Screening for Asymptomatic Bacteriuria in Pregnancy

Objective: To compare the following 4 screening strategies for detecting asymptomatic bacteriuria (ABU) in pregnancy: urine testing with leukocyte-esterase-nitrite (LEN) strips at each prenatal visit followed by a urine culture if positive; a single urine culture at fewer than 20 weeks’ gestation; 2 urine cultures, at fewer than 20 weeks’ gestation and at 28 weeks’ gestation; or 3 urine cultures, at fewer than 20 weeks’, at 28 weeks’, and at 36 weeks’ gestation.Methods: Participants were pregnant women presenting to 2 obstetricians and 6 family physicians at outpatient family medicine and obstetrical clinics in a large Canadian urban teaching hospital. LEN dipstick urine testing was conducted at each prenatal visit. A midstream urine culture was obtained from all women before 20 weeks’ gestation and at 28 weeks’ and 36 weeks’ gestation, as well as for positive LEN tests. Any positive urine culture in an asymptomatic woman was designated a case of ABU. The total number of ABU cases that would be detected by each of the 4 strategies (LEN dipstick testing only, a single urine culture, 2 cultures, and 3 cultures) was determined and compared.Results: There were 49 cases of ABU among 1050 women (4.7%). LEN testing at each prenatal visit identified 7 cases (14.3%), compared with 20 cases (40.8%) with 1 urine culture, 31 (63.3%) with 2 urine cultures, and 43 (87.8%) with 3 urine cultures.Conclusion: A single urine culture before 20 weeks’ gestation missed more than one-half the ABU cases. A culture in each trimester identified most ABU cases.     

Prevalance of Pregnancy Associated Asymptomatic Bacteriuria: A Study Done in a Tertiary Care Hospital

Objectives

A prospective study was conducted in the Department of microbiology (IGMC) and the Department of obstetrics & gynecology (KNH), Shimla, and Himachal Pradesh over a period of 1 year from May 2005 to April 2006 on 463 asymptomatic pregnant females with a period of gestation (POG) 28 weeks or less. The aim was to find out the prevalence of pregnancy associated bacteriuria and bacterial causes responsible for this entity.

Methods

The pregnant women were taught to collect the urine sample by aseptic technique which was then subjected to semi quantitative culture method.

Results

Significant bacteriuria was present in 7.34% cases. About 78% samples were found to be sterile. Insignificant count and growth of contaminants was positive in 1 and 13% samples, respectively. The most common etiological agent came out to be E. coli followed by other gram positive and gram negative organisms.

Conclusion

Asymptomatic bacteriuria is a common occurrence which should be diagnosed and treated in early pregnancy keeping in view its adverse effects on pregnancy.     

Bacteriuria in Pregnancy

In a racially mixed community in Gisborne, New Zealand, the prevalence of asymptomatic (covert) bacteriuria of pregnancy was 9.6%. The prevalence in Maori women was 17.1% and in non-Maori women 4.7%. There was a higher prevalence of bacteriuria in the younger women. Escherichia coli was the infecting organism in 58 of the 72 women with bacteriuria. Twenty-five (44%) of the E. coli were resistant to ampicillin and amoxycillin. Fifty-eight (81%) of the women with bacteriuria also had pyuria. In 37 of the 44 women (84%) who received antimicrobial therapy, the infection was cured. Single dose therapy was just as effective as a course of treatment. In 14 of the 28 untreated women, the infection cleared spontaneously. Four of the 28 (14%) patients in the untreated bacteriuric group developed acute pyelonephritis. More patients with bacteriuria had anaemia and a low fetal birth-weight.     

A Critical Review of Recent Randomized Controlled Clinical Trials in the Treatment of Asymptomatic Bacteriuria of Pregnancy

The randomized clinical trial represents the gold standard of intervention studies in clinical medicine. This is partly due to the validity of results obtained when confounders, both known and unknown, are assigned equally to treatment groups without the practitioners’ bias of treatment selection. Few clinical trials exist to assess the effectiveness of various treatment regimes for asymptomatic bacteriuria of pregnancy. This study reviews critically the randomized controlled clinical trials for the treatment of asymptomatic bacteriuria of pregnancy. Articles for the review were obtained through a literature search employing MEDLINE over a ten-year period. Nine randomized trials resulted from the search that were in the English language or had English translation available. These included five randomized trials without control groups done in a single centre, and one trial with a control group assessing prophylaxis against recurrent asymptomatic bacteriuria.Review of these studies finds that single dose therapy when compared to longer dosing regimes shows a trend to a higher cure rate but that all of the studies were under-powered. This lack of power results in a significant beta error. No difference between short and long term therapy could, therefore, be shown statistically. When a control group is introduced into the randomized trial, a high rate of spontaneous resolution is seen. Short term therapy resulted in a lower cure rate when compared to no treatment in this setting and only three day or greater treatments showed cure rates above spontaneous remission rates. The only study addressing prophylaxis was severely under-powered and suffered technical complications leading to the inability to draw any conclusions. Adequately powered studies to show effectiveness of single dose therapy and prophylaxis of asymptomatic bacteriuria of pregnancy are needed.     

