Accuracy of an accelerated, culture-based assay for detection of group B streptococcus.

OBJECTIVE: To determine the validity of a novel Group B Streptococcus (GBS) diagnostic assay for the detection of GBS in antepartum patients. STUDY DESIGN: Women were screened for GBS colonization at 35 to 37 weeks of gestation. Three vaginal-rectal swabs were collected per patient; two were processed by traditional culture (commercial laboratory versus in-house culture), and the third was processed by an immunoblot-based test, in which a sample is placed over an antibody-coated nitrocellulose membrane, and after a six-hour culture, bound GBS is detected with a secondary antibody. RESULTS: 356 patients were evaluated. Commercial processing revealed a GBS prevalence rate of 85/356 (23.6%). In-house culture provided a prevalence rate of 105/356 (29.5%). When the accelerated GBS test result was compared to the in-house GBS culture, it demonstrated a sensitivity of 97.1% and a specificity of 88.4%. Interobserver reliability for the novel GBS test was 88.2%. CONCLUSIONS: The accelerated GBS test provides a high level of validity for the detection of GBS colonization in antepartum patients within 6.5 hours and demonstrates a substantial agreement between observers.

Giant uterine leiomyomata.

OBJECTIVE: To present the case of a patient with giant uterine leiomyomata and review literature pertinent to the subject. DESIGN: Case report and literature review. SETTING: A major university, tertiary-care hospital. PATIENT(S): One patient, with said pathology, who gave informed consent for exploratory laparotomy, total abdominal hysterectomy, and bilateral salpingo-ophorectomy. INTERVENTION(S): Exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-ophorectomy, reoperation with abdominal washout, and hemostasis for hemoperitoneum. MAIN OUTCOME MEASURE(S): Not applicable. RESULT(S): Not applicable. CONCLUSION(S): Those with giant uterine leiomyomata are a very unique and tiny subset of the millions of women with fibroids. They should be treated similarly to older, more critically ill patients. Their optimal surgical management requires the careful attention to considerations and techniques not common to the typical myomectomy or hysterectomy.

Pregnancy after organ transplant.

The frequency and variety of solid organ transplantation in reproductive-age women increases each year. Pregnancy is no longer contraindicated in transplant recipients provided that their graft is functioning well and they are in good general health. Physicians who care for pregnant transplant recipients should be aware of the surmounting data that are available in the literature and through registries of maternal, fetal, and neonatal risks and complications as well as outcome data. Newer immunosuppressive agents preserve graft function and registry data attest to their safety in pregnancy. For optimal maternal and neonatal outcomes, a multispecialty care approach that includes the obstetrician/maternal-fetal specialist,transplant team, anesthesiologist, and neonatal team is prudent when caring for pregnancies after organ transplantation.