Friday, December 23, 2016 Written by Dr. Najoua El Helali, Microbiologiste, Hôpital Paris-Saint-Joseph

Q&A with Dr. Najoua El Helali

Dr. Najoua El Helali discusses the diagnosis of intrapartum screening using the Cepheid Xpert GBS molecular test.

Q: How have clinicians responded to the changes to intrapartum testing?

Najoua El Helali: The midwives, obstetrician, and the neonatologist feel much more confident in the management of EOGBS disease. In the last 2.5 years they have been able to get results on GBS colonization status, on-demand while it is most clinically important.

Q: How did you implement testing in the labor ward and how easily did midwives adapt?

Najoua El Helali: The GeneXpert® System was transferred to the delivery room in March 2011. We trained our midwives to use the swabs and perform the tests. At first they were uncertain if they would be able to add testing to their busy workload, but now they are very happy. They can manage their own time and they find the test easy to perform. Now they know when the results will be available and they don’t lose time taking samples to the lab and waiting for results.

Q: With the intrapartum strategy do you collect vaginal and rectal swabs to test?

Najoua El Helali: We only collect lower vaginal swabs for Xpert GBS intrapartum testing. This is sufficient when a woman is about to deliver normally and it is not necessary to test the rectal swab. In antenatal screening both lower vaginal and rectal swabs are collected to increase the positive predictive value of GBS culture.

Q: How did you convince the various stakeholders to adopt and comply with intrapartum screening?

Najoua El Helali: All the obstetricians were convinced and enthusiastic about the need for intrapartum screening. The midwives were convinced by the results of false positive and false negatives they saw for antenatal screening. Now that our midwives have started using the Xpert GBS test they would be reluctant to go back to antenatal screening. They find it easier to manage patients. They go to the delivery room with the Xpert GBS cartridge in one pocket and a swab in the other ready to perform the test. All our delivery rooms have a chart with the PCR results and IAP status listed. Not only is this easier for the midwives, they feel empowered and confident that they are making the right choices for their patients and newborn babies.

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