Egle Barcaite

Prevalence of maternal group B streptococcal colonisation in European countries

Background. Group B streptococcus (GBS) is a leading cause of neonatal sepsis in many industrialised countries. However, the burden of perinatal GBS disease varies between these countries. We undertook a systematic review to determine the prevalence of maternal group B streptococcal colonisation, one of the most important risk factor for early onset neonatal infection, and to examine the serotype distribution of the GBS strains isolated and their susceptibility to antibiotics in European countries. Methods. We followed the standard methodology for systematic reviews. We prepared a protocol and a form for data extraction that identifies key characteristics on study and reporting quality. The search was conducted for the years 1996–2006 including electronic, hand searching and screening of reference lists. Results. Twenty‐one studies presented data on 24,093 women from 13 countries. Among all studies, GBS vaginal colonisation rates ranged from 6.5 to 36%, with one‐third of studies reporting rates of 20% or greater. The regional carriage rates were as follows: Eastern Europe 19.7–29.3%, Western Europe 11–21%, Scandinavia 24.3–36%, and Southern Europe 6.5–32%. GBS serotypes III, II and Ia were the most frequently identified serotypes. None of the GBS isolates were resistant to penicillin or ampicillin, whereas 3.8–21.2% showed resistance to erythromycin and 2.7–20% showed resistance to clindamycin. Conclusion. Although there is variation in the proportion of women colonised with GBS, the range of colonisation, the serotype distribution and antimicrobial susceptibility reported from European countries appears to be similar to that identified in overseas countries.

Vaginal misoprostol for cervical priming before hysteroscopy in perimenopausal and postmenopausal women

Objective: To evaluate the effectiveness and possible adverse effects of vaginal misoprostol for cervical priming before hysteroscopy in perimenopausal and postmenopausal women. Methods: A total of 105 women scheduled for hysteroscopy were randomly assigned to 2 groups. The study group (n = 51) received 400 μg of vaginal misoprostol at least 12 h before the procedure and the control group (n = 54) received no cervical priming agent. The primary outcome measure was the number of women who required cervical dilation. Secondary outcomes were cervical width (the largest size of Hegar dilator inserted without resistance) as well as complications and adverse effects. Results: In the misoprostol group 27 women (52.9%) required cervical dilation vs. 53 (98.1%) in the control group (P < 0.0001). The largest size of Hegar dilator inserted without resistance was 7.6 ± 1.4 mm in the misoprostol group vs. 5.0 ± 1.1 mm in the control group (P < 0.0001). A similar effect of misoprostol on cervical dilation was also found in the subgroup of treated postmenopausal women. Only 2 women (3.9%) experienced mild lower abdominal pain after misoprostol application. Conclusion: Vaginal misoprostol applied before hysteroscopy reduced cervical resistance and the need for cervical dilation in perimenopausal and postmenopausal women, with only mild adverse effects.

Oral, vaginal and sublingual misoprostol for induction of labor

Objective: To evaluate the effectiveness and safety of different administration routes of misoprostol for induction of labor.Method: PubMed, Cochrane Library and EMBASE searches were carried out using the keywords oral, vaginal, sublingual, buccal, misoprostol, labor induction, identifying randomized case–controlled trials comparing different routes for giving misoprostol to induce labor, published in English between 1994 and 2004. Results: Seventeen studies (3549 participants) were included. Compared to vaginal administration, oral misoprostol was associated with higher failure rates for achieving vaginal delivery within 24 h (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.23–2.10), higher rates of uterine hyperstimulation without fetal heart rate (FHR) changes (OR 2.21, 95% CI 1.12 – 4.34) and lower cesarean section rates (OR 0.74, 95% CI 0.56–0.97). A lower dose of oral misoprostol (50 μg) compared to the 25–50 μg administered vaginally was associated with a higher rate of vaginal delivery not being achieved within 24 h (OR 3.60, 95% CI 2.10 – 6.18), more need for oxytocin augmentation (OR 2.19, 95% CI 1.65–2.92), less uterine hyperstimulation both without FHR changes (OR 0.58, 95% CI 0.42–0.80) and with FHR changes (OR 0.34, 95% CI 0.17–0.67) and fewer cesarean sections (OR 0.69, 95% CI 0.51–0.91). Compared to vaginal administration, buccal misoprostol resulted in a higher rate of failure to achieve vaginal delivery after 24 h, more frequent uterine hyperstimulation and lower rates of cesarean section, but these differences were not significant. When 50 μg of misoprostol used sublingually was compared to oral administration, the sublingual misoprostol was associated with less failure to achieve vaginal delivery after 24 h, less oxytocin augmentation and reduced cesarean section, but none of the differences were statistically significant. Conclusions: Vaginal misoprostol appears more effective than the equivalent dosage administered orally. However, the vaginal route appears to be associated with a higher risk of uterine hyperstimulation. Sublingual misoprostol seems an effective route of administration, but a lack of data necessitates more clinical trials to establish the effectiveness and safety of the buccal/sublingual route.

GROUP B STREPTOCOCCUS AND ESCHERICHIA COLI COLONIZATION IN PREGNANT WOMEN AND NEONATES IN LITHUANIA

To evaluate the prevalence of maternal and neonatal colonization with group B streptococcus (GBS) and Escherichia coli, and examine GBS serotypes and susceptibility to antibiotics.