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vol.67 número6USO DEL ASA ELECTROQUIRURGICA EN NEOPLASIAS PRECLINICAS DEL CERVIX, ¿QUIENES, CUANTAS Y POR QUE NECESITARON UN SEGUNDO TRATAMIENTO?COMPARACION DEL INDICE LECITINA/ ESFINGOMIELINA VERSUS FOSFATIDILGLICEROL EN LA EVALUACION DE LA MADUREZ PULMONAR FETAL índice de autoresíndice de assuntospesquisa de artigos
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Revista chilena de obstetricia y ginecología

versão impressa ISSN 0048-766Xversão On-line ISSN 0717-7526

Resumo

OVALLE S, Alfredo et al. INFECCION VAGINAL Y TRATAMIENTO DEL STREPTOCOCCUS GRUPO B EN EMBARAZADAS CON FACTORES UNIVERSALES DE RIESGO DE INFECCION: RESULTADOS NEONATALES Y FACTORES DE RIESGO DE INFECCION NEONATAL. Rev. chil. obstet. ginecol. [online]. 2002, vol.67, n.6, pp.467-475. ISSN 0048-766X.  http://dx.doi.org/10.4067/S0717-75262002000600007.

Objetives: To determine the efficiency of antibiotic therapy in neonatal outcomes of pregnant women with universal risk factors and vaginal infecton by Streptococcus group B (SGB) and to know the risk factors for neonatal infection produced by this bacteria. Study Design: Women with vaginal infection by SGB in a population of 443 pregnant women with universal risk of bacterial infection were incorporated in this study. The genitourinary infection risk antecedents and pathologies of bacterial infection risk during gestation were considered as universal maternal factors of bacterial infection risk. The genitourinary infection risk antecedents are: spontaneous abortion of second trimester (without cause or associated to genitourinary infection), repeated vaginitis (3 or more events), urinary tract infection, preterm delivery, with premature rupture of membranes (PROM) or with intact membranes (without cause or associated to genitourinary infection), puerperal infection, antecedent of diabetes, psyquiatric pathologies (epilepsy, depression) and thyphoid fever (Ovalle test). The following pathologies of bacterial infection risk during gestation were considered: acute pyelonephritis, preterm PROM, PROM at term and premature labor without an evident clinical cause. Patients with risk antecedents were treated with ampicillin; pregnant women with bacterial infection risk were treated with association of clindamycin-gentamicin or clindamycin-cefuroxime during 7 days. Patient with acute pyelonephritis were treated with cefuroxime for 14 days. Morbidity, mortality and neonatal risk factors associated to SGB infection were evaluated. Results: Thirty one pregnant women with vaginal infection caused by SGB. The antibiotic therapy prevented the neonatal infection in every pregnant woman with vaginal infection and without intra-amniotic infection by SGB.With microbial invasion of the amniotic cavity (MIAC) by SGB, neonatal early infection was present in the 50% (3/6 cases) and neonatal early death for this cause in the 33.3% (2/6 cases). Factors that significantly contributed to the appearance of infectious neonatal morbidity caused by SGB in comparison with children without infection were: MIAC caused by SGB (100% (3/3) vs 10,7% (3/28) p < 0.01); premature labor (100% (3/3) vs 32.1% (9/28) p < 0.05); PROM in pregnancy < 34 weeks (100% (3/3) vs 28.6% (8/28) p < 0.05); clinical chorioaminonitis (66.7% (2/3) vs 10.7% (3/28) p < 0.01) and bacterial vaginosis (100% (3/3) vs 17.9% (5/28) p < 0.05). Conclusions: The antibiotic therapy in pregnant women with vaginal infection by SGB and universal factors of infection risk, prevents the neonatal infection, but it does not avoid it when there is MIAC by this bacterium. The failure of the therapy and the neonatal infection by SGB are favored with premature labor, PROM in pregnancy < 34 weeks, clinical chorioamnionitis vaginal infection by Mycoplasma hominis and bacterial vaginosis.

Palavras-chave : Streptococcus group B; preterm labor; antibiotic therapy; intra-amniotic infection; neonatal outcomes.

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