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Screening for Gonorrhea and Chlamydia in Pregnancy: Room for Improvement

Published:April 03, 2019DOI:https://doi.org/10.1016/j.jogc.2019.02.006

      Abstract

      Objective

      This study sought to determine the proportion of pregnant women who are tested for gonorrhea and chlamydia as part of their prenatal care and to examine patient and provider factors affecting testing rates.

      Methods

      The study investigators conducted a retrospective chart review of all patients who delivered at St. Michael's Hospital, an urban tertiary care centre in Toronto, Ontario, between November 2015 and April 2016. Rates of testing and the prevalence of positive test results for gonorrhea and chlamydia were calculated. Chi-square tests were used to compare rates of testing among different types of prenatal care providers (obstetricians, maternal-fetal medicine specialists, family practitioners, midwives) and to determine whether testing rates were affected by patient demographics or characteristics. This study was a Canadian Task Force Classification II-2 retrospective cohort study.

      Results

      Of the 1315 women who delivered at St. Michael's Hospital during the study period, 1220 met inclusion criteria for the study. Of these women, 186 (15.3%) were not tested for gonorrhea and chlamydia during their pregnancy. There were 11 cases of chlamydia (1.1%) and no cases of gonorrhea. Testing rates were not affected by patient demographic variables or obstetrical history. Midwives and family physicians had the highest testing rates among the provider groups: 93.8% and 91.4%, respectively. Generalist obstetricians tested 88.5% of their patients. Maternal-fetal medicine specialists had a significantly lower rate of testing than the other provider groups, at 64.8% (P < 0.0001).

      Conclusions

      Fifteen percent of women were not tested for gonorrhea and chlamydia during the study period even though testing was recommended as part of routine prenatal care. Testing rates varied among providers, and strategies to improve these rates need to be explored.

      Résumé

      Objectif

      Cette étude visait à déterminer la proportion de femmes enceintes qui subissent un dépistage de la gonorrhée et de la chlamydia dans le cadre de leurs soins prénataux et à examiner les facteurs relatifs aux patientes et aux fournisseurs influençant cette proportion.

      Méthodologie

      Les chercheurs ont effectué un examen rétrospectif des dossiers de toutes les patientes qui ont accouché à l'Hôpital St. Michael's, un centre de soins tertiaires en milieu urbain à Toronto (Ontario), entre novembre 2015 et avril 2016. Le taux de dépistage de la gonorrhée et de la chlamydia et la prévalence de résultats positifs ont été calculés. Des tests du chi carré ont été utilisés dans le but de comparer le taux de dépistage selon les types de fournisseurs de soins prénataux (obstétriciens, spécialistes en médecine fœtomaternelle, omnipraticiens, sages-femmes) et de déterminer si le taux était influencé par les caractéristiques démographiques ou autres des patientes. Il s'agissait d'une étude de cohorte rétrospective conforme à la classification II-2 du Groupe d'étude canadien.

      Résultats

      Des 1315 femmes qui ont accouché à l'Hôpital St. Michael's durant la période à l'étude, 1 220 respectaient les critéres d'inclusion de l'étude. Parmi celles-ci, 186 (15,3 %) n'avaient pas subi de dépistage de la gonorrhée ou de la chlamydia durant leur grossesse. Il y avait 11 cas de chlamydia (1,1 %) et aucun cas de gonorrhée. Le taux de dépistage n'était pas influencé par les caractéristiques démographiques ou les antécédents obstétricaux des patientes. Les sages-femmes et les médecins de famille présentaient les plus hauts taux de dépistage : 93,8 % et 91,4 %, respectivement. Les obstétriciens généralistes soumettaient au dépistage 88,5 % de leurs patientes. Quant aux spécialistes en médecine fœtomaternelle, leur taux de dépistage était beaucoup plus faible que celui des autres groupes de fournisseurs, soit 64,8 % (P < 0,0001).

