Background Group B Streptococcus (GBS), Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) cervico-vaginal infections can be involved in pregnancy complications such as preterm birth and premature rupture of membrane (PROM). These infections can also be transmitted to the newborn during delivery leading to serious consequences. Therefore, CDC guidelines suggest microbial prenatal screening for administration of target prophylaxis based on culture results. To accurately predict the colonisation of genital tract, the test should be better performed during labour, because microbial presence may be transient/intermittent and re-colonisation can occur. GeneXpert®GBS and GeneXpert®CT/NG tests (Cepheid), fully-automated, easy-to-use and rapid PCR-assays (about 45 and 90 min, respectively) can be the right alternative to culture tests (at least 72 hours).
This study evaluates the advantages of GeneXpert®GBS in the management of women, with unknown cervico-vaginal microbial status, during labour. Moreover, it assesses whether the prevalence of CT, NG and GBS infections is higher in pregnancy complicated by preterm labour or PROM.
Methods During a four months’ period, all women with singleton pregnancy at beginning of labour either-term or preterm or PROM were enrolled. Exclusion criteria were planned caesarean section or recent use of systemic or topical antibiotics. Cervico-vaginal (for CT/NG) and vaginal-rectal (for GBS) swabs were collected from each patient and analysed by GeneXpert®GBS and GeneXpert®CT/NG assays on GeneXpert®System.
Results CT/NG screening showed positive results only among PROM pregnancies (2.5% CT positive) while no positive results were found among preterm/term pregnancies.
Among pregnant women analysed for GBS, 24.4% resulted positive and 75.6% negative. Only positive patients received IAP, instead of current guidelines, for which all patients would have been treated due to unknown GBS infection status.
Conclusion With GeneXpert®GBS test, we could correctly manage all women and reduce administration of IAP. We calculated that the savings for the hospital was 3,500 EUR every three months.
- CT/NG screening
- GBS screening
- real time PCR