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OBJECTIVES: The objective of this thesis is to explore the effectiveness and safety of common pharmacotherapeutic options used for the management of patent ductus arteriosus (PDA) in preterm infants. METHODS: Following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidance, article 1 develops the protocol to conduct the systematic review and network meta-analysis to answer the research question. Article 2 details the actual methods implemented to conduct the network meta-analysis and presents the results in the form of network plots, league tables, rank heat maps, rankograms and forest plots. RESULTS: Article 1 suggests the need to conduct a Bayesian random-effects network meta-analysis of randomized controlled trials (RCTs) as the analysis would involve multiple treatments with potentially both direct and indirect comparisons. Article 1 also a priori defines potential effect modifiers and statistical strategies to control for the same. In article 2, the results of the meta-analysis show that in 68 RCTs that included 4802 infants, 14 different variations of indomethacin, ibuprofen or acetaminophen were used. Oral high-dose ibuprofen was associated with a significantly higher odds of PDA closure compared with standard-dose intravenous ibuprofen (Odds Ratio [OR], 3.59; 95% Credible Interval [CrI],1.64-8.17) and intravenous indomethacin (OR, 2.35; 95% CrI,1.08-5.31). Oral high-dose ibuprofen ranked the best option for PDA closure (SUCRA [surface under the cumulative ranking curve],0.89 [SD, 0.12]) and to prevent surgical PDA ligation (SUCRA,0.98 [SD, 0.08]). There was no significant difference in the odds of mortality, necrotizing enterocolitis or intra-ventricular hemorrhage with use of placebo or no treatment compared with any of the other treatment modalities. CONCLUSION: This thesis suggests that oral high-dose ibuprofen could be the best treatment option for closure of a hemodynamically significant PDA. Placebo or no treatment for a hemodynamically significant PDA may not increase morbidity and mortality. / Thesis / Master of Science (MSc) / The following thesis explores the effectiveness and safety of commonly used drugs for the treatment of a heart condition in premature infants called the patent ductus arteriosus (PDA). Article 1 outlines the protocol for the systematic review and network meta-analysis designed to evaluate the effectiveness and safety of indomethacin, ibuprofen and acetaminophen for the treatment of PDA in preterm infants. Article 2 provides in detail the results of the network meta-analysis that examined all eligible randomized controlled trials that compared intravenous or oral formulations of indomethacin, ibuprofen or acetaminophen compared against to other or placebo for the treatment of a PDA that may be harmful for a premature infant based on certain clinical and echocardiographic criteria set by the clinicians and researchers. Overall, this body of work suggests that a higher dose of oral ibuprofen is the best treatment for PDA in premature infants.

Background: Recent research is revealing the high rate of false-positive screening results for IEMs in the NICU population. No study published to date has specifically studied the possible relationship between nutrition and newborn screening in this population. Objective: It is suspected that NICU infants who receive PN are more likely to have abnormal newborn screening results than infants who receive EN. An understanding of the role of nutrition will assist in developing protocols for screening in the NICU and decrease false-positives. Design: Infants admitted to the NICU between January 1-June 30, 2009 were included in this retrospective chart review study (n=339). The type of nutrition and timing of its initiation was recorded and compared to newborn screening results to identify correlations with false-positives. Statistical analysis included means, percentages, Fisher's exact test, Chi-square test, and the Cochran-Mantel-Haenszel test. Results: Nutrition type was significantly associated with newborn screening (p<0.001); those who received parenteral nutrition were more likely to have a false-positive. For infants who also received PN, EN of breast milk exclusively increased risk of an abnormal screen more than formula exclusively or breast milk plus formula. The timing of parenteral nutrition had no effect on screening. Premature infants who received PN exclusively had a higher percentage of false-positives than those who received EN Conclusions: Although the hypothesis could not be statistically supported, PN appears to contribute to false-positive newborn screens. More research is needed to ascertain the role of EN and GA in newborn screening and to develop standardized protocols. / Master of Science

MicroRNAs (miRNAs) are small non-coding RNAs with a length of 18 to 25 nucleotides playing a pivotal role in post-transcriptional regulation of gene expression. There are miRNAs whose expression is limited to a certain tissue type and diseases which are characterized by a unique miRNA expression profile. I assumed spontaneous preterm birth (PTB) and preterm prelabor rupture of membranes (PPROM) would be characterized by a unique miRNA expression profile. I observed the gene expression of 15 placental specific miRNAs (miR-512-5p, miR-515-5p, miR-516b-5p, miR-517-5p, miR-518b, miR-518f-5p, miR-519a-5p, miR-519d-3p, miR-519e- 5p, miR-520a-5p, miR-520h, miR-524-5p, miR-525-5p, miR-526a and miR-526b-5p) in placental tissue of pacients with PTB, PPROM and women with term in labor pregnancies (FG). PTB group consisted of 24 pacients, PPROM group of 75 pacients and FG group of 20 pacients. Quantitative real-time PCR was used to quantify gene expression. In the group of PTB pregnancies I identified 3 significantly upregulated miRNAs (miR-516b-5p, miR-519d-3p and miR-524-5p) and 4 miRNAs (miR-518b, miR-519a-5p, miR-520h and miR-526a) with a trend to upregulation compared to controls (FG). In the group of PPROM pregnancies I identified 3 miRNAs (miR-519d-3p, miR-520h and miR-256b-5p) with a trend to...