Comparison of Single Dose with a 5-day Course of Co-trimoxazole for Asymptomatic (Covert) Bacteriuria of Pregnancy

Forty-four pregnant women with covert (asymptomatic) bacteriuria proven by suprapubic bladder aspiration were randomly allocated to treatment with either a single 1.92g dose or a standard 5-day course of co-trimoxazole. Twenty-one of 24 women were cured with a single dose. Seven of these 21 women were reinfected later in the pregnancy. All 20 women treated with a 5-day course of co-trimoxazole were cured, and 2 became reinfected later in the pregnancy. There were no side-effects of treatment, and no detrimental effects on the outcome of pregnancy. Single dose therapy should be considered as the treatment of choice for covert bacteriuria in pregnancy.     

The Accuracy of Urine Dipsticks as a Screening Test for Proteinuria in Hypertensive Disorders of Pregnancy

Background. Proteinuria is used as a criterion in the classification system for hypertensive disorders of pregnancy including preeclampsia. The aim of the study was to evaluate the accuracy of dipstick urinalysis in a single voided urine sample and in an aliquot of a 24-hour urine collection in the assessment of proteinuria in hypertensive pregnant women, using the 24-hour urine protein excretion as the gold standard. Methods. One hundred ninety-eight women who presented with hypertension in pregnancy were recruited at the antenatal clinic at King Edward VIII Hospital in Durban, South Africa, a tertiary referral center. Exclusion criteria included women with eclampsia, urinary tract infection, and chronic renal disease. Routine dipstick urinalysis (Bayer) was performed by midwives for proteinuria, and a 24-hour urine specimen was collected for quantitative protein assessment. A laboratory technician performed urine dipstick test for protein on a mixed aliquot of the 24-hour urine specimen. This result, together with that of the screening dipstick urinalysis, was compared to the 24-hour urine protein excretion. Results. The results of the 198 patients were analyzed, of the total, 72 had preeclampsia. Using a value of ≥ 0.3 g protein excretion per 24 hours (1 + to 4 + on urine dipsticks) as positive, sensitivity, specificity, and predictive values for dipstick urinalysis were calculated. The positive predictive value for dipstick urinalysis ranged from 64.9% (single voided urine sample) to 94.2% (24-hour urine aliquot). The negative predictive value ranged from 75.2% (single voided urine sample) to 84.2% (24-hour urine aliquot). Conclusion. Dipstick urinalysis is not very accurate: therefore, all women presenting with hypertension during pregnancy should have a 24-hour urine protein measurement.     

The Effectiveness of Screening for Hepatitis C in Pregnancy

ObjectiveTo determine the effectiveness of universal versus targeted screening for hepatitis C (HCV) during pregnancy at an urban health care centre.MethodsWe conducted a cross-sectional study of 653 pregnant women. Patients completed a demographic and standardized questionnaire identifying known risk factors for HCV. Patients then underwent blood testing for HCV antibodies. The effectiveness of screening based on risk factors was determined by comparing the number of women who screened positive for HCV risk factors with those who tested seropositive.ResultsOf those who entered the study, 0.5% (3/645) tested positive for HCV. HCV risk factor screening showed that 72% answered Yes to one or more risk factors and 28% answered No to all risk factors. Answering Yes to any risk factor was not associated with testing positive for HCV antibodies (P > 0.05). Screening positive for a high severity risk factor (exposure to intravenous drug use or to the blood of an HCV-positive individual) was associated with testing positive for HCV antibodies (P = 0.002), but screening positive for a moderate or low severity risk factor was not (P > 0.05).ConclusionDuring pregnancy, universal testing for HCV and testing based on the presence of any risk factors for HCV is not recommended. HCV testing based on the presence of high severity risk factors, however, may be warranted.     

