[Group B streptococcus colonization during pregnancy and prevention of early onset of disease]. / Colonizacion por estreptococo beta hemolitico del grupo B durante el embarazo y prevencion de enfermedad neonatal.

Group B Streptococcus (GBS) is the most frequent cause of early onset of neonatal sepsis. Case-fatality rate is 6-20% for newborns. Neurological sequel occurs in 30% of survivors. In 1996, the Centers for Disease Control and Prevention (CDC), the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics recommended that obstetrics providers should adopt either a culture-based or a risk-based approach for the prevention of this disease. The aim of this prospective study was to determine the colonization rate of GBS in our population of pregnant women between July 1st 2001 and December 31st 2002, and to introduce a culture-based strategy to prevent early onset neonatal GBS disease. From a population of 1756 pregnant women, 1228 were screened with rectal and vaginal swabs (69.9%). Maternal colonization rate was 1.4% (17 patients). There was one case of early-onset neonatal sepsis consistent with GBS disease (0.6%) in a patient with negative cultures. From the colonized patients, only one presented risk factors. Because most of the colonized women did not present intrapartum risk factors, the results of this study suggest that the culture-based approach should be used for the prevention of early-onset GBS disease in our population. Cost-benefit studies are needed in our country to determine if this prevention strategy is able to be implemented in all the settings of Argentina.

Colonizacion por estreptococo beta hemolitico del grupo B durante el embarazo y prevencion de enfermedad neonatal. / [Group B streptococcus colonization during pregnancy and prevention of early onset of disease]

Group B Streptococcus (GBS) is the most frequent cause of early onset of neonatal sepsis. Case-fatality rate is 6-20

for newborns. Neurological sequel occurs in 30

of survivors. In 1996, the Centers for Disease Control and Prevention (CDC), the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics recommended that obstetrics providers should adopt either a culture-based or a risk-based approach for the prevention of this disease. The aim of this prospective study was to determine the colonization rate of GBS in our population of pregnant women between July 1st 2001 and December 31st 2002, and to introduce a culture-based strategy to prevent early onset neonatal GBS disease. From a population of 1756 pregnant women, 1228 were screened with rectal and vaginal swabs (69.9

). Maternal colonization rate was 1.4

(17 patients). There was one case of early-onset neonatal sepsis consistent with GBS disease (0.6

) in a patient with negative cultures. From the colonized patients, only one presented risk factors. Because most of the colonized women did not present intrapartum risk factors, the results of this study suggest that the culture-based approach should be used for the prevention of early-onset GBS disease in our population. Cost-benefit studies are needed in our country to determine if this prevention strategy is able to be implemented in all the settings of Argentina.

Prospective evaluation of the learning curve of laparoscopic-assisted vaginal hysterectomy in a university hospital.

STUDY OBJECTIVE: To prospectively analyze the learning curve of laparoscopic-assisted vaginal hysterectomy (LAVH) in a surgical team and evaluate if length of surgery can be reduced safely. DESIGN: Prospective observational study (Canadian Task Force classification II-2). SETTING: Department of obstetrics and gynecology in a university-affiliated hospital. PATIENTS: One hundred and sixty consecutive women undergoing LAVH performed between January 1, 1998 and April 30, 2001. INTERVENTION: LAVH (AAGL Classification System for Laparoscopic Hysterectomy III-B-3). MEASUREMENTS AND MAIN RESULTS: The primary parameter evaluated was length of surgery. Patients were grouped in cohorts of 10, in order to perform a time curve that would assist us in evaluation of the learning process. Once the plateau was reached, we evaluated the process before and after this plateau (groups 1 [learning stage] and 2 [second stage], respectively). Average length of surgery was 126 minutes (range, 60-260). Length of surgery was 138 minutes (range, 75-260) in the learning stage (first 80 cases) and 112 minutes (range, 60-225) in the second stage (p <.0001). Total rate of complications was 11.6%. There were three major complications, and they occurred before the plateau. There were 15 minor complications (9.67%), 8 during the first stage and 7 in the second stage, (p =.9; NS). A second learning curve excluding LAVH with associated surgeries was obtained. The average length of surgery for the first stage was 133 minutes (range, 75-205) and 102 minutes for the second stage (range, 60-130) (p >.0001). CONCLUSION: Analysis of the learning curve demonstrated that the length of surgery in LAVH could be reduced without increasing the number of complications.