Preterm Labor and GBS Prophylaxis!

[tyagee]

is preterm labor itself indication for pencilin for GBS prophylaxis ? or we need to do culture first

[K06100]

I think its itself an indication ...no need to culture.......

[aman_j]

So many causes of preterm labor... If infection is suspected from clinical feat. Or labs then role of penicillin otherwise I doubt there is any role of penicillin

[stfidel]

Aman_J....indications for GBS prophylaxis

Preterm labour<37 wks...irrespective of cause

PROM>18hrs

Previous Hx of GBS neonate

Culture positive for GBS during current pregnancy

Maternal Fever at term

[tyagee]

Kaplan mentions to take urine cx. That means we can give pencilin without cx in ptl ?


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[rocketprinciple]

Stfidel is right! No need for culture first

And there's one more point though,
*If you don't know the current GBS status of the patient and she is in labor, You STILL give prophylaxis!

Case Closed..... Hopefully

[tyagee]

Originally Posted by rocketprinciple

Stfidel is right! No need for culture first

And there's one more point though,
*If you don't know the current GBS status of the patient and she is in labor, You STILL give prophylaxis!

Case Closed..... Hopefully

The indications for GBS prophylaxis include delivery at < 37
weeks, duration of membrane rupture greater than or equal to 18 hours, temperature greater than or equal to
37.0C ( 100.4 F), GBS bacteriuria in any concentration during their current pregnancy, or women who
previously gave birth to an infant with Group B streptococcal disease.

**friends, this is from uworld.

i just want to re-confirm that PTL [preterm labor] is indication of IV penicilin or not ?

so far i have read from kaplan & uworld --- they mention PROM as indication of IV penicilin not PTL. hopefully, we are not confussing PROM with PTL and making PTL also as indication!!!
this question is very high yeild as my know.

so ?

[Novobiocin]

CDC 2010 guidelines

The foundations of prevention in 2010 remain unchanged from the 2002 guidelines:
Pregnant women should undergo vaginal-rectal screening for GBS colonization at 35-37 weeks.
Intrapartum antibiotic prophylaxis (IAP) is recommended for:
Women who delivered a previous infant with GBS disease
Women with GBS bacteriuria in the current pregnancy
Women with a GBS-positive screening result in the current pregnancy
Women with unknown GBS status who deliver at less than 37 weeks’ gestation, have an intrapartum temperature of 100.4°F or greater, or have rupture of membranes for 18 hours or longer.
Penicillin remains the preferred agent with ampicillin an acceptable alternative.

Algorithm for screening for group B streptococcal (GBS) colonization and use of intrapartum prophylaxis for women with preterm labor (PTL)

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.