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Old 11-10-2012
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ObGyn PTL PROM Penicillin

frnz
is preterm labor indication for GBS prophylaxis ? its not mentioned in formal indication for the same.

PROM IMO is an indication !
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Old 11-11-2012
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If its prolonged (greater than 18 hours) then yes, you give prophylaxis, even if you dont know the carrier status or if it was positive, you give prophylaxis.

Must look for chorioamnionitis which is suspected if the rupture of membranes is prolonged + maternal fever and absence of an UTI or URI.
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Old 11-11-2012
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Algorithm for screening for group B streptococcal (GBS) colonization and use of intrapartum prophylaxis for women with preterm* labor (PTL)



Algorithm for screening for group B streptococcal (GBS) colonization and use of intrapartum prophylaxis for women with preterm* premature rupture of membranes (pPROM)
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Old 11-11-2012
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Threatened Preterm Delivery

Women admitted with signs and symptoms of preterm labor (before 37 weeks and 0 days' gestation) should be managed according to the algorithm provided (Figure 5). Women with rupture of membranes at <37 weeks and 0 days' gestation should be managed according to the algorithm provided (Figure 6).
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The following are key components of threatened preterm delivery GBS management:
  • Women admitted with signs and symptoms of labor or with rupture of membranes at <37 weeks and 0 days' gestation should be screened for GBS colonization at hospital admission unless a vaginal-rectal GBS screen was performed within the preceding 5 weeks (AII).
  • Women admitted with signs and symptoms of preterm labor who have unknown GBS colonization status at admission or a positive GBS screen within the preceding 5 weeks should receive GBS prophylaxis at hospital admission (AII).
  • Antibiotics given for GBS prophylaxis to a woman with preterm labor should be discontinued immediately if at any point it is determined that she is not in true labor or if the GBS culture at admission is negative (AII).
  • Negative GBS colonization status should not affect the administration of antibiotics for other indications (AIII).
  • Women with threatened preterm delivery who have a GBS screen performed that is positive and do not deliver at that time should receive GBS prophylaxis when true labor begins (AII).
  • Women with threatened preterm delivery who have a GBS screen performed that is negative but do not deliver at that time should undergo repeat screening at 35--37 weeks' gestation. If such women are re-admitted at a later date with threatened preterm delivery, they should undergo repeat screening if the previous culture was performed >5 weeks prior (AIII).
The following key changes were made from the 2002 guidelines:
  • Separate algorithms are presented for GBS prophylaxis in the setting of threatened preterm delivery, one for spontaneous preterm labor (Figure 5) and one for preterm premature rupture of membranes (Figure 6).
  • GBS prophylaxis provided to women with signs and symptoms of preterm labor should be discontinued if it is determined that the patient is not in true labor (AI).
  • Antibiotics given to prolong latency for preterm premature rupture of membranes with adequate GBS coverage (specifically 2 g ampicillin administered intravenously followed by 1 g administered intravenously every 6 hours for 48 hours) are sufficient for GBS prophylaxis if delivery occurs while the patient is receiving that antibiotic regime (CIII). Oral antibiotics alone are not adequate for GBS prophylaxis (DII).
  • Women with preterm premature rupture of membranes who are not in labor and are receiving antibiotics to prolong latency with adequate GBS coverage should be managed according to standard of care for preterm premature rupture of membranes; GBS testing results should not affect the duration of antibiotics (BIII).
  • Women with preterm premature rupture of membranes who are not in labor and are not receiving antibiotics to prolong latency (or are receiving antibiotics that do not have adequate GBS coverage) should receive GBS prophylaxis for 48 hours, unless a GBS screen performed within the preceding 5 weeks was negative (CIII). If the results from a GBS screen performed on admission become available during that 48-hour period and are negative, then GBS prophylaxis should be discontinued at that time.
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Last edited by Novobiocin; 11-11-2012 at 05:08 PM.
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