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ASB-study Screening and treating as ymptomatic b acteriuria in pregnancy

ASB-study Screening and treating as ymptomatic b acteriuria in pregnancy. Symposium 3 handen op 1 buik 13/12/11. Brenda Kazemier (AMC) Suzanne Geerlings (AMC) Prof. Christianne de Groot (VU) Prof. Ben Willem Mol (AMC). Bacteria Urine. Pregnancy.

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ASB-study Screening and treating as ymptomatic b acteriuria in pregnancy

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  1. ASB-studyScreening and treatingasymptomaticbacteriuria in pregnancy Symposium 3 handen op 1 buik 13/12/11 Brenda Kazemier (AMC) Suzanne Geerlings (AMC) Prof. Christianne de Groot (VU) Prof. Ben Willem Mol (AMC)

  2. BacteriaUrine Pregnancy http://4.bp.blogspot.com/_bAIZPjDtT_Q/TNsTfObFrXI/AAAAAAAAGes/yzeidwY2CC8/s1600/pee.jpg www.bacteriapictures.net http://4.bp.blogspot.com/-IHm3oSut4-U/TbfJk77WWgI/AAAAAAAAA2o/fyQP8qo3OKs/s1600/ultrasounds.jpg

  3. Urinarytract and pregnancy http://health.nytimes.com/health/guides/disease/urinary-tract-infection/background.html http://www.nvscc.com/images/normal_female_anatomy.jpg

  4. What is ASB? • Urine is normally sterile (contains no bacteria) • 2-10% have bacteria in urine without complaints • ASB = ASymptomatic Bacteriuria

  5. What is ASB? • Outside pregnancy no problems with ASB • In pregnancy untreated ASB can lead to pyelonephritis (up to 30%) • Also increased risk of preterm delivery and delivering a low birthweight baby

  6. Screening and treating ASB • Other countries routinely screen and treat ASB • Dutch obstetric guideline: not enough evidence for routine screen and treat program • Usefulness of screening depends on incidence in population • In Netherlands different antenatal care system

  7. Evidence

  8. Evidence

  9. Research questions What is the incidence of ASB in the Dutch population? Is a screening strategy with a dipslide useful and costeffective? Does treatment with nitrofurantoin decrease the incidence of pyelonephritis and preterm delivery? What are the riskfactors for developing ASB ?

  10. Study design • Alongside the Triple P • Screeningpart (4400 women) • Treatpart (230 women) • Population: singletons • Use logistic network of

  11. ASB screening • Gold standard is urinary culture • Dutch primary antenatal care no direct access to microbiology lab  urinary culture not feasible • Alternative: dipslide • Sensitivity: 98 * • Specificity: 99.6 * * Mignini 2009 obstetrics and gynaecology

  12. ASB screening • Screening between 16-22 weeks • Easy to implement in Triple P screening • Need of emptying bladder for cervical length measurement • Exclusion criteria: • Previous spontaneous preterm delivery <34wks • Diabetes Mellitus • Allergy to nitrofurantoin

  13. ASB treat Randomized controlled trial 230 women Intervention: 2x100mg nitrofurantoin for 5 days or placebo One week after finishing studymedication again urine dipslide

  14. Endpoints • Primary endpoint: • Pyelonephritis and/or preterm delivery <34 weken • Secondary endpoints: • Neonatal and maternal morbidity/mortality • Costeffectiveness • Screening for ASB • Screening for cervical-length • Screening for both

  15. Currentsituation • 105 women participated in ASB screening • 51 also had a cervical length measurement • 12 positive dipslide • 2 randomisations • 2 thinking about participation • 4 excluded • 3 refusers • 1 got symptomatic before randomisation

  16. Why research in primary care? • Effect of screeningstudyneeds to beinvestigated in wholepopulation • Improve risk selection and care in primary setting • Treatpatientsaccordinglywithintheirown setting • 4 hands ononebelly

  17. 4 hands onone pregnant belly: Primary care Pregnant woman Tertiary care Secondarycare http://static.zoom.nl/78783E7FA227DD69B691F42FB910B2EC-4-handen-op-1-buik.jpg

  18. Participatingcentres: • Primary care: • Espérance, Arnhem • MaMa, Velserbroek • EVA, Varsseveld • FARA, Ede • Secondary care: • Flevoziekenhuis, Almere • Diakonessenhuis, Utrecht • Atrium Medisch Centrum, Heerlen • Tertiary care: • AMC, Amsterdam • Vu, Amsterdam • MMC, Veldhoven

  19. Distribution care Netherlands 20 weeks ultrasound screening referral from midwivery practice to:

  20. My dreamsfor 2012 • Follow in Triple P’s great footsteps • Finish ASB study in 12 months • Publish in high impact journal • Increase the participating centres of the ASB study to at least 20 ultrasoundcentres

  21. Thank you for your attention! Want to participate? • Email or call Brenda: • B.m.kazemier@amc.uva.nl • Tel: 0630471389 • Website: www.studies-obsgyn.nl/asb • Approach me after symposium

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