Thesis (M. (Nursing)) -- University of Limpopo, 2022 / Background Despite all the interventions that have been developed previously preterm labour remain to be the leading cause of perinatal morbidity and mortality worldwide. Preterm labour occurs before 37 weeks of gestation under two obstetric circumstances namely, ‗spontaneous preterm labour‘ and ‗indicated preterm labour‘. The aim of the study was to develop the strategies to enhance prevention of preterm labour in selected hospitals in Capricorn District, Limpopo Province. Research Method A sequential explanatory mixed method was adopted, the study was conducted in three phases, namely, quantitative study, qualitative study, and development of strategies. Self-developed questionnaires with 50 item questions each for mothers and registered midwives were administered. Both questionnaires were pre-tested prior to being administered to the respondents of the main study. The sample size of mothers was 77 mothers and 62 registered midwives. Data collected from the respondents were analysed using Statistical Package for Social Science (SPSS) version 25 with the help of the statistician. Tables, pie charts and bar graphs were drawn to present the results. The results of quantitative phase were utilized to formulate the Interview Guides that were used to explore the knowledge and practise of registered midwives and obstetricians regarding preterm labour. Interviews were conducted with 20 mothers, 6 registered midwives and 4 obstetricians until data saturation was reached. Data were analysed qualitatively using Tesch‘s Open-Coding method. v Quantitative Results The quantitative results for midwives revealed that about 60% of the mothers who had preterm labour were teenagers. Most of the respondents had ‗spontaneous preterm labour‘ and did not have any comorbidities while few had ‗indicated preterm labour‘ and were induced. All 62(100%) of the midwives showed that the facility does not offer an Outreach Programme on the prevention of preterm labour. Themes and Sub-Themes Results Themes and sub-themes were coded manually. Results that emerged from the integration and comparison of quantitative and qualitative results revealed that the mothers who went into preterm labour spontaneously had little information or no health education regarding preterm labour. Developed strategies The following strategies were developed based on the identified factors that might hinders the prevention of preterm labour and after exploring the knowledge and practice of midwives and obstetricians in the selected hospitals, Capricorn District, Limpopo Province. Strategies includes strengthening of BANC Plus, staff establishment, laboratory turnaround time, outreach programmes and improvement of counselling and support services. Recommendations of the Study The recommendation of the study is divided into three groups which includes recommendations for midwives at the PHC and hospital, recommendations for the obstetricians at the hospital and the recommendations for the Department of Health. The midwives to visit schools and community centres at least twice in a month to give information to the woman of childbearing age and reinforce health education on each Antenatal Care visit. The obstetricians to screen all mothers who are at risk of preterm labour for infections, follow up the results and treat the mothers accordingly. The Department of Health should hire enough staff so that quality care can be vi rendered to the pregnant woman at the PHC and hospital. The Department of Health should develop the electronic database, to register all mothers who have a history of preterm labour, so that when they are pregnant the database system will also help to identify them at the PHC, and they would then be referred to the hospital in time. If the developed strategies to enhance prevention of preterm labour may be adopted and adhered to by the midwives and obstetricians, these may help in reduction of high figures of preterm labour in the selected hospitals.

