title: Self-sampling for group B streptococcus in women 35 to 37 weeks pregnant is accurate and acceptable: a randomized cross-over trial.
abstract: OBJECTIVE
  In Canada, screening for group B Streptococcus (GBS) in pregnant women is recommended at 35 to 37 weeks' gestation. Since there is normally no other indication for pelvic examination at this stage of pregnancy, women may be more comfortable performing the test themselves. We assessed the accuracy of self- sampling versus clinician sampling for GBS and women's preference for each collection method.
  
  
  METHODS
  Consecutive patients presenting between October 2003 and April 2005 to a maternity centre in Hamilton for their 35- to 37-week prenatal visit were randomly allocated to having vaginal-rectal swabs self-collected, and then collected by a clinician, or to having the swabs clinician-collected, and then self-collected. The main outcomes were prevalence of infection and sensitivity of the two methods. Other analyses compared women who refused participation in the study with those who participated, and preference for sampling method before and after conducting the tests.
  
  
  RESULTS
  Of the 386 women approached, 330 (85.5%) agreed to participate. The prevalence of GBS was 17.0% (56/330) and 18.8% (62/330) in the self-obtained and clinician-obtained specimens respectively (difference =1.8%; 95% confidence intervals [CI] -2.0-6.0). Sensitivity was 87.5% (95% CI 77.0-93.8) and 96.9% (95% CI 88.7-99.8) for the self-obtained and clinician-obtained specimens respectively. Women who declined to participate in self-sampling were significantly more likely not to have completed high school and to prefer clinician sampling. Prior to testing, 79% of women preferred self-sampling or had no preference. Preference was unchanged for approximately two-thirds of women after sampling.
  
  
  CONCLUSIONS
  Self-sampling for GBS is an accurate and acceptable alternative for the majority of pregnant women. Less-educated women may be hesitant to self-sample, and clinician sampling should remain an option.
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton ON.
authors.forename: David
authors.initials: D
authors.lastname: Price
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton ON.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shaw
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton ON.
authors.forename: Michelle
authors.initials: M
authors.lastname: Howard
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton ON.
authors.forename: Joyce
authors.initials: J
authors.lastname: Zazulak
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton ON.
authors.forename: Heather
authors.initials: H
authors.lastname: Waters
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton ON.
authors.forename: Janusz
authors.initials: J
authors.lastname: Kaczorowski
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D018592:Cross-Over Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008403:Mass Screening / Q000379:methods; D016017:Odds Ratio; D010358:Patient Participation; D017060:Patient Satisfaction; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000453:epidemiology; D011295:Prenatal Care; D015995:Prevalence; D012648:Self Care; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000379:methods*; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000453:epidemiology; D013292:Streptococcus agalactiae / Q000302:isolation & purification*