Ethical Issues Associated With Routine Screening andProphylaxis for Group B Streptococcus in Pregnancy

[摘要] An increased awareness of the impact of group B streptococcus (GBS) infection on neonataloutcome has prompted several seemingly discordant committee recommendations. Intrapartumantibiotics are effective in reducing the risk of neonatal morbidity when administered to a colonizedwoman who has a clinical condition that places her neonate at high risk for early-onset sepsis.However, less is known about the efficacy of prophylactic antibiotics in the colonized woman whodoes not have obvious risk factors. Some authorities have suggested that providers refrain fromadministering intrapartum antibiotics to colonized women who do not have any of these risk factors,primarily due to concerns about potential adverse reactions, selection of resistant pathogens, andcost-effectiveness. These recommendations may conflict with the desires of an informed womanwho weighs the real, albeit low, risk for serious neonatal disease against the lower perceived riskof adverse maternal sequelae from allergic reactions to the antimicrobial agents. Selective prophylaxisfor GBS disease that is limited to the colonized parturient with risk factors has the potentialfor creating conflict because maternal beneficence-based obligations of the physician may be atodds with maternal autonomy-based obligations. We believe that, given all currently availableinformation, providers have a moral obligation to discuss GBS screening and treatment issues withpatients. The potential for conflict between patient and physician at the time of delivery can beminimized through the use of preventive ethics, allowing patients to develop advance directivesregarding intrapartum management within the confines of reasonable and cost-effective care. Untila consensus is reached among experts, the most prudent approach would be to address such issuesproactively and individualize care based upon the overall estimation and anticipation of risk as wellas the patient's specific desires.

[学科分类] 妇产科学