{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T13:31:41Z","timestamp":1746711101770,"version":"3.40.5"},"reference-count":18,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,2,1]]},"abstract":"<jats:p>The updated Guidelines on Prevention of Perinatal Group B Streptococcal Disease, issued by the Centers for Disease Control and Prevention, actually represent the mainstay in the prevention of neonatal early-onset group B streptococcal (GBS) sepsis. According to these guidelines, patients with possible preterm delivery are screened for GBS colonization and offered intrapartum prophylaxis only if they enter preterm labor or experience preterm premature rupture of the membranes. Nonetheless, the fulfillment of these recommendations seems to be suboptimal in clinical practice, as it is heavily influenced by the knowledge of the colonization status. We report here 2 cases of blood culture\u2013proven, early-onset neonatal GBS sepsis involving preterm infants delivered by mothers who had midtrimester cervical insufficiency and bulging membranes. Midtrimester acute cervical insufficiency strongly predicts preterm delivery. These women are liable to miss intrapartum antibiotic prophylaxis because they typically have shorter labor, and the test results for GBS status are unlikely to be available before delivery. We believe that women with midtrimester cervical insufficiency and bulging membranes should be screened for GBS infection soon after hospital admittance if the gestational age is close to the threshold of fetal viability. A timely diagnosis of GBS colonization may not only increase the number of patients receiving targeted intrapartum antibiotic prophylaxis but would also allow consideration of the administration of antepartum antibiotic prophylaxis. Indeed, as further outlined in this report, GBS intraamniotic infection may dramatically occur before the onset of preterm labor or preterm premature rupture of the membranes.<\/jats:p>","DOI":"10.1542\/peds.2011-3677","type":"journal-article","created":{"date-parts":[[2013,1,8]],"date-time":"2013-01-08T23:12:31Z","timestamp":1357686751000},"page":"e612-e615","source":"Crossref","is-referenced-by-count":1,"title":["Cervical Insufficiency: A New Issue for Guidelines on Prevention of Perinatal Group B Streptococcal Disease?"],"prefix":"10.1542","volume":"131","author":[{"given":"Fabio","family":"Natale","sequence":"first","affiliation":[{"name":"Dipartimento di Pediatria e Neuropsichiatria Infantile, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Brunelli","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Ginecologico-Ostetriche e Scienze Urologiche, \u201cSapienza\u201d University of Rome, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bianca","family":"Bizzarri","sequence":"additional","affiliation":[{"name":"Dipartimento di Pediatria e Neuropsichiatria Infantile, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Castronovo","sequence":"additional","affiliation":[{"name":"Dipartimento di Pediatria e Neuropsichiatria Infantile, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"De Curtis","sequence":"additional","affiliation":[{"name":"Dipartimento di Pediatria e Neuropsichiatria Infantile, and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2013,2,1]]},"reference":[{"issue":"5","key":"2021120903254307400_B1","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1542\/peds.2010-2217","article-title":"Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues.","volume":"127","author":"Stoll","year":"2011","journal-title":"Pediatrics"},{"issue":"1","key":"2021120903254307400_B2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ajog.2005.12.002","article-title":"The role of cervical cerclage in obstetric practice: can the patient who could benefit from this procedure be identified?","volume":"194","author":"Romero","year":"2006","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"2021120903254307400_B3","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1016\/j.bpobgyn.2007.03.009","article-title":"Cervical cerclage in the prevention of preterm birth.","volume":"21","author":"Simcox","year":"2007","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"issue":"9","key":"2021120903254307400_B4","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1093\/aje\/kwn202","article-title":"Pregnancy disorders that lead to delivery before the 28th week of gestation: an epidemiologic approach to classification.","volume":"168","author":"McElrath","year":"2008","journal-title":"Am J Epidemiol"},{"issue":"9","key":"2021120903254307400_B5","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1056\/NEJM199602293340904","article-title":"The length of the cervix and the risk of spontaneous premature delivery.","volume":"334","author":"Iams","year":"1996","journal-title":"N Engl J Med"},{"year":"2010","key":"2021120903254307400_B6","first-page":"446.e1"},{"key":"2021120903254307400_B7","first-page":"1","article-title":"Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). 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Microbial invasion of the amniotic cavity in patients with suspected cervical incompetence: prevalence and clinical significance.","volume":"167","author":"Romero","year":"1992","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"2021120903254307400_B12","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/S0301-2115(99)00009-3","article-title":"Chorioamniotic membranes constitute a competent barrier to group b streptococcus in vitro.","volume":"83","author":"Kjaergaard","year":"1999","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"24","key":"2021120903254307400_B13","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1056\/NEJM196412102712401","article-title":"Neonatal sepsis and other infections due to group B beta-hemolytic streptococci.","volume":"271","author":"Eickhoff","year":"1964","journal-title":"N Engl J Med"},{"issue":"5","key":"2021120903254307400_B14","first-page":"445","article-title":"Perinatal group B streptococcal infections across intact amniotic membranes.","volume":"33","author":"Katz","year":"1988","journal-title":"J Reprod Med"},{"issue":"5","key":"2021120903254307400_B15","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1080\/00016340902852898","article-title":"The cervical mucus plug: structured review of the literature.","volume":"88","author":"Becher","year":"2009","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"6","key":"2021120903254307400_B16","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/j.jprot.2011.02.025","article-title":"Protein profiling underscores immunological functions of uterine cervical mucus plug in human pregnancy.","volume":"74","author":"Lee","year":"2011","journal-title":"J Proteomics"},{"issue":"3\u20134","key":"2021120903254307400_B17","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1155\/S106474490000017X","article-title":"Is antenatal group B streptococcal carriage a predictor of adverse obstetric outcome?","volume":"8","author":"Garland","year":"2000","journal-title":"Infect Dis Obstet Gynecol"},{"issue":"1","key":"2021120903254307400_B18","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1177\/1933719109348025","article-title":"Choriodecidual inflammation: a harbinger of the preterm labor syndrome.","volume":"17","author":"Grigsby","year":"2010","journal-title":"Reprod Sci"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/131\/2\/e612\/1088142\/peds_2011-3677.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/131\/2\/e612\/1088142\/peds_2011-3677.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T18:05:28Z","timestamp":1639073128000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/131\/2\/e612\/31884\/Cervical-Insufficiency-A-New-Issue-for-Guidelines"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,2,1]]},"references-count":18,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2013,2,1]]},"published-print":{"date-parts":[[2013,2,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2011-3677","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"type":"print","value":"0031-4005"},{"type":"electronic","value":"1098-4275"}],"subject":[],"published":{"date-parts":[[2013,2,1]]}}}