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Re: any evidence to support your statement that colonization of the urine in a prior pregnancy is more important than than colonization of the vagina/rectum in a prior pregnancy wh From: Garry E. Siegel, M.D. (@obgyn.net) Wed Jan 19 19:28:25 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "OB: Macrosomia" Previous message: DoctorJoe@aol.com: "Re: Refreshing skills" Robert: I have no evidence other than my impression, supported by Hank and Joe (thanks) and documented below. In my answer (and Hank's subsequent post), I didn't realize that she had negative urine cultures THIS pregnancy. My conclusions are thus as clear as mud and supported by obstetric horse sense, i.e. If I had no information about urine THIS pregnancy (which are the circumstances under which my post was written)--treat with Penicillin If I knew the current pregnancy had a negative urine culture (the actual scenario, thanks Efrain)--flip a coin! Actually, I probably would NOT treat in this case, with one caveat: If the mother pressed me, I would have an informed discussion about why antibiotics aren't always good. At the conclusion, I would use antibiotics if WE decided to after the discussion. Garry (see you at NSH in AM--C/S 0730, Cerclage 0930) At Wed, 19 Jan 2005, Henry Gregor wrote: > >RModugno@aol.com wrote: >Do you have any evidence to support your statement that colonization of the urine in a prior pregnancy is more important than than colonization of the vagina/rectum in a prior pregnancy when it comes to the chance of spreading GBS disease to the fetus? > >Riobert Modugno MD MBA FACOG >Marietta, GA >http://www.novaobgyn.yourmd.com > >Robert, >None of us are going to know what the patient did or did not carry in urine, rectum or vagina prior to labor in this pregnancy. She did have positive Group B urine results in prior pregnancy. > >On page 15 of the MMWR Prevention of Gp B Strep Disease Revised Guidelines from CDC, August 16. 2002 it is advised that "Women with GBS isolated from the urine in any concentration should receive intrapartum chemoprophylaxis because such women usually are heavily colonized with GBS and are at increased risk of delivering an infant with eanly-onset GBS disese." > >I would err of the side of the risk benefit equation of abx use this labor, and involve the patient in a documented decision process, recognizing she might be GBS free in this pregnancy. However, just as I find a past ROS response of prior UTI relevant (don't know if this is scientifically accurate or not) in terms of alerting me to a patient's being at possibly increased risk of a recurrent UTI, I would use her past history and this CDC guideline to suggest intrapartum prophylaxis currently....gosh, we are all a talkative and cumpulsive and driven lot, aren't we?...that's why I love this profession, despite all the silly JCAHO, COBRA, HCFA, CLIA, yada, yada. And the net and email...makes life great to be able to converse in cyber hallways with so many talented folk. > >Hank -- Garry E. Siegel, M.D. Private Practice Roswell, GA Next message: art fougner, md: "OB: Macrosomia" Previous message: DoctorJoe@aol.com: "Re: Refreshing skills"

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