Antepartum Membrane Stripping in GBS Carriers, Is It Safe? (The STRIP-G Study)

Doron Kabiri, Yael Hants, Tom Raz Yarkoni, Esther Shaulof, Smadar Eventov Friedman, Ora Paltiel, Ran Nir-Paz, Wesam E Aljamal, Yossef Ezra, Doron Kabiri, Yael Hants, Tom Raz Yarkoni, Esther Shaulof, Smadar Eventov Friedman, Ora Paltiel, Ran Nir-Paz, Wesam E Aljamal, Yossef Ezra

Abstract

Objective: Stripping of the membranes is an established and widely utilized obstetric procedure associated with higher spontaneous vaginal delivery rates, reduced need for formal induction of labor and a lower likelihood of post-term pregnancy. Due to the theoretical concern of bacterial seeding during the procedure many practitioners choose not to sweep the membranes in Group B Streptococcus (GBS) colonized patients. We conducted 'the STRIP-G study' in order to determine whether maternal and neonatal outcomes are affected by GBS carrier status in women undergoing membrane stripping.

Study design: We conducted a prospective study in a tertiary referral center, comparing maternal and neonatal outcomes following membrane stripping among GBS-positive, GBS-negative, and GBS-unknown patients. We compared the incidence of composite adverse neonatal outcomes (primary outcome) among the three study groups, while secondary outcome measure was composite adverse maternal outcomes.

Results: A total of 542 women were included in the study, of which 135 were GBS-positive, 361 GBS-negative, and 46 GBS-unknown status. Demographic, obstetric, and intra-partum characteristics were similar for all groups. Adverse neonatal outcomes were observed in 8 (5.9%), 31 (8.6%), and 2 (4.3%) in the GBS-positive, GBS-negative, and unknown groups, respectively (P = 0.530), (Odds Ratio between GBS-Positive vs. GBS-Negative groups 0.67 (95%, CI = 0.30-1.50)); while composite adverse maternal outcomes occurred in 9 (6.66%), 31 (8.59%), and 5 (10.87%) in the GBS-positive, GBS-negative, and unknown groups, respectively (P = 0.617).

Conclusions: Antepartum membrane stripping in GBS carriers appears to be a safe obstetrical procedure that does not adversely affect maternal or neonatal outcomes.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Clinical Indicators Of Possible-Early-Onset Neonatal…
Fig 1. Clinical Indicators Of Possible-Early-Onset Neonatal Infection.
(Figure reproduced from “Antibiotics for early-onset neonatal infection”, NICE clinical guidelines 149, 2012).
Fig 2. Maternal Colonization with GBS.
Fig 2. Maternal Colonization with GBS.
Fig 3. ‘Compromised Neonate’ Rate and Composite…
Fig 3. ‘Compromised Neonate’ Rate and Composite Adverse Maternal Outcomes Rate.

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