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Pre-labour rupture of membranes at term: have our changes in practice made any difference to maternal and neonatal outcomes?
  1. R Mohamed,
  2. M Ramsay
  1. Queen's Medical Centre, Nottingham, UK


Pre-Labour Rupture of Membranes (PROM) occurs in approximately 8% of term pregnancies. 116 cases were reviewed in 2005 to look at the relationship between PROM at term and infectious morbidity with regards to maternal and neonatal outcomes.

There was a 30% rate of intrapartum sepsis and 17 babies received antibiotics. Sepsis was more likely to occur in primigravidae who had longer labours and more vaginal examinations.

The re-audit in 2009 looked at 100 cases of PROM at term to assess whether or not induction of labour occurs at 24 h after rupture of membranes, as recommended by NICE guidelines; and to see if our changes in practice have reduced infectious morbidity.

The results showed that the authors induce women at 30 h after PROM, therefore not meeting the NICE standards. The authors have reduced the rates of sepsis, with only 17 women having signs of infection, and five babies receiving intravenous antibiotics.

The most interesting finding of this study was the low rate of Group B Streptococcus (GBS) infection, with four cases in total and only one picked up at presentation. In the previous study, there were eight cases identified during pregnancy and another 15 cases at presentation with PROM. As per the NICE guidelines of 2008, the authors are taking fewer swabs; therefore possibly missing cases of GBS.

I would like to conduct a further study using a larger sample of women to assess the rates of GBS infection with and without taking High Vaginal Swabs at presentation with PROM at term.

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