A 24-YEAR-OLD G2P1 PRESENTS AT 36 WEEKS’ GESTATION IN ACTIVE LABOR. HER GBS CULTURE IS NOT AVAILABLE. WHICH OF THE FOLLOWING REPRESENTS THE MOST APPROPRIATE MANAGEMENT IN THIS SETTING

• A. Do nothing
• B. Administer GBS chemoprophylaxis empirically ✓
• C. Administer antibiotics only if she develops a fever
• D. Send a GBS perineal culture and wait for the result to decide whether or not to give antibiotics
• E. Review her GBS status from her prior pregnancy to decide whether or not to give antibiotics

The most appropriate management in this scenario would be to Administer GBS chemoprophylaxis empirically. Group B Streptococcus (GBS) is a common bacterium that can colonize the genital tract of pregnant women and poses a risk of transmitting to the newborn during delivery, potentially causing serious infections such as sepsis, pneumonia, and meningitis. Given that the patient’s GBS culture is not available and she is in active labor at 36 weeks’ gestation, it is crucial to initiate empiric antibiotic treatment to reduce the risk of neonatal GBS infection.

Empirical antibiotic prophylaxis for GBS is recommended in cases where the GBS status is unknown but there are risk factors present, such as preterm labor or rupture of membranes at term without adequate intrapartum antibiotic prophylaxis. The standard regimen for GBS prophylaxis typically involves administering intravenous penicillin or ampicillin during labor, as these antibiotics have been shown to effectively reduce the transmission of GBS to the newborn.

Delaying antibiotic administration until the patient develops a fever (option C) or waiting for the results of a GBS perineal culture (option D) can increase the risk of neonatal infection and should be avoided in this urgent clinical scenario. Reviewing her GBS status from a prior pregnancy (option E) may not accurately reflect her current colonization status, as GBS colonization can change over time.

In summary, given the lack of available GBS culture and the patient being in active labor at 36 weeks’ gestation, it is most appropriate to administer empirical GBS chemoprophylaxis to reduce the risk of neonatal infection.

In other words, Empirical administration of antibiotics in such cases helps reduce the risk of vertical transmission of GBS from mother to newborn during delivery, thereby preventing potential neonatal complications associated with GBS infection.