G L Gilbert1, M C Hewitt, C M Turner, S R Leeder. 1. Centre for Infectious Diseases and Microbiology Laboratory Service, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.
Abstract
OBJECTIVES: To determine the incidence of and factors affecting risk factors for neonatal group B streptococcal (GBS) sepsis and their predictive values for intrapartum GBS carriage; to calculate the proportions of women eligible for intrapartum antibiotic prophylaxis (IAP) using different selection protocols. DESIGN: Cohort study. SETTING: Antenatal clinics and labour wards of a community hospital and a tertiary referral centre in western Sydney POPULATION: Women attending antenatal clinics during the study periods were invited to participate. METHODS: Approximately 500 women attending antenatal clinics were screened for GBS carriage at 26-32 weeks gestation and at delivery, using several screening methods. Clinical risk factors for neonatal sepsis were recorded during labour. MAIN OUTCOME MEASURES: Incidence of antenatal anovaginal GBS carriage and clinical risk factors during labour, their predictive values for intra-partum GBS carriage and their relationship, if any, to demographic and obstetric factors. RESULTS: Antenatal and intra-partum GBS carriage rates were similar but varied from 18% to 27%, depending on screening methods. The best positive and negative predictive values of antenatal GBS culture, for intra-partum carriage, were 69% (95% confidence interval (CI) 64-74) and 92% (95% CI 50-94) respectively Clinical risk factors occurred in similar proportions of GBS carriers and non-carriers. CONCLUSIONS: Neither early antenatal screening nor clinical risk factors are reliable predictors of intra-partum GBS carriage. Intra-partum antibiotic prophylaxis based on GBS carriage or risk factors when carrier status is unknown would involve approximately 35% of women, compared with approximately 16% if based on risk factors only Both strategies would prevent similar proportions of neonatal deaths from GBS sepsis. Compliance with a preventive protocol is the most likely determinant of its overall effectiveness.
OBJECTIVES: To determine the incidence of and factors affecting risk factors for neonatal group B streptococcal (GBS) sepsis and their predictive values for intrapartum GBS carriage; to calculate the proportions of women eligible for intrapartum antibiotic prophylaxis (IAP) using different selection protocols. DESIGN: Cohort study. SETTING: Antenatal clinics and labour wards of a community hospital and a tertiary referral centre in western Sydney POPULATION: Women attending antenatal clinics during the study periods were invited to participate. METHODS: Approximately 500 women attending antenatal clinics were screened for GBS carriage at 26-32 weeks gestation and at delivery, using several screening methods. Clinical risk factors for neonatal sepsis were recorded during labour. MAIN OUTCOME MEASURES: Incidence of antenatal anovaginal GBS carriage and clinical risk factors during labour, their predictive values for intra-partum GBS carriage and their relationship, if any, to demographic and obstetric factors. RESULTS: Antenatal and intra-partum GBS carriage rates were similar but varied from 18% to 27%, depending on screening methods. The best positive and negative predictive values of antenatal GBS culture, for intra-partum carriage, were 69% (95% confidence interval (CI) 64-74) and 92% (95% CI 50-94) respectively Clinical risk factors occurred in similar proportions of GBS carriers and non-carriers. CONCLUSIONS: Neither early antenatal screening nor clinical risk factors are reliable predictors of intra-partum GBS carriage. Intra-partum antibiotic prophylaxis based on GBS carriage or risk factors when carrier status is unknown would involve approximately 35% of women, compared with approximately 16% if based on risk factors only Both strategies would prevent similar proportions of neonatal deaths from GBS sepsis. Compliance with a preventive protocol is the most likely determinant of its overall effectiveness.
Authors: Janet E Hiller; Helen M McDonald; Philip Darbyshire; Caroline A Crowther Journal: BMC Pregnancy Childbirth Date: 2005-07-22 Impact factor: 3.007
Authors: Gaurav Kwatra; Peter V Adrian; Tinevimbo Shiri; Eckhart J Buchmann; Clare L Cutland; Shabir A Madhi Journal: PLoS One Date: 2014-06-30 Impact factor: 3.240