Antibiotic use and misuse during pregnancy and delivery: benefits and risks

Although pregnancy is considered as a physiological state, most pregnant women in developed countries receive multiple medications to prevent maternal or neonatal complications, with antibiotics among the most frequently prescribed. During pregnancy, antibiotics are often prescribed in the context of preterm labor, intrapartum fever, prevention of neonatal Group B Streptococcus fever, and cesarean section. Outside this period, they are commonly prescribed in the community setting for respiratory, urinary, and ear, nose and throat infection symptoms. Whereas some of the current indications have insightful reasons to justify their use, potential risks related to overuse and misuse may surpass the benefits. Of note, the recent 2014 World Health Assembly expressed serious concern regarding antibiotic resistance due to antibiotic overuse and misuse and urged immediate action to combat antibiotic resistance on a global scale. Most studies in the obstetrics field have focused on the benefits of antibiotics for short-term maternal and neonatal complications, but with very little (if any) interest in long-term consequences

Infectious complications during pregnancy: from the vagina to the mouth, but affecting the uterus

Infectious diseases have a broad spectrum of effects on reproduction. Infections inflict their most serious damage on fertility, embryogenesis, and fetal development. Preterm delivery, particularly very preterm delivery, is emerging as an end point to which infections may make a major contribution. Infections have more subtle and disputed effects on the risk of miscarriage and impaired fetal growth. Understanding the impact of infectious diseases on reproductive outcomes allows the clinician to better evaluate and counsel the patient affected by these diseases. A thorough understanding of the acquisition, natural course, and pathological sequelae of infectious diseases on the various stages of reproduction will complement the interpretation of reproductive epidemiologic studies that can further guide clinical management

Vaginal cleansing with chlorhexidine gluconate or povidone-iodine prior to cesarean delivery: a randomized comparator-controlled trial

Background: Several randomized controlled trials have demonstrated that preoperative abdominal skin preparation with chlorhexidine gluconate is superior to povidone-iodine for the prevention of surgical site infections. Despite these results, povidone-iodine is still the most commonly used agent for vaginal preparation, even though it may not be ideal

Prévenir la coqueluche chez le nouveau-né : mère vaccinée durant la grossesse, nourrisson protégé

Pertussis is a serious health issue in infants < 3 months. Too young to be vaccinated, they are at higher risk of developing pertussis and vulnerable to severe complications. Two vaccine strategies exist to prevent infant pertussis. The older « cocooning » strategy involves vaccinating parents and close contacts, indirectly protecting newborns. The more effective strategy is to immunize women during pregnancy, providing infants passive protection by transplacental transfer of pertussis antibodies. However, some women and their caregivers are worried about receiving the vaccine during pregnancy. We review the effectiveness, safety, timing and implementation of pertussis antenatal immunization. The aim is to remind practitioners of current recommendations with supporting data. This can be used to reassure future parents and enable informed decisions

Molecular-based Screening for Perinatal Group B Streptococcal Infection: Implications for Prevention and Therapy

Group B streptococci (GBS) are a leading cause of infectious neonatal morbidity and mortality. Timely and accurate identification of colonized pregnant women is imperative to implement intrapartum antibioprophylaxis (IAP) to reduce the risk of early neonatal sepsis. Current guidelines recommend screening for GBS carriage with vaginal-rectal cultures. However, cultures require 24-72 h, thus precluding their use for intrapartum screening and these are only performed at 35-37 weeks gestation. New rapid molecular-based tests can detect GBS within hours. They have the potential to be used intrapartum and to allow for selective IAP in women carrying GBS. An advantage is that they can sometimes be performed by non-laboratory staff in the labor suite, thus avoiding delays in sample transfers to the microbiology laboratory. Another possible use of molecular-based assays is for the diagnosis of neonatal sepsis, where tests with a short turnaround time and high sensitivity and specificity are crucial. In this situation, the detection of microorganisms once antibiotic therapy has already been started is important, as treatment is started immediately once sepsis is suspected without waiting for microbiological confirmation. In this article, we discuss the state-of-the-art molecular-based tests available for GBS screening during pregnancy, as well as their implications for IAP for the diagnosis and prevention of neonatal sepsis

Étude MAVRIC: quand le cerclage par voie abdominale est préférable à la voie vaginale

Le cerclage par voie vaginale permet de pallier une incompétence cervicale, diminuant ainsi le risque d'issues défavorables. Néanmoins, il peut s'avérer inefficace. Un des enjeux pour le gynécologue-obstétricien est de savoir quelle attitude adopter lors d'une grossesse suivante après échec de cerclage vaginal. L'étude MAVRIC, publiée récemment, apporte la preuve que la réalisation d'un cerclage par voie abdominale avant ou en début de grossesse permet une diminution du taux de fausse couche tardive et d'accouchement prématuré par rapport à la voie vaginale. Ceci implique une naissance par césarienne, et donc une deuxième intervention pour la femme. Il reste encore à déterminer le choix de la technique chirurgicale du cerclage abdominal. L'abord par laparotomie ayant été utilisé pour l'étude MAVRIC, il reste à montrer si cette approche est supérieure à la laparoscopie