title: Interpretation of 2002 Centers for Disease Control guidelines for group B streptococcus and evolving provider practice patterns.
abstract: We investigated if clinicians were altering their care of group B streptococcus (GBS)-positive women in labor to achieve 4 hours of intrapartum antibiotic prophylaxis based on their interpretation of the 2002 Centers for Disease Control (CDC) guidelines on prevention of perinatal GBS disease. We surveyed all clinicians with privileges on the labor floor at our institution about their interpretation and clinical application of the 2002 CDC guidelines. Seventy of 96 eligible clinicians (72.9%) completed our survey. In our survey, only 22.9% of clinicians reported not altering their management of labor in GBS-positive pregnancies that achieved less than 4 hours of prophylaxis. These alterations included "laboring down" or delaying pushing; turning off or decrease an oxytocin infusion; or delaying or avoiding artificial rupture of membranes. Clinicians are altering their management of labor to attempt to achieve 4 hours of intrapartum prophylaxis. The 2002 CDC guidelines do not specifically recommend prolonging labor and are being interpreted differently in the clinical setting than the authors may have intended. The effects and consequences of this interpretation are unknown.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA.
authors.forename: Emma L
authors.initials: EL
authors.lastname: Barber
authors.forename: Edmund F
authors.initials: EF
authors.lastname: Funai
authors.forename: Michael B
authors.initials: MB
authors.lastname: Bracken
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Illuzzi
mesh_terms: D019072:Antibiotic Prophylaxis / Q000379:methods* / Q000639:trends; D002353:Carrier State / Q000382:microbiology*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007743:Labor, Obstetric; D008297:Male; D008880:Midwifery; D010820:Physicians; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000382:microbiology*; D013290:Streptococcal Infections / Q000188:drug therapy / Q000635:transmission*; D013292:Streptococcus agalactiae