Cervical Manipulations Linked to Perinatal Sepsis: Consider GBS-specific chemoprophylaxis

OB/GYN News, Oct 15, 2001 by Kathryn DeMott

QUEBEC CITY -- Obstetricians may want to hold off on performing cervical manipulation or membrane stripping to hasten labor in women with cervical/vaginal infection or colonization with pathogens, Dr. Carol Stamm reported at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

In a series of eight case reports, Dr. Stamm of the University of Colorado, Denver, described how cervical manipulation or membrane stripping preceded perinatal sepsis and even one instance of stillbirth caused by invasive group B streptococcus (GBS) as well as other pathogens.

In each case, the salient features were the same: Each woman had a history of term gestation in a previously healthy pregnancy. All had elective or nonurgently indicated promotion of labor, digital cervical manipulation, and rapid labor with placental findings of histologically severe intrauterine infection or funisitis, half the time in the absence of classical clinical criteria of chorioamnionitis.

One patient gave birth to a stillborn 15 hours after membrane stripping due to overwhelming fetal GBS sepsis. In four of the eight cases, the women had no risk factors such as known GBS infection or symptoms of chorioamnionitis; in the remaining four cases there were such red flags.

It has always been assumed that such events are rare; however, their incidence can only really be established by large, prospective epidemiologic studies, Dr. Stamm noted in her poster presentation.

Membrane stripping and cervical manipulation to release prostaglandins can be considerably vigorous. And this series of case reports builds on prior evidence that suggests that it is traumatic enough to cause vaginal microbes to spread into the lower uterus.

On the basis of these case reports, obstetricians may want to reconsider doing elective cervical manipulation, at least on patients who have cervical vaginal infection or colonization with potential perinatal pathogens. They may also want to consider providing GBS-specific chemoprophylaxis before membrane stripping, she said.