A Retrospective Review of Neonatal Sepsis among GBS-Colonized Women Undergoing Planned Cesarean Section after Labor Onset or Rupture of Membranes

Abstract

Background. Sepsis is a leading cause of mortality and morbidity in neonates, with group B streptococcus (GBS) remaining the most frequent pathogen isolated from term infants. Surveillance data showed that the majority of cases of early-onset GBS disease were neonates born to women who either received no or suboptimal intrapartum antibiotic prophylaxis with a notable portion of those women having a missed opportunity to receive ≥4 hours of chemoprophylaxis. Women planning delivery by cesarean section who present in labor or rupture of membranes prior to their scheduled surgery are unlikely to receive optimal GBS chemoprophylaxis and thus their neonates are at risk of having sepsis. Materials and Methods. A retrospective cohort study of women-infant dyads was extracted from the Consortium on Safe Labor dataset. Women who had an unlabored cesarean section at ≥37+0 week gestation were selected and divided into four groups based on GBS status and timing of cesarean section with respect to onset of labor or rupture of membranes. The rate of neonatal sepsis and the patterns of intrapartum antibiotic chemoprophylaxis were determined. Results. The sepsis rate (4.5%) among neonates of GBS-colonized women having their unlabored cesarean section after onset of labor or rupture of membranes was significantly higher than that in any other group in this study. In this group, 9.4% of women received chemoprophylaxis for ≥4 hours, while 31% had a missed opportunity to receive ≥4 hours of chemoprophylaxis. Conclusion. This study suggests that neonates of GBS-colonized women having a planned cesarean section after onset of labor or rupture of membranes are at increased risk of having a sepsis diagnosis. This finding suggest the need for additional studies to assess the risk of sepsis among neonates of women in this group.

Oral Probiotic Supplementation in Pregnancy to Reduce Group B Streptococcus Colonisation (OPSiP trial): study protocol for a double-blind parallel group randomised placebo trial

“…We will examine subgroups by BMI status as pregnant individuals with obesity may have a higher likelihood of being GBS positive 63. Sufficient numbers permitting, we will also undertake a subgroup analysis according to the mode of delivery (caesarean vs vaginal birth) as caesarean birth does not prevent ascending colonisation occurring during pregnancy 64…”

“… 63 Sufficient numbers permitting, we will also undertake a subgroup analysis according to the mode of delivery (caesarean vs vaginal birth) as caesarean birth does not prevent ascending colonisation occurring during pregnancy. 64 …”

“…63 Sufficient numbers permitting, we will also undertake a subgroup analysis according to the mode of delivery (caesarean vs vaginal birth) as caesarean birth does not prevent ascending colonisation occurring during pregnancy. 64 Additional analyses will be used to examine the treatment effect by reported compliance with study supplements (per protocol analysis), treatment effect adjusted by intake GBS status (prior to beginning the intervention), to assess the potential impact of established versus new colonisation after initiation of supplements and treatment effect adjusted for use of other dietary probiotic sources.…”