Authors' reply re: Prevention of early‐onset Group B streptococcal disease. Green‐top Guideline No. 36

Hughes, Rhona; Brocklehurst, Peter; Steer, Philip; Heath, Paul T; Stenson, Ben J

doi:10.1111/1471-0528.15165

Cited by 27 publications

(47 citation statements)

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“…Inaccurate prediction of intralabor GBS colonization by an-tenatal screening is one of the reasons the Royal College of Obstetricians and Gynaecologists did not recommend universal screening in their 2017 guideline 8. However, within 4 weeks after screening, < 4% of the GBS-negative women in our study changed to GBS-positive.…”

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confidence: 56%

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The effect of screening‐to‐labor interval on the sensitivity of late‐pregnancy culture in the prediction of group B streptococcus colonization at labor: A prospective multicenter cohort study

Virranniemi

Raudaskoski

Haapsamo

et al. 2019

Acta Obstet Gynecol Scand

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Introduction:The aim of this study was to evaluate the effect of increasing screening-to-labor interval on the performance of group B streptococcus (GBS) screening by late-pregnancy enriched culture compared with intrapartum real-time polymerase chain reaction (RT-PCR). Material and methods: Group B streptococcus colonization was determined in 2624women with singleton pregnancies by culture at 35-37 weeks of gestation and at the beginning of labor by culture and RT-PCR from recto-vaginal swab samples. Results:Group B streptococcus colonization rates were 29.0% in late-pregnancy culture, 29.7% in intrapartum culture and 28.2% in intrapartum PCR. Intrapartum culture was used as a reference, the late-pregnancy culture had an overall sensitivity of 89.2% (95% CI 88.0%-90.4%) and specificity of 96.5% (95% CI 95.8%-97.2%), and intrapartum PCR had sensitivity of 91.5% (95% CI 90.4%-92.6%) and specificity of 98.5% (95% CI 98.0%-99.0%). However, up to 4 weeks after screening, the sensitivity of late-pregnancy culture was equivalent to or higher than that of RT-PCR. The RT-PCR was invalid in 0.9% of the women. Between late-pregnancy screening and labor, GBS colonization changed from negative to positive in 3.2% and from positive to negative in 2.5% of the women. Conclusions:The late-pregnancy enriched culture and intrapartum RT-PCR have comparable sensitivities in the detection of GBS when culture screening is conducted no more than 4 weeks before labor. Late-pregnancy culture sampling should be postponed to at least 37 weeks of gestation. K E Y W O R D S enriched culture, Group B streptococcus, intrapartum RT-PCR, late-pregnancy Group B streptococcus screening, screening | 495 VIRRANNIEMI Et Al.

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confidence: 56%

“…Antenatal GBS screening and intrapartum antibiotic prophylaxis (IAP) of GBS-positive mothers reduce neonatal GBS infections by 80%. 8 The reference standard of GBS detection has long been enriched culture for GBS, with a sensitivity of 80%-100%. 2,3 Problematically, GBS colonization may be transient or periodic.…”

Section: Introductionmentioning

confidence: 99%

The effect of screening‐to‐labor interval on the sensitivity of late‐pregnancy culture in the prediction of group B streptococcus colonization at labor: A prospective multicenter cohort study

Virranniemi

Raudaskoski

Haapsamo

et al. 2019

Acta Obstet Gynecol Scand

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“…Alternative cefazolin or vancomycin (20 mg/kg IV every 8 h -maximum 2 g) RCOG (UK) [104,105] Penicillin Erythromycin (may be used if allergic to penicillin) For 10 days IAP regime for GBS colonized women: benzylpenicillin (3 g IV and 1.5 g 4-h until delivery) or clindamycin (900 mg IV 8-h) if allergic to penicillin; alternative vancomycin by resistant SOGC (Canada) [100,106] Ampicillin and/or erythromycin (alone if allergic to penicillin) 2 g IV every 6 h for 48 h and amoxicillin 250 mg PO every 8 h for 5 days 250 mg IV every 6 h for 48 h following by 333 mg PO every 8 h for 5 days or 250 mg PO every 6 h for 10 days IAP regime for GBS colonized women: penicillin G 5 million units IV, then 2.5 million 4 h instead of ampicillin or cefazolin (2 g IV then 1 g IV 8 h) if penicillin allergic but not at risk of anaphylaxis or erythromycin (500 mg IV every 6 h) or clindamycin (900 mg IV every 8 h) if penicillin allergic and at risk of anaphylactic shock PPROM to prevent bacteremia, chorioamnionitis and FIRS. The amniotic membranes and the umbilical cord do not have an effective capillary net and the antibiotic from the maternal circulation does not reach the bacteria which is colonized on the surfaces in sufficient concentrations ( Figure 3).…”

