Clinical Triggers to Initiate Intrapartum Penicillin Therapy for Prevention of Group B Streptococcus Infection
| Autor: | Benjamin D. Hamar, Edmund F. Funai, Jessica L. Illuzzi |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Adult
Time Factors medicine.drug_class Narcotic medicine.medical_treatment Antibiotics Penicillins Group B Streptococcus agalactiae Pregnancy Streptococcal Infections medicine Humans Rupture of membranes Retrospective Studies Labor Obstetric business.industry Clinical events Obstetrics and Gynecology Antibiotic Prophylaxis Penicillin Parity Neonatal infection Oxytocin Anesthesia Pediatrics Perinatology and Child Health Female Labor Stage First business medicine.drug |
| Zdroj: | American Journal of Perinatology. 23:493-498 |
| ISSN: | 1098-8785 0735-1631 |
| Popis: | Despite national recommendations for prophylactic group B streptococci intrapartum penicillin therapy (GBS-IPT), there is little guidance for clinicians regarding to how to achieve the recommended 4 hours of therapy. We sought to identify clinical triggers for effective temporal prompts to initiate GBS-IPT to achieve the recommended duration of therapy. GBS-colonized women who delivered between 37 and 42 weeks were analyzed retrospectively. The clinical record was reviewed for clinical events including rupture of membranes, oxytocin therapy, 4-cm dilation, active labor, narcotic analgesia, epidural analgesia. In addition, combinations of these triggers were evaluated using the first appearance of 4-cm dilation or active labor, narcotic analgesia or epidural, and a composite indicator of each of these four triggers. Antibiotic duration and proportion receiving 4 hours of GBS-IPT for each trigger were compared with the conventional penicillin management the patient actually received (CM). Data were analyzed with Z-test for proportions with Bonferroni correction and one-way analysis of variance. Two hundred thirteen women met study criteria and were reviewed. Using CM, 90.8% of nulliparas and 68.7% of parous women achieved adequate GBS-IPT. In nulliparas, each clinical trigger resulted in equivalent rates of adequate GBS-IPT compared with CM. The duration of therapy was less for 4-cm dilation, epidural, epidural or narcotic analgesia, and 4-cm dilation or active labor triggers in nulliparas, suggesting better identification of the period 4 hours prior to delivery. In parous women, clinical triggers did not perform better than CM. In nulliparous women, clinical triggers to initiate therapy may achieve high rates of GBS-IPT, with a significant decrease in the duration of antibiotic therapy. In nulliparous women, clinical triggers better identify the 4-hour window prior to delivery than CM. |
| Databáze: | OpenAIRE |
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