Evaluation of two rapid commercial assays for detection of Streptococcus agalactiae from vaginal samples.

INTRODUCTION: Streptococcus agalactiae, also known as group B streptococci (GBS), is associated with invasive infections in neonates. Identification of GBS vaginal colonization in pregnant women before delivery is essential for treatment with antibiotics to prevent intrapartum vertical transmission to the newborn. This study was designed to evaluate applicability of two rapid real-time PCRs in comparison to standard culture identification. MATERIAL AND METHODS: We compared the Xpert GBS assay, hereafter referred to as Xpert, and GenomEra GBS PCR, hereafter referred to as GenomEra. The standard culture identification consisted of two different agar plates as well as an enrichment broth. RESULTS: We analyzed vaginal samples of 260 pregnant women; 42 samples were tested GBS-positive by using standard culture as a gold standard, 30 by Xpert, and 37 by GenomEra. Xpert and GenomEra assays performed with sensitivities of 71.4% and 88.1% as well as specificities of 98.6% and 99.1%, respectively. Twelve vaginal samples were false-negative by Xpert and five samples by GenomEra. Interestingly, three negative Xpert results of standard culture-positive samples exhibited high Ct-values indicating the presence of GBS. If higher Ct-values are taken into consideration, the sensitivity of Xpert increases up to 78.6%. Moreover, only three Xpert PCRs had to be repeated, whereas two Genomera were invalid even after repetition and further 15 GenomEra PCRs were repeated because of borderline results or inhibition of the PCR test. CONCLUSIONS: In this study, GenomEra assay performed with a higher sensitivity than the Xpert PCR. On the other hand, the Xpert assay needs less hands-on-time for a sample preparation and requires approximately four-fold less repetitions as compared to the GenomEra assay. This robust performance of the Xpert assay make it applicable as a rapid intrapartum point-of-care test, although a higher sensitivity would be desirable. Therefore, culture in the 35-37 week of gestation remains the gold standard to detect vaginal colonization.

Association between the side of levator Ani muscle trauma and fetal position at birth - a prospective observational study.

INTRODUCTION: Trauma of the levator ani muscle (LAM) is common after vaginal birth and can most reliably be diagnosed by 3-dimensional (3D) translabial ultrasound (TLUS). Multiple risk factors are known in general, but not in association to a specific side of the body. Therefore, our aim was to evaluate different impact factors which cause LAM trauma on either side of the body or bilateral by focusing on the fetal position at birth. MATERIAL AND METHODS: As part of a prospective cohort study between 3/2017 and 4/2019, we analyzed vaginal births of nulliparous women with singletons in vertex presentation≥36+0 gestational weeks. We evaluated their pelvic floor for hematomas, partial and complete LAM avulsions by 3D TLUS 2-4 days postpartum and searched for an association between the affected body side and different fetal, maternal and obstetrical factors. RESULTS: 71 out of 213 women (33.3%) suffered from LAM trauma - 17 (23.9%) on the right side, 20 (28.2%) on the left side and 34 (47.9%) bilateral. No association between the different evaluated factors and the affected body side could be identified, except for the quality of fetal heart rate tracing. CONCLUSIONS: No significant impact factors of LAM trauma could be associated with a specific side of the body. Other possible mechanisms need investigation in the future, such as the time of the birth canal and the fetus to adapt to each other, including adequate time for the tissue to stretch and the fetus to rotate into the ideal position within the LAM hiatus. EINLEITUNG: Levatormuskelverletzungen sind häufig nach Vaginalgeburten und können zuverlässig mittels translabialem 3D-Ultraschall diagnostiziert werden. Diverse Risikofaktoren sind hierfür bekannt, allerdings keine hinsichtlich der Assoziation zu einer der beiden Körperseiten. Daher war das Ziel dieser Arbeit, verschiedene Einflussfaktoren im Rahmen vaginaler Geburten zu evaluieren, welche eine Levatorverletzung auf einer der beiden Körperseiten bzw. beidseitig begünstigen, v. a. hinsichtlich der Kindsposition im Geburtskanal. MATERIAL UND METHODIK: In einer prospektiven Kohortenstudie analysierten wir von 3/2017-4/2019 Erstgebärende mit vaginalen Einlingsgeburten aus Schädellage≥36+0 SSW. Wir evaluierten 2-4 Tage postpartal ihren Beckenboden mittels 3D-Ultraschall hinsichtlich Hämatomen sowie partiellen und kompletten Levatoravulsionen und suchten nach Assoziationen zwischen der betroffenen Körperseite und fetalen, maternalen und geburtshilflichen Einflussfaktoren. ERGEBNISSE: Von 213 Frauen erlitten 71 (33.3%) eine Levatorverletzung - 17 (23.9%) rechtsseitig, 20 (28.2%) linksseitig und 34 (47.9%) beidseitig. Es wurden keine Assoziationen zwischen den untersuchten Einflussfaktoren und der betroffenen Körperseite gefunden, bis auf die Qualität der fetalen Herzfrequenz. DISKUSSION: Es konnten keine signifikanten Einflussfaktoren für das Auftreten einer Levatorverletzung einer spezifischen Körperseite eruiert werden. Daher bedarf es in Zukunft der Untersuchung weiterer Mechanismen, wie der Adaptationsvorgänge von Geburtskanal und Fet und der adäquaten Zeit für das Gewebe zur notwendigen Dehnung, v. a. im Bereich der Levatoröffnung.

