Incidence of intrapartum maternal risk factors for identifying neonates atrisk for early-onset group B streptococcal sepsis: A prospective study

OBJECTIVE: In mid-1996 and early 1997, the Centers for Disease Control and Prevention, The American College of Obstetricians and Gynecologists, and th e American Academy of Pediatrics all published guidelines outlining 2 poten tial strategies for the purpose of preventing neonatal sepsis caused by gro up B Streptococcus. One of these approaches involves treating pregnant wome n intrapartum with antibiotics if any of the following risk factors develop : delivery at <37 weeks' gestation, membrane rupture for greater than or eq ual to 18 hours' duration, or temperature during labor of greater than or e qual to 38 degrees C. However, to date there have been no population-based studies that have ascertained the percentage of pregnant women eligible to receive intrapartum antibiotic chemoprophylaxis if these risk factors were used. Our objective was to perform a large patient-based study at >1 instit ution evaluating all deliveries for the presence of maternal risk factors b y using the definitions of the current guidelines. STUDY DESIGN: A prospective cohort study was initiated in 1995 at 3 private community hospitals and 1 private referral center. The study population wa s composed of 5410 consecutively delivered patients from the 4 different ho spitals. Every pregnancy was analyzed for gestational age at delivery, dura tion of membrane rupture, temperature during labor, and use of intrapartum antibiotic chemoprophylaxis. RESULTS: Of the 5410 patients, a total of 455 (8.4%) were delivered of thei r neonates before 37 weeks' gestation, 421 (7.8%) had rupture of membranes for at least 18 hours' duration, and 378 (7.0%) had an intrapartum temperat ure of greater than or equal to 38 degrees C. Overall, 1071 pregnant women (19.8% of the population studied) had greater than or equal to 1 of the def ined risk factors. CONCLUSIONS: These data suggest that, if the current risk factor strategy i s used, 19.8% of the delivering population would potentially be candidates for intrapartum antibiotic chemoprophylaxis.