PPROM + GBS GTG

Question 1

How common is PPROM in pregnancy?

Answer 1

3%

Question 2

PPROM is associated with what % of preterm births?

Answer 2

30-40%

Question 3

Median latency from PROM to delivery?

Answer 3

7 days (shortens as GA advances)

Question 4

Risks of PPROM

Answer 4

Prematurity
Sepsis
Cord prolapse
Pulmonary hypoplasia
Chorio
Placental abruption

Question 5

Assessment

Answer 5

Speculum + visualise liquor or ROM test
HVS ?GBS
Clinical assessment
Bloods ?increased inflammation makers

Question 6

Management?

Answer 6

Inform neonates
Abx (erythromycin for 10 days or until delivery or penicillin)
Give steroids 24-33+6, consider 34-35+6
Mgsu if delivery expected with 24 hrs 24-29+6, consider 30-33+6

Question 7

Expectant management until what gestation?

Answer 7

37 weeks
If GBS 34 weeks

Question 8

Overal incidence EOGBS?

Answer 8

0.57/1000

Question 9

Incidence EOGBS in term infants and preterm infants?

Answer 9

Term 0.2/1000
Preterm 2.3/1000

Question 10

Risk EOGBS if GBS detect this pregnancy?

Answer 10

1/400

Question 11

Risk EOGBS if GBS detect last pregnancy?

Answer 11

1/800

Question 12

Risk EOGBS if temperature >38 in labour

Answer 12

5.3/1000

Question 13

What % of women who are carriers in last pregnant are carriers in this pregnancy?

Answer 13

50%

Question 14

If performing GBS screening on woman with previous GBS, when to offer?

Answer 14

Singleton 35-37 weeks
Multiple: 32-34 weeks

Question 15

What % of women who are +ve at 35-37 weeks are negative at delivery?

Answer 15

17-25%

Question 16

What % of women who are -ve at 35-37 weeks are positive at delivery?

Answer 16

5-7%

Question 17

If SROM at term and GBS +ve?

Answer 17

Offer immediate IOL and IAP

Question 18

If SROM at term and GBS -ve?

Answer 18

Expectant management for 24 hours, then IOL and IAP.

Question 19

PPROM/preterm labour when to start Abx?

Answer 19

Regardless of GBS status, give IAP

Question 20

If GBS and no Abx, how long should the baby be monitored?

Answer 20

12 hours after birth
0,1,2, then 2 hourly until 12 hrs

Question 21

If GBS and had IV Abx for 4 hours before delivery, what monitoring?

Answer 21

No monitoring required