A 32-year-old G2P1 woman at 34 weeks’ gestation presents to the labor and delivery floor with the chief complaint of regular contractions, bloody show, and a gush of fluids. A 2.3 kg (5 Ib 1 oz) boy is delivered by spontaneous vaginal delivery without further complication 1 hour after presentation. Twenty-four hours later, the infant has developed irritability, fever, and respiratory distress. He is diagnosed with sepsis secondary to pneumonia. The mother has no complaints other than anxiety regarding the condition of her child. She denies rigors, chills, sweats, nausea, or vomiting. The mother’s pulse is 60/min, blood pressure is 125/80 mm Hg, and temperature is 37degC (98.6degF). Physical examination reveals lungs that are clear to auscultation bilaterally, and no murmurs, rubs, or gallops are present on cardiac examination. The suprapubic region is not tender to palpation. Vaginal and cervical examination reveals no significant tears or bleeds.Which prenatal test would have provided the most useful information in preventing this condition:
Correct Answer: Rectovaginal group B streptococcal culture
Description: Ans. is d, i.e. Rectovaginal group B streptococcal cultureNeonatal sepsis Group B streptococci, Streptococcus agalactiae is a major cause of neonatal mortality and morbidity.Neonates present with respiratory distress, apnea, hypotension, i.e. the neonate in the question is having neonatal sepsis due to Group B Streptococci.ACOG recommends universal culture screening for rectovaginal Group B streptococci at 35-37 weeks in all pregnant females.Samples are taken from lower third of vagina and rectum as colonization of the birth canal occurs secondary to colonization of anorectal region.In the question, patient had delivered at 34 weeks and so her screening for group B streptococci by rectovaginal culture was not done. In all such cases, where patient presents with preterm labour or term labour with unknown GBS status, a shot of penicillin should be given prophylactically to protect her against GBS infection.Prophylaxis Against GBSIntrapartum prophylaxis is indicatedIntrapartum prophylaxis is not indicated* Previous infant with invasive GBS disease* GBS bacteriuria during present pregnancy* Positive GBS screening or culture during present pregnancy unless LSCS is planned* Unknown GBS status with any of the following;- Delivery at <37 weeks- Amniotic membrane rupture >18 hrs- Intrapartum temperature >100.4degF* Previous pregnancy with positive GBS screening* Planned cesarean delivery performed in absence of labor or membrane rupture (regardless of maternal GBS culture status)* Negative GBS vaginal and rectal screening cultureDrugs Used in GBS ProphylaxisBest drug - PenicillinSecond best drug - AmpicillinPenicillin-allergic patients - At low risk for anaphylaxis--cefazolinAt high risk--idamycin/erythromycin/vancomycinNote: Mode of delivery - In pregnant patients with GBS infectionIf treatment is given - vaginal deliveryIf treatment has not been given - cesarean section
Category:
Gynaecology & Obstetrics
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