Incidence of intrapartum maternal risk factors for identifying neonates at risk 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 the American Academy of Pediatrics all published guidelines outlining 2 potential strategies for the purpose of preventing neonatal sepsis caused by group B Streptococcus. One of these approaches involves treating pregnant women intrapartum with antibiotics if any of the following risk factors develop: delivery at <37 weeks' gestation, membrane rupture for greater than or equal to 18 hours' duration, or temperature during labor of greater than or equal 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 institution evaluating all deliveries for the presence of maternal risk factors by 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 was composed of 5410 consecutively delivered patients from the 4 different hospitals. Every pregnancy was analyzed for gestational age at delivery, duration 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 their 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 temperature 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 defined risk factors. CONCLUSIONS: These data suggest that, if the current risk factor strategy is used, 19.8% of the delivering population would potentially be candidates for intrapartum antibiotic chemoprophylaxis.