Group B Streptococci Screening Before Repeat Cesarean Delivery

Albright, Catherine M.; MacGregor, C; Sutton, Desmond; Theva, Meena; Hughes, Brenna L.; Werner, Erika F.

doi:10.1097/aog.0000000000001800

Cited by 10 publications

(5 citation statements)

References 34 publications

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“…Screening is only effective if the target population and healthcare providers are engaged. Twenty-nine evaluations (42.6%) identified patient participation and compliance as an important model parameter [ 12 , 14 , 16 – 20 , 25 , 27 , 28 , 32 , 36 , 37 , 43 – 46 , 48 – 51 , 55 – 62 ]. Morton et al reported that the results of a national breast cancer screening program in the UK would be impacted by the proportion of the at-risk population who decided to participate [ 50 ].…”

Section: Resultsmentioning

confidence: 99%

“…However, information about the compliance rates for different screening tests was rarely available. Ten studies (14.7%) assumed a 100% compliance rate [ 17 , 25 , 27 , 28 , 32 , 45 , 51 , 55 , 57 , 59 , 63 ]. The effect of this assumption over cost-effectiveness estimates depends on the specific evaluation being conducted, specifically the trade-off between lower screening costs and worse health outcomes due to unidentified disease.…”

Section: Resultsmentioning

confidence: 99%

“…These analyses evaluate the trade-off between health and any other outcome, but this information is rarely known, i.e., societal preferences between health and productivity or educational benefits [ 81 ]. This review identified 38 (55.8%) and 15 (22%) studies that developed their analyses under a healthcare [ 12 , 14 , 18 , 20 – 23 , 25 , 27 , 29 , 34 – 40 , 42 , 44 , 46 – 55 , 58 , 60 , 62 , 65 , 66 , 68 , 69 , 75 , 78 ] and societal perspective [ 13 , 15 , 17 , 19 , 28 , 33 , 41 , 43 , 56 , 57 , 59 , 61 , 67 , 76 , 80 ], respectively. The following were specific studies that included non-health costs and/or outcomes: Cressman et al estimated the productivity loss of lung cancer patients who had been previously working before starting treatment [ 56 ].…”

Section: Resultsmentioning

confidence: 99%

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Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Iragorri

Spackman

2018

Public Health Rev

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BackgroundScreening is an important part of preventive medicine. Ideally, screening tools identify patients early enough to provide treatment and avoid or reduce symptoms and other consequences, improving health outcomes of the population at a reasonable cost. Cost-effectiveness analyses combine the expected benefits and costs of interventions and can be used to assess the value of screening tools.ObjectiveThis review seeks to evaluate the latest cost-effectiveness analyses on screening tools to identify the current challenges encountered and potential methods to overcome them.MethodsA systematic literature search of EMBASE and MEDLINE identified cost-effectiveness analyses of screening tools published in 2017. Data extracted included the population, disease, screening tools, comparators, perspective, time horizon, discounting, and outcomes. Challenges and methodological suggestions were narratively synthesized.ResultsFour key categories were identified: screening pathways, pre-symptomatic disease, treatment outcomes, and non-health benefits. Not all studies included treatment outcomes; 15 studies (22%) did not include treatment following diagnosis. Quality-adjusted life years were used by 35 (51.4%) as the main outcome. Studies that undertook a societal perspective did not report non-health benefits and costs consistently. Two important challenges identified were (i) estimating the sojourn time, i.e., the time between when a patient can be identified by screening tests and when they would have been identified due to symptoms, and (ii) estimating the treatment effect and progression rates of patients identified early.ConclusionsTo capture all important costs and outcomes of a screening tool, screening pathways should be modeled including patient treatment. Also, false positive and false negative patients are likely to have important costs and consequences and should be included in the analysis. As these patients are difficult to identify in regular data sources, common treatment patterns should be used to determine how these patients are likely to be treated. It is important that assumptions are clearly indicated and that the consequences of these assumptions are tested in sensitivity analyses, particularly the assumptions of independence of consecutive tests and the level of patient and provider compliance to guidelines and sojourn times. As data is rarely available regarding the progression of undiagnosed patients, extrapolation from diagnosed patients may be necessary.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Iragorri

Spackman

2018

Public Health Rev

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“…For term patients, appropriate GBS prophylaxis occurring with universal surgical prophylaxis has called into question the cost effectiveness of screening women with planned cesarean section. 15 After implementation, patients delivering soon after presentation before labor orders were written also would not have been counted. However, the number of such patients was small and not likely to impact the findings.…”

Section: Manuscriptmentioning

confidence: 99%

Maternal Group B Streptococcus Prophylaxis Improvement using an Electronic Medical Record Dynamic Order Set

