., Cliver S. P., Cutter G. R., Mennemeyer S. T., Fargason C. A., Jr Strategies for the prevention of early-onset neonatal group B streptococcal sepsis: a decision analysis. Obstet Gynecol. 1994 Apr;83(4):483–494. doi: 10.1097/00006250-199404000-00001. [DOI] [PubMed] [Google Scholar]
- Yow M. D., Mason E. O., Leeds L. J., Thompson P. K., Clark D. J., Gardner S. E. Ampicillin prevents intrapartum transmission of group B streptococcus. JAMA. 1979 Mar 23;241(12):1245–1247. [PubMed] [Google Scholar]