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Clinical Decisionmaking

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Obstetricians don't always follow guidelines for preventing group B streptococcal infection in neonates

Group B streptococcus (GBS), which is typically transmitted from mothers to their infants during birth, is the most common cause of early-onset sepsis, pneumonia, and meningitis among newborns. It can be prevented by screening pregnant women for GBS—for example, through anorectal/vaginal culture during labor—and providing them with intrapartum antibiotics to prevent transmission of infection to their babies. Although most New Jersey obstetricians/gynecologists agree with one or another guideline for antenatal GBS screening and intrapartum antibiotics, they don't necessarily follow them in practice, according to a survey supported in part by the Agency for Healthcare Research and Quality (HS09788).

Obstetricians need to be better educated about GBS prevention in neonates to promote more evidence-based practice, conclude researchers at the Robert Wood Johnson Medical School. They surveyed by mail American College of Obstetricians and Gynecologists (ACOG) fellows in New Jersey on physician characteristics, existing GBS guideline preferences, and reported actual GBS prevention practices. The guidelines vary in whether they recommend culture of the mothers for GBS, timing of culture, and selective or universal use of intrapartum antibiotics.

Of the 306 obstetricians who responded to the survey, 75 percent said they preferred the GBS guidelines from the Centers for Disease Control and Prevention (CDC), 13 percent preferred those of ACOG, 9 percent preferred guidelines of the American Academy of Pediatrics (AAP), and 4 percent preferred other guidelines. The proportions of obstetricians who actually adhered to their stated preferred guidelines were 58 percent, 64 percent, and 39 percent for CDC, ACOG, and AAP guidelines, respectively. In addition, only 57 percent of the obstetricians appropriately cultured women for GBS with the use of combined vaginal-anorectal swabs.

See "Obstetrician preferences for prenatal strategies to reduce early-onset group B streptococcal infection in neonates: A population-based survey," by Anna Petrova, M.D., Ph.D., John C. Smulian, M.D., M.P.H., and Cande V. Ananth, Ph.D., M.P.H., in the September 2002 American Journal of Obstetrics & Gynecology 187, pp. 709-714.

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