经阴道超声检查诊断无症状输卵管妊娠的价值

目的评价经阴道超声检查(TVUS)对无症状输卵管妊娠(TP)的临床诊断价值.方法选择68例临床怀疑输卵管妊娠患者,其中β-血清人绒毛膜促性腺激素(p-HCG)水平超过1500U/L或妊娠超过37天者52例,排除了有急腹症的患者16例,均施行腹腔镜检查与TVUS,并经手术病理证实为TP诊断.结果52例患者中,TVUS怀疑输卵管妊娠50例,包块位于右侧输卵管28例.其中间质部4例;左侧输卵管22例,其中间质部5例.50例患者中,48例与腹腔镜检查结果一致.另2例中,1例被误诊,1例TVUS所见的TP包块位置与腹腔镜检查不一致.超声所见为正常的2例,经腹腔镜检查也未能确定TP病灶.TVUS对TP诊断的敏感性、特异性、阳性预期值,阴性预期值分别为100%、50%、98%、100%.结论TVUS对早期诊断无症状输卵管妊娠具有重要的临床价值和可信度,而且对希望保守治疗的患者能够代替诊断性腹腔镜检查.     

Protocol for Tuberculosis Screening in Pregnancy

Screening for tuberculosis in pregnancy should be considered in clinics where the incidence of the disease is high. With early diagnosis and adequate chemotherapy, available literature suggests that the disease should not adversely affect the outcome of pregnancy. Current research is needed in this area. Much of the literature is dated. Because the disease is still prevalent in many large cities, studies could be initiated to examine the complications of tuberculosis in pregnancy, treatment regimens, and drug resistance, as well as the fetal and neonatal effects of the disease. Nurses involved in providing prenatal care are in a unique position to screen for tuberculosis. Pregnancy may be the first condition for which many young women seek medical attention. Also, prenatal nurses have access to many segments of the population at particular risk for tuberculosis infection: the indigent, people living in crowded urban areas, foreign-born people, and non-white races. In these segments, preventive health care and medical screening may be inaccessible or nonexistent. Therefore, prenatal care provides an excellent opportunity for screening for tuberculosis infection.     

Group B Streptococcal Bacteriuria in Pregnancy: An Evidence‐Based,Patient‐Centered Approach to Care

Screening and management of group B streptococcus (GBS) bacteriuria in pregnancy aims to reduce the incidence of pyelonephritis and GBS‐related neonatal morbidity and mortality. Universal screening and management of GBS bacteriuria in pregnancy are standards of care in the United States; however, some women may decline guideline‐based recommendations for screening, treatment, or intrapartum antibiotic prophylaxis. This article uses a case study approach to discuss evidence‐based, patient‐centered care for GBS bacteriuria in pregnancy as well as ethical incorporation of individual patient preferences and values.     

Screening for Gonorrhea and Chlamydia in Pregnancy: Room for Improvement

ObjectiveThis study sought to determine the proportion of pregnant women who are tested for gonorrhea and chlamydia as part of their prenatal care and to examine patient and provider factors affecting testing rates.MethodsThe study investigators conducted a retrospective chart review of all patients who delivered at St. Michael's Hospital, an urban tertiary care centre in Toronto, Ontario, between November 2015 and April 2016. Rates of testing and the prevalence of positive test results for gonorrhea and chlamydia were calculated. Chi-square tests were used to compare rates of testing among different types of prenatal care providers (obstetricians, maternal-fetal medicine specialists, family practitioners, midwives) and to determine whether testing rates were affected by patient demographics or characteristics. This study was a Canadian Task Force Classification II-2 retrospective cohort study.ResultsOf the 1315 women who delivered at St. Michael's Hospital during the study period, 1220 met inclusion criteria for the study. Of these women, 186 (15.3%) were not tested for gonorrhea and chlamydia during their pregnancy. There were 11 cases of chlamydia (1.1%) and no cases of gonorrhea. Testing rates were not affected by patient demographic variables or obstetrical history. Midwives and family physicians had the highest testing rates among the provider groups: 93.8% and 91.4%, respectively. Generalist obstetricians tested 88.5% of their patients. Maternal-fetal medicine specialists had a significantly lower rate of testing than the other provider groups, at 64.8% (P < 0.0001).ConclusionsFifteen percent of women were not tested for gonorrhea and chlamydia during the study period even though testing was recommended as part of routine prenatal care. Testing rates varied among providers, and strategies to improve these rates need to be explored.     

Delaying Pap Test Screening in the Adolescent Population: An Evidence-Based Approach

Cervical cancer screening guidelines have evolved significantly over the past ten years in the adolescent population. The objective of this article is to review the cervical screening guidelines in the adolescent population as well as examine the evidence and studies that support delaying screening until 21 years old. Delaying HPV and Papanicolaou testing until 21 years old is safe and will not increase cervical cancer rates in the adolescent population.