Tomlinson,

Baker,

Ulrich

et al. 2023

Am J Perinatol

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Objective: Develop and implement a Group B Streptococcal (GBS) dynamic order set to improve adherence to ACOG/CDC prevention guidelines. Study Design: A team of information technology and clinical experts developed a dynamic order block. The content was patterned after the CDC “Prevent GBS” mobile app. It was then embedded in the labor and delivery/induction order set and piloted at a single high volume OB unit. Following the pilot and incorporation of the 2019 ACOG update of the CDC guidelines, the order set was rolled out in 5 additional hospitals within a region of a large health system. Information on GBS prophylaxis performance before and after implementation was available for the pilot site and 4 of the additional hospitals. Information before implementation was obtained electronically from electronic medical record (EMR) laboratory and pharmacy data and supplemented by manual chart review. Postimplementation data was obtained from discrete order set EMR data elements. Adherence to the guidelines before and after were compared using chi-squared test. Results: There were 7114 deliveries before implementation and 4502 after. Preterm delivery occurred in 6.8% and 6.9% respectively. There was an increase in appropriate treatment of preterm patients (positive and unknown GBS) delivering after implementation (88.7% to 99.1%, p <0.001). More patients were reported to have a penicillin allergy before implementation than after (14.7% vs 11.1% respectively, p=0.01). Associated changes in therapy noted after implementation included a nonsignificant decrease in the proportion reporting a high-risk allergy (50.3% vs 41.9%, p=0.18), an increase in the appropriate use of clindamycin and vancomycin (64.4% vs 92.3%, p<0.001) and a decrease in clindamycin use in those without sensitivity testing. Conclusion: Routine universal use of a dynamic admission labor/induction order set was associated with high and improved adherence to GBS prophylaxis guidelines.

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“…The rationale being even patients who are planning cesarean may rupture membranes or begin labor before their scheduled delivery and/or might consider a trial of labor after cesarean; these scenarios put the fetus at risk of infection. A recent analysis found screening for GBS in patients planning for cesarean to be cost-effective among populations with GBS prevalence >28%, or those populations with a >29% risk for labor before cesarean delivery, or populations where there is more than a 1 in 10 chance of delivering vaginally despite the plan for cesarean 36 . Given the prevalence of colonization in the United States, the potentially devastating consequences of inadequately treated infection, and the relatively low cost for screening, universal screening is recommended in the United States for patients planning cesarean.…”

Section: Gbs Screening: Updates and Nuancesmentioning

confidence: 99%

Group B Streptococcus and Pregnancy: Critical Concepts and Management Nuances

Dotters‐Katz

Kuller

Heine

et al. 2022

Obstetrical &Amp; Gynecological Survey

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ImportanceGroup B Streptococcus (GBS) is a common pathogen with an effective treatment. However, it remains a significant cause of neonatal sepsis, morbidity, and mortality. The screening and management of this infection are some of the first concepts learned during medical training in obstetrics. However, effective screening and evidence-based management of GBS are nuanced with many critical caveats.ObjectiveThe objectives of this review are to discuss the essential aspects of GBS screening and management and to highlight recent changes to recommendations and guidelines.Evidence AcquisitionOriginal research articles, review articles, and guidelines on GBS were reviewed.ResultsThe following recommendations are based on review of the evidence and professional society guidelines. Screening for GBS should occur between 36 weeks and the end of the 37th week. The culture swab should go 2 cm into the vagina and 1 cm into the anus. Patients can perform their own swabs as well. Penicillin allergy testing has been shown to be safe in pregnancy. Patients with GBS in the urine should be treated at term with antibiotic prophylaxis, independent of the colony count of the culture. Patients who are GBS-positive with preterm and prelabor rupture of membranes after 34 weeks are not candidates for expectant management, as this population has higher rates of neonatal infectious complications. Patients with a history of GBS colonization in prior pregnancy who are GBS-unknown in this current pregnancy and present with labor should receive intrapartum prophylaxis. Work on the GBS vaccine continues.ConclusionsAlthough all of the efforts and focus on neonatal early-onset GBS infection have led to lower rates of disease, GBS still remains a major cause of neonatal morbidity and mortality requiring continued vigilance from obstetric providers.Target AudienceObstetricians and gynecologists, family physicians.Learning ObjectivesAfter participating in this activity, the provider should be better able to explain updates to GBS screening recommendations; identify indications for the GBS prophylaxis in common antepartum and intrapartum scenarios; and describe the correct method for performing the GBS swab.

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Group B Streptococci Screening Before Repeat Cesarean Delivery

Cited by 10 publications

References 34 publications

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Maternal Group B Streptococcus Prophylaxis Improvement using an Electronic Medical Record Dynamic Order Set

Group B Streptococcus and Pregnancy: Critical Concepts and Management Nuances

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