Introdução: Prematuridade é a principal causa de morbimortalidade perinatal. A aplicação de um instrumento que identifique o grupo de pacientes de risco para parto pré-termo (PPT) permitirá a aplicação de estratégias de prevenção e reduzirá essa complicação. Objetivos: validar a calculadora de risco para PPT espontâneo antes da 34ª semana de gestação, disponibilizada pela Fetal Medicine Foundation (FMF), em uma amostra de mulheres brasileiras. Métodos: Estudo retrospectivo, observacional que analisou 1325 gestantes admitidas para seguimento pré-natal. Variáveis maternas de interesse foram coletadas por meio da análise de questionários, prontuários e contato telefônico. Em seguida, os dados foram inseridos na calculadora para cálculo do risco de PPT. As gestantes foram divididas em dois grupos de acordo com a ocorrência de PPT antes da 34ª semana (Grupo 1) ou parto após 37 semanas de gestação (Grupo 2). Análise de regressão múltipla foi efetuada para avaliar os efeitos das variáveis estudadas sobre a ocorrência de parto pré-termo antes da 34ª semana e para a construção de um modelo de discriminação, que foi avaliado pelo índice c. Curva ROC foi utilizada para os cálculos de sensibilidade e especificidade e, com base nesses valores, do valor de corte acima do qual o risco de PPT antes de 34 semanas foi significativamente maior em nossa amostra de pacientes. Resultados: A prevalência de PPT espontâneo antes da 34ª semana foi de 1.3%. As variáveis que apresentaram diferenças significativas entre os Grupos 1 e 2 foram: tabagismo (p=0,0002), antecedente de prematuridade de prematuridade repetitiva entre 16 - 30 semanas sem parto prévios a termo e de prematuridade eletiva (p<0,0001 e p=0,0271, respectivamente) e risco calculado de PPT antes de 34 semana (1.32% X 0.78%, p<0,01). A regressão múltipla confirmou que o tabagismo e os antecedentes de PPT aumentaram o risco de PPT espontâneo em nossa amostra. Na avaliação do desempenho do teste índice para detectar PPT antes de 34 semanas, observou-se área sob a curva significante de 0.64 e o ponto de corte acima do qual o risco de PPT aumenta significativamente foi 0.7%. Conclusões: a calculadora de risco de PPT antes da 34ª semana da FMF é um bom instrumento para rastrear gestantes em nossa amostra populacional e o valor de corte acima do qual esse risco aumenta é 0.7%. / Introduction: Prematurity is the leading cause of perinatal morbidity and mortality. The use of an instrument to identify the group of patients at risk for preterm birth (PTB) will allow the implementation of prevention strategies, therefore reducing this complication. Objectives: To validate the calculator for assessment of risk for spontaneous delivery before 34 weeks of pregnancy, provided by the Fetal Medicine Foundation (FMF) for a group of Brazilian women. Methods: This retrospective and observational cohort study comprised 1,325 women undergoing routine antenatal care. Maternal variables were collected through the analysis of questionnaires, medical records and telephone calls. Then the data were inserted in the software to calculate the risk of PTB. The patients were divided in two groups according to the occurrence of PTB before 34 weeks (Group 1) or birth after 37 weeks of pregnancy (Group 2). Multilevel regression analysis was used to determine the effects of maternal characteristics on the occurrence of PTB before 34 weeks and to build a discrimination model which was evaluated by the index c. ROC curve was used to determine sensitivity and specificity, and the cutoff value above which it the risk of PTB before 34 weeks was significantly higher in our patient sample. Results: The prevalence of spontaneous PTB before 34 weeks was 1.3%. Variables that showed significant differences between groups 1 and 2 were: smoking (p=0.0002), history of repetitive PTB between 16-30 weeks without prior term and elective PTB (p<0.0001 and p=0.0271, respectively), and the risk of PTB before 34 week (1.32% vs. 0.78%, p<0.01). Multilevel regression analysis confirmed that smoking and history of PTB increased the risk of spontaneous PTB in our patient sample. On the assessment of performance index test to detect PPT before 34 weeks there was a significant area under the curve of 0.64 and the cutoff above which it the risk of PTB before 34 weeks was significantly higher was 0.7 %. Conclusions: the calculator for assessment of risk for spontaneous delivery before 34 weeks of pregnancy is a good tool for screening pregnant women in our population sample and the cutoff value above which it the risk increases is 0.7%.

