UNIVERSAL SCREENING FOR GROUP-B STREPTOCOCCUS - RECOMMENDATIONS AND OBSTETRICIANS PRACTICE DECISIONS

Objective: To determine how obstetricians' opinions regarding universa l screening of pregnant women for group B streptococcus (GBS) and thei r responses to positive culture results vary from American Academy of Pediatrics recommendations, and to determine the physician characteris tics that predict divergent opinions. Methods: One hundred ninety-four practicing obstetricians in the middle Tennessee region were queried by a mail survey. They were asked if they agreed with universal screen ing for GBS and to indicate whether they would prescribe antibiotics f or women in labor, represented by six scenarios that differed with res pect to presence or absence of preterm labor, premature rupture of mem branes (ROM), prolonged ROM, and a positive GBS cervical culture. They were also asked to describe their practice and personality characteri stics. Results: Completed surveys were returned by 135 of 194 obstetri cians (70%). Although only 28% of the respondents agreed with routine prenatal screening for GBS, most (74%) said they would treat a patient on the basis of a positive culture alone. Other risk factors, when ad ded to a positive culture, slightly increased the decision to treat (f rom 74 to 88%). Multiple logistic regression, used to assess the relat ive effect of clinical and physician characteristics on treatment deci sions, revealed that chemoprophylaxis for GBS was predicted most stron gly by a positive culture at 28 weeks' gestation followed by prolonged ROM and preterm labor. Practicing in an urban location and seeing few er than 20 patients per day also influenced the decision to treat. Con clusion: Although most obstetricians in the middle Tennessee region do not believe in universal screening, most will prescribe intrapartum a ntibiotics on the basis of a positive screening culture. However, othe r clinical risk factors and physician characteristics significantly an d independently affect the decision to treat as well.