• In utero transplacentally or through ruptured membranes
• In the birth canal during delivery (intrapartum)
• From external sources after birth (postpartum)
In utero infection, which can occur any time before birth, results from overt or subclinical maternal infection. Consequences depend on the agent and timing of infection in gestation and include spontaneous abortion, intrauterine growth restriction, premature birth, stillbirth, congenital malformation (eg, rubella), and symptomatic (eg, cytomegalovirus [CMV], toxoplasmosis, syphilis) or asymptomatic (eg, CMV) neonatal infection.
Common viral agents include herpes simplex viruses, HIV, CMV, and hepatitis B. Intrapartum infection with HIV or hepatitis B occurs from passage through an infected birth canal or by ascending infection if delivery is delayed after rupture of membranes; these viruses can less commonly be transmitted transplacentally. CMV is commonly transmitted transplacentally.
Bacterial agents include group B streptococci, enteric gram-negative organisms (primarily Escherichia coli), Listeria monocytogenes, gonococci, and chlamydiae.
Postpartum infections are acquired from contact with an infected mother directly (eg, TB, which also is sometimes transmitted in utero) or through breastfeeding (eg, HIV, CMV) or from contact with health care practitioners and the hospital environment.
Group B Streptococcus (GBS), also known as Streptococcus agalactiae, is best known as a cause of postpartum infection and as the most common cause of neonatal sepsis. This organism is also causes infection in nonpregnant adults. Group B streptococcal infection in healthy adults is extremely uncommon, except in young and middle-aged women, and is almost a...
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...onized with GBS and administration of peripartum prophylaxis to those identified as carriers to reduce the risk of early-onset GBS disease in neonates, and more important than that is to find a test which has high sensitivity and specificity comparing to standard methods for prenatal GBS screening and more reliable. Also as it was mentioned before, up to 15% of pregnant women do not receive adequate prenatal care including routine screening for GBS. In these cases, a more rapid and sensitive direct testing method for screening may be desirable. The Smart GBS molecular test demonstrated sensitivity and specificity of 96.8% and 95.5%, respectively. The sensitivities of the two broth-enriched molecular methods were superior to those for direct testing of specimens using the Xpert GBS assay, which demonstrated sensitivity and specificity of 85.7% and 96.2%, respectively.
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