Compliance With Guidelines on Group B Streptococcus Sepsis Prophylaxis Among Women Requiring Unscheduled Cesarean Delivery [147

Abstract

INTRODUCTION: Group B streptococcus (Streptococcus agalactiae, GBS) has been a recognized cause of neonatal morbidity and mortality since the 1970s. Antibiotic prophylaxis guidelines have been established by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (the College) to reduce early onset of GBS sepsis. However, adherence to the established guidelines in some instances may be suboptimal. Women in active labor or those having ruptured membranes before unscheduled cesarean delivery may not receive recommended prophylactic antibiotics. METHODS: A retrospective, consecutive medical record review of GBS-positive women at term gestation who delivered by unscheduled cesarean delivery between January 1, 2011, and December 31, 2013, was conducted. Records were eligible for review if women were 37–39 weeks of gestation at the time of unscheduled primary or repeat cesarean delivery, GBS culture-positive status, and either had spontaneous rupture of membranes or active labor before cesarean delivery. Compliance was determined based on evidence of appropriate antibiotics for GBS (taking allergies into consideration) according to College guidelines. RESULTS: Of 115 cases reviewed, 83 (72.2%) cases were primary and 32 (27.8%) were repeat cesarean delivery. At delivery, women averaged 38 1/7 weeks of gestation. Thirty-five cases (30.4%) were considered noncompliant with College guidelines for GBS. Of those noncompliant, 28 instances (80%) were because no antibiotics were given for GBS and seven patients (20%) received inappropriate antibiotics. CONCLUSION: Adherence to College GBS prophylaxis guidelines is inadequate before unscheduled cesarean delivery, and additional interventions, education, and training are needed to improve compliance.