      Conclusions

      Durant la période à l'étude, 15 % des femmes n'ont pas subi de dépistage de la gonorrhée et de la chlamydia, même si celui-ci est recommandé dans le cadre des soins prénataux habituels. Le taux de dépistage variait selon les fournisseurs, et des stratégies pour l'augmenter devront être explorées.

      Key Words

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      REFERENCES

        • Ontario Agency for Health Protection and Promotion (Public Health Ontario)
        Infectious disease in focus. Monthly infectious diseases surveillance report 4.2. Queen's Printer for Ontario, Toronto, ON2015: 1-7
        • Ontario Agency for Health Protection and Promotion (Public Health Ontario)
        Reportable disease trends in Ontario, 2013.
        Queen's Printer for Ontario, Toronto, ON2015
        • Blatt AJ
        • Lieberman JM
        • Hoover DR
        • et al.
        Chlamydial and gonococcal testing during pregnancy in the United States.
        Am J Obstet Gynecol. 2012; 207: e1-e8
        • LeFevre ML
        • U.S. Preventive Services Task Force
        Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2014; 161: 902-910
        • Calonge N
        • U.S. Preventive Services Task Force
        Screening for gonorrhea: recommendation statement.
        Ann Fam Med. 2005; 3: 263-267
        • Meyers DS
        • Halvorson H
        • Luckhaupt S
        • et al.
        Screening for chlamydial infection: an evidence update for the U.S. Preventive Services Task Force.
        Ann Intern Med. 2007; 147: 135-142
        • Matejcek A
        • Goldman RD
        Treatment and prevention of ophthalmia neonatorum.
        Can Fam Physician. 2013; 59: 1187-1190
        • Canadian Paediatric Society
        Recommendations for the prevention of neonatal ophthalmia.
        Paediatr Child Health. 2002; 7: 480-488
      1. Statistics Canada. Table 051-0004 - Components of population growth, Canada, provinces and territories, annual (persons). CANSIM. Available at: https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1710000801. Accessed on January 10; 2018.

        • Wise MR
        • Sadler L
        • Ekeroma A
        Chlamydia trachomatis screening in pregnancy in New Zealand: translation of national guidelines into practice.
        J Prim Health Care. 2015; 7: 65-70
        • U.S. Preventive Services Task Force
        Ocular prophylaxis for gonococcal ophthalmia neonatorum: reaffirmation recommendation statement.
        Am Fam Physician. 2012; 85: 195-196
        • Darling EK
        Is mandatory neonatal eye prophylaxis ethically justified? A case study from Canada.
        Public Health Ethics. 2011; 4: 185-191
        • Darling EK
        • McDonald H
        A meta-analysis of the efficacy of ocular prophylactic agents used for the prevention of gonococcal and chlamydial ophthalmia neonatorum.
        J Midwifery Womens Health. 2010; 55: 319-327
        • Moore DL
        • MacDonald NE
        • Canadian Paediatric Society, Infectious Diseases and Immunization Committee
        Preventing ophthalmia neonatorum.
        Can J Infect Dis Med Microbiol. 2015; 26: 122-125
        • HIV and Sexually Transmitted Infections Department
        All new episodes seen at GUM clinics: 1999–2003, country specific tables.
        Health Protection Agency Centre for Infections, London2004
        • Office for National Statistics
        Birth statistics: review of the Registrar General on births and patterns of family building in England and Wales, 2003.
        Office for National Statistics, London2004
        • HIV and Sexually Transmitted Infections Department
        Selected STI diagnoses and diagnosis rates from GUM clinics in the UK: 2003–2007.
        Health Protection Agency, Centre for Infections, London2008
      2. 2004 Canadian sexually transmitted infections surveillance report.
        Can Commun Dis Rep. 2007; 33: 1-69
        • Schaller UC
        • Klauss V
        Is Crede's prophylaxis for ophthalmia neonatorum still valid?.
        Bull World Health Organ. 2001; 79: 262-263