Section: Antibiotics and Probioticsmentioning

confidence: 99%

Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome

Tchirikov

Schlabritz‐Loutsevitch

Mäher

et al. 2017

Journal of Perinatal Medicine

187

153

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Mid-trimester preterm premature rupture of membranes (PPROM), defined as rupture of fetal membranes prior to 28 weeks of gestation, complicates approximately 0.4%-0.7% of all pregnancies. This condition is associated with a very high neonatal mortality rate as well as an increased risk of long-and short-term severe neonatal morbidity. The causes of the mid-trimester PPROM are multifactorial. Altered membrane morphology including marked swelling and disruption of the collagen network which is seen with PPROM can be triggered by bacterial products or/and pro-inflammatory cytokines. Activation of matrix metalloproteinases (MMP) have been implicated in the mechanism of PPROM. The propagation of bacteria is an important contributing factor not only in PPROM, but also in adverse neonatal and maternal outcomes after PPROM. Inflammatory mediators likely play a causative role in both disruption of fetal membrane integrity and activation of uterine contraction. The "classic PPROM" with oligo/anhydramnion is associated with a short latency period and worse neonatal outcome compared to similar gestational aged neonates delivered without antecedent PPROM. The "high PPROM" syndrome is defined as a defect of the chorio-amniotic membranes, which is not located over the internal cervical os. It may be associated with either a normal or reduced amount of amniotic fluid. It may explain why sensitive biochemical tests such as the Amniosure (PAMG-1) or IGFBP-1/alpha fetoprotein test can have a positive result without other signs of overt ROM such as fluid leakage with Valsalva. The membrane defect following fetoscopy also fulfils the criteria for "high PPROM" syndrome. In some cases, the rupture of only one membrane -either the chorionic or amniotic membrane, resulting in "pre-PPROM" could precede "classic PPROM" or "high PPROM". The diagnosis of PPROM is classically established by identification of nitrazine positive, fern positive watery leakage from the cervical canal observed during in specula investigation. Other more recent diagnostic tests include the vaginal swab assay for placental alpha macroglobulin-1 test or AFP and IGFBP1. In some rare cases amniocentesis and infusion of indigo carmine has been used to confirm the diagnosis of PPROM. The management of the PPROM requires balancing the potential neonatal benefits from prolongation of the pregnancy with the risk of intraamniotic infection and its consequences for the mother and infant. Close monitoring for signs of chorioamnionitis (e.g. body temperature, CTG, CRP, leucocytes, IL-6, procalcitonine, amniotic fluid examinations) is necessary to minimize the risk of neonatal and maternal complications. In addition to delayed delivery, broad spectrum antibiotics of penicillin or cephalosporin group and/or macrolide and corticosteroids have been show to improve neonatal outcome [reducing risk of chorioamnionitis (average risk ratio (RR) = 0.66), neonatal infections (RR = 0.67) and abnormal ultrasound scan of neonatal brain (RR = 0.67)]. The positive effect of continuo...

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“…Early‐onset neonatal sepsis is a leading cause of mortality and morbidity in neonates . Group B streptococcus (GBS, Streptococcus agalactiae or Lancefield group B streptococcus) is the major cause of severe early‐onset group B streptococcal infection (EOGBS) in neonates, defined as GBS acquired before 7 days of age . EOGBS is associated with manifestations of severe disease, such as respiratory distress, pneumonia, sepsis, and meningitis, within the first 24–48 hours of life .…”

Section: Introductionmentioning

confidence: 99%

Risk‐based approach versus culture‐based screening for identification of group B streptococci among women in labor

Khalil

Uldbjerg

Thorsen

et al. 2018

Intl J Gynecology & Obste

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Objective To compare a risk‐based and culture‐based screening approach for identification of group B streptococci (GBS) vaginal colonization using an intrapartum rectovaginal culture as the reference standard. Methods Pregnant women attending the prenatal clinic at Lillebaelt Hospital, Kolding, Denmark, between April 1, 2013, and June 30, 2014, were invited to participate in a prospective observational study. For prepartum culture‐based screening, vaginal and rectal culture samples were obtained and, for reference, standard, paired vaginal and rectal culture samples were collected during labor. Risk factors for risk‐based screening were previous early‐onset GBS, GBS bacteriuria during pregnancy, maternal temperature ≥38.0°C intrapartum, and rupture of membranes for more than 18 hours. Results The intrapartum rectovaginal GBS colonization rate was 30% (32/108) among participants with risk factors and 15% (123/794) among participants without risk factors. Culture‐based screening demonstrated a sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio in predicting intrapartum GBS carriage of 78% (95% confidence interval [CI] 71–84), 95% (94–97), 78% (70–84), 95% (94–97), and 17 (12–23), respectively; for risk‐based screening, these values were 21% (15–28), 90% (87–92), 30% (22–38), 85% (83–86), and 2 (1–3), respectively. Conclusions Culture‐based screening performed considerably better than a risk‐based approach in identifying intrapartum GBS colonization.

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Authors' reply re: Prevention of early‐onset Group B streptococcal disease. Green‐top Guideline No. 36

Cited by 27 publications

References 5 publications

The effect of screening‐to‐labor interval on the sensitivity of late‐pregnancy culture in the prediction of group B streptococcus colonization at labor: A prospective multicenter cohort study

The effect of screening‐to‐labor interval on the sensitivity of late‐pregnancy culture in the prediction of group B streptococcus colonization at labor: A prospective multicenter cohort study

Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome

Risk‐based approach versus culture‐based screening for identification of group B streptococci among women in labor

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