Money Deborah, Allen Victoria M
Vancouver BC.
Halifax NS.
J Obstet Gynaecol Can. 2016 Dec;38(12S):S326-S335. doi: 10.1016/j.jogc.2016.09.042. Epub 2017 Jan 4.
To review the evidence in the literature and to provide recommendations on the management of pregnant women in labour for the prevention of early-onset neonatal group B streptococcal disease. The key revisions in this updated guideline include changed recommendations for regimens for antibiotic prophylaxis, susceptibility testing, and management of women with pre-labour rupture of membranes.
Maternal outcomes evaluated included exposure to antibiotics in pregnancy and labour and complications related to antibiotic use. Neonatal outcomes of rates of early-onset group B streptococcal infections are evaluated.
Published literature was retrieved through searches of MEDLINE, CINAHL, and The Cochrane Library from January 1980 to July 2012 using appropriate controlled vocabulary and key words (group B streptococcus, antibiotic therapy, infection, prevention). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to May 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.
The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1).
BENEFITS, HARMS, AND COSTS: The recommendations in this guideline are designed to help clinicians identify and manage pregnancies at risk for neonatal group B streptococcal disease to optimize maternal and perinatal outcomes. No cost-benefit analysis is provided.
There is good evidence based on randomized control trial data that in women with pre-labour rupture of membranes at term who are colonized with group B streptococcus, rates of neonatal infection are reduced with induction of labour (I). There is no evidence to support safe neonatal outcomes with expectant management in this clinical situation.
回顾文献证据，并就分娩期孕妇的管理提供建议，以预防早发型新生儿B族链球菌病。本更新指南中的主要修订内容包括对抗生素预防方案、药敏试验以及胎膜早破孕妇管理的建议变化。
评估的母体结局包括孕期和分娩期抗生素暴露以及与抗生素使用相关的并发症。评估早发型B族链球菌感染率的新生儿结局。
通过检索1980年1月至2012年7月的MEDLINE、CINAHL和考克兰图书馆，使用适当的控制词汇和关键词（B族链球菌、抗生素治疗、感染、预防）检索已发表的文献。结果仅限于系统评价、随机对照试验/对照临床试验和观察性研究。没有日期或语言限制。检索定期更新，并纳入截至2013年5月的指南。通过搜索卫生技术评估和卫生技术相关机构的网站、临床实践指南汇编、临床试验注册库以及国家和国际医学专业协会，识别灰色（未发表）文献。
本文件中的证据质量使用加拿大预防保健工作组报告中描述的标准进行评级（表1）。
益处、危害和成本：本指南中的建议旨在帮助临床医生识别和管理有新生儿B族链球菌病风险的妊娠，以优化母体和围产期结局。未提供成本效益分析。
基于随机对照试验数据有充分证据表明，足月胎膜早破且感染B族链球菌的孕妇，引产可降低新生儿感染率（I）。在这种临床情况下，没有证据支持期待管理能实现安全的新生儿结局。
