Análise da Prevalência e Conduta das Gestantes Colonizadas por Estreptococo do Grupo B e Evolução de seus Recém-Nascidos segundo o guideline de 2010 do Centers for Disease Control and Prevention (CDC)

Abstract

OBJECTIVE: To evaluate the implementation of the 2010 Centers for Disease Control and Prevention (CDC) guidelines by the obstetrics and neonatology teams of a tertiary public hospital located in Rio de Janeiro, Brazil. METHODS: This retrospective study included the medical records of pregnant women who underwent vaginal-rectal swabs at the hospital between Nov. 1, 2014 and Oct. 31, 2015. Of the 595 included swabs, 122 were positive for Group B Streptococcus (GBS). After excluding incomplete medical records, malformations, and women who delivered at other hospitals, 85 pregnant women with positive swabs and 92 newborns were included. RESULTS: The prevalence of maternal colonization was 20.5%. The time to vaginal/rectal swab collection ranged from 18 to 39 weeks of gestation, with a mean of 34.9 weeks. Thirty-three of the 85 included pregnant women (38.9%) were not properly managed, since in 19 cases delivery occurred within less than four hours of antibiotic administration, and in 14 prophylaxis was not initiated when indicated. Five of the 92 included newborns (5.4%) were not properly managed, mainly due to unnecessary screening for infection; screening was incomplete in one case, since blood culture was not ordered although the guidelines in effect required it. Of the 86 newborns with management considered adequate, 53 (61.6%) had mothers who were also adequately managed. Thirty-three (57.75%) of the newborns managed adequately had mothers submitted to inadequate obstetric management. CONCLUSIONS: Although the 2010 CDC guidelines for prevention of early sepsis by GBS has been implemented in the hospital, we have detected failures in maternal intrapartum prophylaxis and newborn assessment. Failure to adhere to the established guidelines yields missed opportunities to prevent early-onset GBS sepsis.

Keywords

• streptococcus agalactiae
• neonatal sepsis
• guideline adherence