Using vaginal Group B Streptococcus colonisation in women with preterm premature rupture of membranes to guide the decision for immediate delivery: a secondary analysis of the PPROMEXIL trials

BJOG. 2014 Sep;121(10):1263-72; discussion 1273. doi: 10.1111/1471-0528.12889. Epub 2014 May 27.


Objective: To investigate whether vaginal Group B Streptococcus (GBS) colonisation or other baseline characteristics of women with preterm premature rupture of membranes (PPROM) can help in identifying subgroups of women who would benefit from immediate delivery.

Design: Secondary analysis of the PPROMEXIL trials.

Setting: Sixty hospitals in the Netherlands.

Population: Women with PPROM between 34 and 37 weeks of gestation.

Methods: Random assignment of 723 women to immediate delivery or expectant management.

Main outcome measures: Early onset neonatal sepsis.

Results: Vaginal GBS colonisation status was the only marker which was significantly associated with the benefit of immediate delivery (P for interaction: 0.04). GBS colonisation was observed in 14% of women. The risk of early onset neonatal sepsis in GBS-positive women was high (15.2%) when they were managed expectantly but this risk was reduced to 1.8% with immediate delivery. The early onset neonatal sepsis risk was much lower in neonates of GBS-negative women: 2.6% after expectant management and 2.9% with immediate delivery. We estimated that by inducing labour only in GBS-positive women, there would be a 10.4% increase in term delivery rate, while keeping neonatal sepsis and caesarean delivery rates comparable to a strategy of labour induction for all.

Conclusions: Our post hoc findings suggest that women with PROM between 34 and 37 weeks might benefit from immediate delivery if they have GBS vaginal colonisation, while in GBS-negative women labour induction could be delayed until 37 weeks.

Keywords: Early onset neonatal sepsis; group B streptococcus; preterm premature rupture of membranes; treatment selection marker; vaginal culture.

Publication types

  • Clinical Trial, Phase I
  • Clinical Trial, Phase II
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Decision Making
  • Delivery, Obstetric*
  • Female
  • Fetal Membranes, Premature Rupture / microbiology*
  • Fetal Membranes, Premature Rupture / therapy
  • Humans
  • Netherlands
  • Pregnancy
  • Pregnancy Complications, Infectious / microbiology*
  • Pregnancy Complications, Infectious / therapy
  • Risk Factors
  • Streptococcal Infections / diagnosis*
  • Streptococcus agalactiae / isolation & purification*
  • Treatment Outcome
  • Vagina / microbiology*

Supplementary concepts

  • Preterm Premature Rupture of the Membranes

Associated data

  • ISRCTN/ISRCTN05689407
  • ISRCTN/ISRCTN29313500