Association between levator ani muscle avulsions and technique of vacuum extraction - a prospective exploratory study.

AIMS OF THE STUDY: Trauma of the levator ani muscle in the form of partial or complete avulsions is common after vaginal births, especially after vaginal-operative births. As there is little information available regarding associations between the technique of vaginal-operative births and levator ani muscle trauma, we aimed to evaluate the association between the process of vacuum extraction and the occurrence of levator ani muscle trauma. METHODS: As part of a prospective cohort study at the University Hospital of Zurich between March 2017 and April 2019, we sub-analysed vacuum extractions in nulliparous women with singletons in vertex presentation ≥36+0 gestational weeks. We evaluated their pelvic floor for partial and complete levator ani muscle avulsions using translabial ultrasound 6–10 weeks postpartum and calculated the association of the vacuum procedure itself, along with other fetal, maternal and obstetrical characteristics, with levator ani muscle trauma. RESULTS: Levator ani muscle trauma was present in 17 (34.7%) out of 49 women. There were no associations between the different factors evaluated and levator ani muscle trauma in vacuum-assisted births, except that the levator ani muscle group had insufficient uterine contractions. CONCLUSIONS: We found no fetal, maternal or obstetrical characteristics or parameters of vacuum technique that were associated with the occurrence of levator ani muscle trauma after vacuum extraction, except for insufficient uterine contractions. Nevertheless, there might be influencing factors that have not yet been evaluated, or are not easily accessible for evaluation, like the adaptations of the fetus inside the birth canal and within the hiatus of the levator ani muscle, and the adaptations of the birth canal to the fetus passing through. This should be the subject of further research with a sample size adequately powered to answer this question properly. (Trial registration number: BASEC-Nr.2016-00908.)  .

Prediction of levator ani muscle avulsion by genital tears after vaginal birth-a prospective observational cohort study.

INTRODUCTION: Visible birth tears and levator ani muscle (LAM) trauma are common after birth. For the diagnosis of LAM trauma ultrasound evaluation is advisable. As ultrasound equipment and trained personnel are not available everywhere at all times, we aimed to evaluate whether specific overt birth tears are an indicator for LAM trauma. METHODS: In a prospective cohort study at our center from March 2017-April 2019, we evaluated vaginal births of nulliparous women with singletons in vertex presentation ≥ 36 + 0 gestational weeks for LAM trauma by translabial ultrasound and for overt birth tears by inspection. We then calculated the association of overt birth tears with complete LAM avulsion. RESULTS: Of 213 women, 23.9% had any kind of LAM trauma, with 14.1% being complete avulsions. In univariate analysis, solely high-grade perineal tears (OASIS) were significantly associated with complete LAM avulsions. CONCLUSIONS: Fourteen percent of women suffered a complete LAM avulsion after vaginal birth, with OASIS being the only associated parameter of significance. The occurrence of such trauma might be an indicator for a mismatch between the size of the fetus and the structures of the birth canal, leading to birth trauma. Assessing for LAM trauma by translabial ultrasound in women with OASIS might be worthwhile.

[Association of Birth Trauma with the Implementation of Obstetrical Monitoring Tools: A Retrospective Cohort Study]. / Assoziation zwischen Geburtsverletzungen und der Einführung geburtshilflicher Observationsmaßnahmen: eine retrospektive Kohortenstudie.

INTRODUCTION: Lacerations are common in vaginal births. They can result in immense physical and psychological morbidity. Ongoing efforts are being made to reduce birth trauma. We implemented different obstetrical monitoring tools in the labor ward and evaluated their association with the incidence and distribution of different types of birth lacerations. MATERIAL AND METHODS: We retrospectively analyzed nulliparous and multiparous women with singleton term pregnancies in vertex presentation, who gave birth vaginally in our tertiary care center between October 2014 and September 2015. We evaluated 3 different time intervals (T1=4 months before the implementation of the monitoring tools, T2=0-4 months and T3=5-8 months afterwards). Outcome parameters were the incidence and distribution of different types of birth lacerations during the 3 different time intervals. RESULTS: The incidence of all types of birth trauma decreased from 95,52% in nulliparous and 68,53% in multiparous women at T1 to 89,92% and 62,27% non-significantly at T3, with a decrease in perineal and vulvar/labial lacerations and an increase in vaginal lacerations. The rate of episiotomies and third-/fourth-degree perineal tears remained stable for nulliparous (33 and 3%) and multiparous (10 and 0.4%) women between the time intervals. CONCLUSION: The overall incidence of birth lacerations is high, with lacerations predominantly appearing as first- and second-degree perineal tears but also vaginal and labial lacerations. The initiation of different obstetrical monitoring tools is associated with a change in the incidence of birth traumas and a shift from an external to an internal distribution, probably due to more careful management by the obstetrical staff. The implementation of such tools might help to improve obstetrical management and laboring women might benefit. However, it is important to realize the effect of monitoring and observation itself on the course of observational studies.