Mercer B M, Ramsey R D, Sibai B M
Department of Obstetrics and Gynecology, University of Tennessee, Memphis, USA.
Am J Obstet Gynecol. 1995 Sep;173(3 Pt 1):837-41. doi: 10.1016/0002-9378(95)90351-8.
Our purpose was to evaluate current obstetric practice regarding screening and prophylaxis for group B Streptococcus and to evaluate the impact of screening on antepartum and intrapartum care.
A total of 1232 members of the Society of Perinatal Obstetricians were asked to indicate their practices regarding screening for group B Streptococcus. Respondents were then asked their practices regarding antepartum and intrapartum prophylaxis on the basis of screening cultures, prior antimicrobial treatment, and other risk factors for neonatal sepsis.
Of the 925 respondents (75.1%), 30.8% performed routine screening in all pregnancies: first prenatal visit (42.3%), 26 to 28 weeks (41.3%), and 34 to 38 weeks (22.1%). In addition, 65.9% would screen patients only under high-risk situations. Although 70.5% sample multiple sites, respondents were inconsistent regarding the sites from which cultures are obtained: distal vagina (64.2%), cervix (53.9%), proximal vagina (40.0%), anal canal (38.5%), and urethra (4.3%). A total of 34.7% of respondents would treat the patient at the time of a positive culture. Knowledge of maternal group B Streptococcus carriage would significantly alter intrapartum prophylaxis in low-risk (60.3% vs 0.5%) and various high-risk populations (74.0% to 98.4% vs 11.3% to 55.0%). However, no consensus as to optimal practice was identified.
This survey demonstrates significant inconsistencies in screening and prophylaxis for group B Streptococcus by specialists in maternal-fetal medicine. In addition, it reveals that the recommendations of The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics are not routinely followed by these specialists. Knowledge of group B Streptococcus carriage significantly increases antepartum and intrapartum treatment regardless of the presence of other risk factors for neonatal sepsis. The impact of this practice on neonatal therapy warrants further evaluation.
我们的目的是评估目前关于B族链球菌筛查和预防的产科实践，并评估筛查对产前和产时护理的影响。
总共1232名围产期产科医生协会成员被要求指出他们关于B族链球菌筛查的实践。然后根据筛查培养结果、先前的抗菌治疗以及新生儿败血症的其他危险因素，询问受访者关于产前和产时预防的实践。
在925名受访者（75.1%）中，30.8%在所有妊娠中进行常规筛查：首次产前检查时（42.3%）、孕26至28周时（41.3%）以及孕34至38周时（22.1%）。此外，65.9%仅在高危情况下对患者进行筛查。尽管70.5%的人采集多个部位的样本，但受访者在获取培养样本的部位上并不一致：阴道远端（64.2%）、宫颈（53.9%）、阴道近端（40.0%）、肛管（38.5%）和尿道（4.3%）。总共34.7%的受访者会在培养结果呈阳性时对患者进行治疗。了解产妇B族链球菌携带情况会显著改变低风险人群（60.3%对0.5%）以及各种高风险人群（74.0%至98.4%对11.3%至55.0%）的产时预防措施。然而，未确定最佳实践的共识。
这项调查表明，母胎医学专家在B族链球菌的筛查和预防方面存在显著不一致。此外，研究表明，这些专家并未常规遵循美国妇产科医师学会和美国儿科学会的建议。无论是否存在新生儿败血症的其他危险因素，了解B族链球菌携带情况都会显著增加产前和产时治疗。这种做法对新生儿治疗的影响值得进一步评估。
