Advertisement

72: Membrane sweeping in GBS positive patients: a randomized controlled trial

      Objective

      Based on the theoretical increased risk of bacterial seeding after membrane sweeping, as well as concern for fast labors and inadequate antibiotic treatment after membrane sweeping, some practitioners elect not to sweep membranes in GBS positive patients. This study was designed to determine whether membrane sweeping in GBS positive women is associated with inadequate antibiotic treatment in labor(defined as less than four hours of antibiotic therapy prior to delivery).

      Study Design

      We performed a randomized controlled trial comparing a policy of membrane sweeping to no sweeping among GBS positive women. All women who presented to an outpatient obstetrics clinic who were >/= 37 weeks, were candidates for vaginal delivery and qualified for GBS prophylaxis were offered enrollment. Subjects were randomized using random number generation and block randomization. No blinding was attempted. A power analysis mandated 60 women in each group. In the intervention group sweeping was attempted at each visit. In the control group, no membrane sweeping was attempted. Standard CDC protocol antibiotic prophylaxis was given. After delivery, information from the patient and infant record was collected. Fishers exact test was used to compare outcomes between the two groups using an intention-to-treat analysis.

      Results

      123 patients were enrolled in the study, 7 of whom withdrew from the study or were lost to follow up.There were no baseline differences in maternal or fetal characteristics, type of GBS positivity, or type of antibiotic received between the two groups. We found no difference in adequacy of antibiotic treatment in labor between the women in the control group and women in the experimental group. There were also no differences in secondary outcomes, including incidence of induction of labor, PROM, or need for infant antibiotic treatment (see table). No adverse maternal effects of membrane sweeping were noted and there was a trend towards decreased neonatal complications in the sweeping arm.
      Tabled 1Outcomes in Control and Sweeping Groups
      OutcomeControl Number (%) n=62Sweeping Number (%) n=61p-value
      # of Episodes of Membrane Sweeping
      059 (95.1)19 (31.7)< 0.001
      13 (4.9)22 (36.7)
      >/=20 (0)19 (31.7)
      Adequate Antibiotics54 (92)54 (93)1.0
      Delivery method
      Vaginal43 (72.9)48 (84.2)0.17
      LTCS16 (27.1)9 (15.8)
      Indication for Admission
      Labor32 (54.3)31 (54.4)0.18
      Induction18 (30.5)19 (33.3)
      PROM9 (15.2)6 (10.5)
      Scheduled CS01 (1.8)
      Chorioamnionitis3 (5.0)2 (3.5)1.0
      Composite Neonatal Outcome12 (19.3)6 (9.8)0.2
      Neonatal Antibiotics Received4 (6.7)4 (7.0)1.0

      Conclusions

      In our study, membrane sweeping did not affect adequacy of antibiotic treatment for GBS.