Cesarean section rates in Lithuania using Robson Ten Group Classification System.

BACKGROUND AND OBJECTIVE: The aim of this study was to analyze cesarean section (CS) rates using Robson Ten Group Classification System (TGCS) and to identify the main contributors to the overall CS rate in Lithuania. MATERIALS AND METHODS: A prospective cross-sectional study was carried out. All women who delivered between January 1 and December 31, 2012, in Lithuania were classified using the TGCS. The CS rates overall and in each Robson group were calculated, as was the contribution of each group to the overall CS rate. RESULTS: The CS rate was 26.4% (6697 among 25,373 deliveries) in 2012. Nulliparous women with single cephalic full-term pregnancy in spontaneous labor (Group 1) or who underwent induction of labor or prelabor CS (Group 2) and multiparous women with a previous CS (Group 5) were the greatest contributors (67.7%) to the overall CS rate. In addition, significant variation of CS rates between different institutions was observed, especially in women with single cephalic full-term pregnancy without previous CS (Groups 1-4), showing big differences in obstetric care across country. CONCLUSIONS: Women in Groups 1, 2 and 5 were the largest contributions to the overall CS rate in Lithuania. It seems that efforts to reduce the overall CS rate should be directed on increasing vaginal birth after CS and reducing CS rates in nulliparous women with single cephalic full-term pregnancy (Groups 1 and 2).

Maternal request is not to blame for an increase in the rate of Cesarean section.

BACKGROUND AND OBJECTIVE: The aim of this study was to establish whether Lithuanian women would request an elective cesarean section in a low-risk pregnancy and to compare how the women's opinion changed during the 5-year period. MATERIAL AND METHODS: A study was conducted at the Hospital of Lithuanian University of Health Sciences from November 1 to December 31, 2006, and from January 1 to February 28, 2011. A total of 204 and 239 women were enrolled in 2006 and 2011, respectively. Self-administered anonymous questionnaires collected information on women's knowledge about the advantages of the different modes of delivery and their preferred type of birth in a low-risk pregnancy. RESULTS: Overall, 82.4% of the participants in 2006 and 74.5% in 2011 thought that women should be able to choose the mode of delivery in a low-risk pregnancy. If they had had such an opportunity, 15.2% of women in 2006 and 14.9% in 2011 would have chosen cesarean section without any medical indication. The most frequently mentioned advantage of vaginal delivery was that it is natural, while safety for the newborn and the possibility of avoiding delivery pain were the mentioned advantages of cesarean section. CONCLUSIONS: Approximately 15% of Lithuanian women would request an elective cesarean section, and this percentage did not change during the 5-year period. While the national cesarean section rate is increasing with every year, it seems that "maternal request" cannot be blamed for this phenomenon. Despite all the available information about the different modes of delivery, women still lack professional and reliable knowledge about it.

Escherichia coli colonization in neonates: prevalence, perinatal transmission, antimicrobial susceptibility, and risk factors.

UNLABELLED: Escherichia coli is one of the leading causes of early-onset neonatal sepsis in many industrialized countries. However, there is a lack of studies on Escherichia coli colonization in women and neonates. The study aimed at determining the prevalence Escherichia coli among pregnant women and newborns, perinatal transmission, antimicrobial susceptibility, and risk factors for neonatal colonization. MATERIAL AND METHODS: In this prospective, cross-sectional study, 827 infants born to 808 mothers were enrolled. The study was carried out from October 1, 2006, to June 30, 2007. Women were screened for E. coli carriage at 35-37 weeks of gestation or on admission for premature rupture of membranes and delivery; neonates, within 15 minutes of their lives. Risk factors for colonization were collected by a questionnaire and were recorded during labor. RESULTS: Maternal E. coli colonization rate was 19.9%; neonatal, 14.4%; and transmission rate, 21.4%. Less than one-fourth (22.7%) of neonatal E. coli strains were resistant to ampicillin. Logistic regression analysis revealed that anal sexual intercourse (OR, 3.91; 95% CI, 1.87-8.19), one sexual partner (OR, 2.01; 95% CI, 1.30-3.11), maternal vaginal Escherichia coli colonization (OR, 1.81; 95% CI, 1.12-2.93), maternal body mass index of ≤27 (OR, 1.77; 95% CI, 1.15-2.73), and maternal education lower than university level (OR, 1.70; 95% CI, 1.06-2.74) were associated with neonatal Escherichia coli colonization. CONCLUSIONS: The prevalence of maternal Escherichia coli colonization was higher in this study than other studies (19.9%). Neonatal Escherichia coli colonization was 14.4%. The resistance of Escherichia coli isolates to ampicillin was not high (22.7%). Improvement of maternal education and modification of mothers' sexual habits need to be undertaken to prevent neonatal Escherichia coli colonization.

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.

Group B streptococcus and Escherichia coli colonization in pregnant women and neonates in Lithuania.

OBJECTIVE: 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. METHODS: A prospective cross-sectional study was carried out in Lithuania between October 2006 and June 2007. Lower vaginal/rectal swabs were obtained from pregnant women (n=998) and ear canal/throat swabs were obtained from their newborns (n=827) for culture. RESULTS: Overall, maternal and neonatal GBS colonization rates were 15.3% and 6.4%, respectively. Serotypes III (34.5%) and Ia (29.7%) were most common. All GBS isolates were susceptible to penicillin and 4.1% were resistant to erythromycin. Overall, maternal and neonatal E. coli colonization rates were 19.9% and 14.4%, respectively. In total, 71.4% of newborns with E. coli colonization were born to E. coli-negative mothers. E. coli was resistant to ampicillin and piperacillin in 25.9% and 16.6% of cases, respectively. The majority of E. coli-colonized newborns were contaminated with maternal fecal, but not vaginal, E. coli strains. CONCLUSION: Maternal and neonatal GBS colonization rates, serotypes, and susceptibility to antibiotics were comparable to those reported in previous studies. Population-based data regarding early-onset neonatal infection rates will enable the formulation of a prevention program for early-onset GBS disease in Lithuania.

La laparoscopia mejora la precisión diagnóstica de la enfermedad pelviana inflamatoria / Laparoscopy improves the diagnostic accuracy in pelvic inflammatory disease

El objetivo de este estudio fue evaluar los criterios de diagnóstico clínico y los hallazgos laparoscópicos en mujeres con enfermedad pelviana inflamatoria (EPI). Métodos: Se inscribieron en el estudio setenta y tres mujeres de 18 a 35 años que acudieron al servicio de Ginecología del Hospital de la Universidad Lituana de Ciencias de la Salud con síntomas clínicos de enfermedad pelviana inflamatoria. Todas las pacientes fueron sometidas a un examen clínico y pruebas de laboratorio bajo el mismo protocolo. La laparoscopia diagnóstica se realizó dentro de las 12 horas posteriores al ingreso. Resultados: Se confirmó la presencia de EPI por laparoscopia en el 71.2% de los casos. La EPI verificada por laparoscopia tuvo una correlación significativa con los siguientes síntomas: dolor abdominal bajo, dolor a la movilización cervical y dolor anexial. Se detectó la presencia de Chlamydia trachomatis y de Neisseria gonorrhoeae en muestras endocervicales en el 46.1% y el 26.9% de las mujeres con EPI confirmada. Conclusiones: El diagnóstico preliminar de EPI debe basarse en criterios de diagnóstico clínico. La laparoscopia diagnóstica temprana mejora la precisión diagnóstica y determina con mayor exactitud la gravedad de la enfermedad.