Rapid identification of group B streptococcus carriage by PCR to assist in the management of women with prelabour rupture of membranes in term pregnancy
Article first published online: 13 NOV 2013
© 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Australian and New Zealand Journal of Obstetrics and Gynaecology
Volume 54, Issue 2, pages 138–145, April 2014
How to Cite
Chan, W. S.W., Chua, S. C., Gidding, H. F., Ramjan, D., Wong, M. Y.W., Olma, T., Thomas, L. and Gilbert, G. L. (2014), Rapid identification of group B streptococcus carriage by PCR to assist in the management of women with prelabour rupture of membranes in term pregnancy. Australian and New Zealand Journal of Obstetrics and Gynaecology, 54: 138–145. doi: 10.1111/ajo.12145
- Issue published online: 1 APR 2014
- Article first published online: 13 NOV 2013
- Manuscript Accepted: 15 SEP 2013
- Manuscript Received: 1 JUL 2013
- Department of Obstetrics & Gynaecology, Westmead Hospital
- Centre of Infectious Diseases and Microbiology – Public Health, Westmead Hospital
- group B streptococcus carriage;
- PCR ;
- prelabour rupture of membranes in term pregnancy
Management of prelabour rupture of membranes at term (37 weeks gestation or later) (TPROM) remains complicated in the absence of a rapid assay for group B streptococcus (GBS) colonisation.
To evaluate the accuracy and clinical utility of a commercial PCR assay, compared with culture, for detection of GBS colonisation in pregnant women presenting with TPROM.
A prospective study of women presenting with TPROM conducted in a large tertiary hospital (Westmead Hospital, Australia). Five hundred and seventy-four consecutive women with TPROM were enrolled between July 2006 and November 2007. Paired low vaginal and anal swabs were collected from women presenting with TPROM for PCR and culture on GBS selective agar following broth enrichment. Primary outcomes were sensitivity and specificity of PCR compared with GBS selective enrichment culture. Secondary analyses included comparison with a historical but otherwise similar cohort regarding clinical utility, maternal and neonatal outcomes.
PCR sensitivity and specificity were 89.0% (95% CI – 82.8–93.6%) and 97.9% (95% CI – 96.0–99.0%), respectively, compared with culture. 72.3% of women were aware of their GBS PCR status within 3 h of presentation. Compared with the historical cohort, PCR reduced the requirement for intrapartum antibiotics by 25.6% (P < 0.001). There were no significant differences in maternal outcomes or combined rates of admissions to neonatal intensive care or special care nursery.
Group B streptococcus PCR is an accurate, rapid, safe and practical alternative to culture for detection of GBS colonisation in pregnant women at the time of TPROM. This method has the potential advantage to reduce costs associated with length of hospital stay.