Diagnosis and Management of Pregnant Women With Placental Abruption and Neonatal Outcomes.

Background Placenta abruptio (PA) remains a serious materno-fetal complication. According to progress realized in maternal-fetal medicine, we aimed to evaluate the diagnosis and management of PA and neonatal outcomes. Methods We conducted a retrospective study that involved all the patients that were diagnosed with PA in a tertiary maternity hospital between 2006 and 2013. Data were analyzed to determine mean and standard deviation and statistically analyzed using the Chi-square test. Results In total, 201 patients were diagnosed with PA out of 35184 deliveries (0.56%). The mean age of patients was 30 years and most of them were multiparous (56.2%). Thirty-six out of 201 patients (17.9%) smoked tobacco or consumed alcohol during the pregnancy. Three patients came from their homes. Twenty-eight patients had preeclampsia and 105 presented with high blood pressure. Furthermore, 117 patients presented metrorrhagia (58.2%) and 39% of patients exhibited abdominal pain. We reported fetal heart rate abnormalities in 57% of the cases. Ultrasound examination revealed PA in only 48 patients (23.9%). One hundred eighty out of 201 patients (84.6%) underwent an emergency caesarean section. One hundred sixty-seven fetuses were born prematurely. Thirteen out of 201 fetuses died, and 98 newborns needed neonatal resuscitation. In total, 31 fetuses had an umbilical artery (UA) with pH ≤ 7 (31/188). The mean time for delivery was 18.7 min. However, UA pH did not differ when the delivery time was shorter (p = 0.09). Seventy-six percent of cases came from their homes. The mean UA pH was significantly lower for PA cases who came from their homes compared to hospitalized women (p = 0.0015). Histological examination of the placenta confirmed the diagnosis in 71 out of 148 cases (47.9%). The mean duration of hospital stay of the newborns was 17 days. Conclusion PA remains a serious materno-fetal emergency with a bad fetal prognosis for many newborns. Many fetuses either died or exhibited severe acidosis. Clinical signs and radiological images of PA are absent in many cases. There was more fetal acidosis for mothers who came from their homes at the time of delivery. We recommend that the delivery should not be delayed and a cesarean section must be the preferred mode of delivery. Pregnant women with vascular and metabolic diseases should be carefully monitored and informed on the risk of PA.

Prepartum vaginal/anorectal Group B Streptococcus screening: improvement of the enrichment step by the broth additive RambaQUICK StrepB.

We used RambaQUICK StrepB in enrichment broth with samples taken from 31 pregnant women and compared its performance to that of standard enrichment media. RambaQUICK StrepB shortened the required incubation time and raised the sensitivity of streptococcal screening by 1.6 fold.

Evaluation of CHROMagar™ StrepB agar, an aerobic chromogenic medium for prepartum vaginal/rectal Group B Streptococcus screening.

An aerobic chromogenic medium, CHROMagar™ StrepB agar, designed for isolation of group B Streptococci, was evaluated on 285 prepartum vaginal/rectal swabs from pregnant women. After overnight enrichment in Todd-Hewitt broth containing 15µg/ml nalidixic acid and 10µg/ml colistin, sensitivities were respectively 79% on day 1 and 92% on day 2, and significantly higher than those achieved by blood agar (40% and 58%) and colimycin-nalidixic-acid agar (82% on day 2).

Evaluation of CHROMagar StrepB: a new chromogenic agar medium for aerobic detection of Group B Streptococci in perinatal samples.

A selective and chromogenic medium, the CHROMagar StrepB agar (CHROM-B) designed for aerobic isolation of Group B Streptococci (GBS) in pregnancy-related specimens, was evaluated in a two-Phase study. CHROM-B was evaluated against CPS3 during the first Phase and against Granada afterwards. It was compared to blood agar plates (COH) and to colimycin nalidixic agar plates (CNA) over both Phases. The study which included 1356 samples, yielded 124 GBS. CHROM-B was significantly more sensitive than COH (76.6% vs 53.2% on d1 and 92.7% vs 64.5% on d2; p<0.001 for both). CHROM-B yielded positive results sooner than CNA. CPS3 under-performed, partly because of microbiota overgrowth and partly because it did not produce a single and unique colour from the GBS colonies. CHROM-B produced its unique GBS-expected colour sooner than Granada yielding a significantly sooner result for 10% (6/60; p<0.025). Every 124 GBS could grow typical colonies on CHROM-B and False Negatives were only due to paucimicrobial samples. Granada failed to produce the expected colour from one non-haemolytic GBS. We conclude that CHROMagar StrepB performed significantly better, irrespective of the haemolytic properties of GBS strains, and significantly sooner than COH, CNA, CPS3 and Granada.