Clinical practice evaluation of atosiban in preterm labour management in six European countries

OBJECTIVE

To evaluate the efficacy and safety of early administration compared with standard administration of atosiban, when predefined eligibility criteria were met.

DESIGN

A prospective, open-label, randomised clinical trial. Women were randomised to receive atosiban either immediately (early) or when specified criteria, in terms of duration/frequency of uterine contraction or status of cervical dilation/effacement, were fulfilled (standard).

SETTING

Carried out at 105 centres in six European countries.

POPULATION

Pregnant women admitted to hospital in threatened preterm labour between 24 and 34 weeks of gestation, comprising a subgroup of women enrolled in the Tractocile Efficacy Assessment Survey in Europe (TREASURE) clinical experience review.

MAIN OUTCOME MEASURES

Efficacy was defined as the successful delay of delivery with no alternative tocolytic agent for 48 hours.

RESULTS

More women in the early group remained undelivered at 48 hours with no alternative tocolytic agent compared with those who received atosiban when specified criteria were fulfilled (88.9 versus 76.1%; P = 0.03). Safety was comparable between the groups. There were no statistical differences in maternal, fetal or neonatal adverse events between the early and standard atosiban arms.

CONCLUSIONS

The use of atosiban was effective for the delay of preterm labour and presented no safety concerns irrespective of the time it was administered.

Acute fatty liver of pregnancy

Acute fatty liver of pregnancy can produce a great variety of complications. Of these, infections are important. We describe two cases, one of them complicated with uterine sepsis. Both gave evidence of the necessity for multidisciplinary treatment, which reduces the maternal-fetal morbidity and mortality produced by this disease.

[Evaluation of three rapid methods for intrapartum detection of group B streptococcus]

OBJECTIVE

The goal of this study was to evaluate three methods for rapid group B streptococcus (GBS) intrapartum vaginal detection.

MATERIALS AND METHODS

In 330 women, at risk of delivering an infant with GBS disease, vaginal exudates were collected and a culture performed. The following rapid tests were also performed: 1) Equate Strep B immunoassay in 133 samples. 2) Icon Strep B immunoassay in 192 samples. 3) Co-agglutination with Phadebact Strep B, with a previous incubation (> 4 hours) of the vaginal swabs in Lim Group B Strep broth, in 88 samples. In some patients, two of these methods were performed simultaneously.

RESULTS

GBS was detected in 37 women (11.2%) by culture. The sensitivity of Equate Strep B was 47%, Icon Strep B was 35% and co-agglutination with Phadebact Strep B was 38%. The specificity was 91%, 99% and 100% for each one of these methods. PPV 44%, 90% and 100%, respectively and NPV 92%, 91% and 90%, respectively.

CONCLUSION

In conclusion, none of these methods was shown sensitive enough to be used for the routine detection of GBS. Therefore, in order to know the GBS carrier status and prevent its vertical transmission, the practice of vaginal culture during late pregnancy is mandatory.

[Characteristics of group b streptococcus vertical transmission]

OBJECTIVE

The goal of this study was to compare the characteristics of group B streptococcus (GBS) or Streptococcus agalactiae vertical transmission in woman, receiving or not intrapartum. antimicrobial prophylaxis, at risk of delivering an infant with GRS disease.

MATERIALS AND METHODS

The study included 330 women, with risk factors for delivering an infant with GBS disease. The vaginal GBS colonization was studied by conventional culture. A clinical and microbiological follow-up was done in both women and neonates.

RESULTS

GHS was detected in 37 women (11.2%). Among these, 21 (56.8%) received intrapartum antibiotics and 16 (43.2%) did not. Forty-one neonates were born from these 37 women. Of these, 11 showed signs of infection (3 with positive blood culture and 8 with blood culture negative for GBS) and 2 presented an asymptomatic bacteremia A GBS neonatal infection (with positive blood culture) was produced in 4.8% of newborns from mothers who received intrapartum antibiotics versus 25% of newborns from mothers who did not receive intrapartum antibiotics. However, this difference was not significant nor was the difference between external colonization by GBS between these two groups of newborns. On the contrary, significant differences were found in the percentage of clinically suspected sepsis (with negative blood cultures), which was more frequent among newborns from mothers without intrapartum antibiotics (30.4% vs 5.6%). A good correlation between the intensity of vaginal colonization and the incidence of microbiologically demonstrated sepsis, suspected sepsis an asymptomatic bacteremia in the newborn was found.

CONCLUSION

In conclusion, in order to minimize the vertical transmission of GBS, the most efficient strategy seems to be to offer antibiotic prophylaxis to women identified as GBS carriers, since the antibiotic administration to women with "obstetric risks" often means that it is impossible that two hours elapse between antibiotic administration and delivery, resulting in the loss of efficacy of this second strategy.