Orientador: Renato Passini Júnior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-11-27T11:47:19Z (GMT). No. of bitstreams: 1 Lajos_GiulianeJesus_D.pdf: 13164683 bytes, checksum: 157ab3724e88a3aa83c69cd29bf06c06 (MD5) Previous issue date: 2014 / Resumo: Introdução: A prematuridade é um problema complexo de saúde pública, sendo a principal causa de morbidade e mortalidade neonatais, com tendência a aumento nas últimas décadas. Foi proposto um estudo com a participação de vários hospitais do Brasil, a fim de avaliar diversos aspectos envolvidos com a ocorrência do parto pré-termo. Objetivos: descrever os métodos de implementação do Estudo Multicêntrico de Investigação em Prematuridade no Brasil; avaliar a homogeneidade amostral dos casos incluídos; estimar a prevalência e analisar fatores associados à prematuridade espontânea. Métodos: estudo transversal multicêntrico, com componente caso-controle aninhado, em 20 hospitais de referência em três regiões geográficas do Brasil. Foram selecionadas as instituições participantes, elaborado o formulário de coleta de dados, escolhido o sistema eletrônico para inclusão de casos, desenvolvido um programa para a digitação dos dados, elaborados manuais de orientação e padronização da coleta de informações, seguidos de implantação do estudo e análise dos dados obtidos. Foi realizada vigilância prospectiva para identificação de partos pré-termo e estimada sua prevalência, subdividindo-os pelas condições determinantes: trabalho de parto espontâneo, ruptura prematura de membranas e parto terapêutico. Foram estimadas taxas de prevalência ou médias, coeficientes de correlação intraclasse, efeitos do desenho do estudo e média de tamanho de conglomerado para mais de 250 variáveis. O risco de parto pré-termo espontâneo foi estimado com Odds Ratio para vários preditores e a análise por regressão logística não condicional identificou fatores independentemente associados. Resultados: Foram incluídas 5.296 mulheres, sendo 4.150 com partos prematuros (casos) e 1.146 com partos a termo (controles), e avaliados 5.752 recém-nascidos. A taxa geral de prematuridade foi 12,3%. Os coeficientes de correlação intraclasse foram baixos (<0,1) na maioria das variáveis. Comparando 2.682 partos prematuros espontâneos com 1.146 partos a termo, a análise multivariada identificou como fatores de risco para o parto pré-termo: antecedente de parto prematuro, gravidez múltipla, suspeita de insuficiência cervical, malformação fetal, polidrâmnio, sangramento vaginal, número insuficiente de consultas de pré-natal, aborto anterior e infecção do trato urinário. Conclusões: A implantação do Estudo Multicêntrico de Investigação em Prematuridade no Brasil foi a primeira etapa de uma ampla avaliação da prematuridade no país. Os coeficientes de correlação intraclasse indicaram adequada heterogeneidade da amostra estudada. Seus valores poderão ser usados como referência no cálculo de tamanho amostral de estudos futuros na área. A prevalência de partos pré-termo nos centros terciários do Brasil foi alta. Antecedente de parto prematuro, gravidez múltipla, suspeita de insuficiência cervical, malformação fetal, polidrâmnio, sangramento vaginal, número insuficiente de consultas de pré-natal, aborto anterior e infecção do trato urinário foram considerados fatores de risco para parto prematuro espontâneo. A identificação desses fatores pode auxiliar no planejamento de medidas para reduzir a ocorrência de partos pré-termo / Abstract: Background: Preterm birth is the main cause of neonatal morbidity and mortality, resulting in a high likehood of sequelae in surviving children, with a tendency to increase in last decades. A study intending to collect information from hospitals in Brazil on several aspects of preterm birth was proposed. Objectives: To describe the methods used in elaborating and implementing the Brazilian Multicenter Study on Preterm Birth; to evaluate the homogeneity of the sample included in the network; to assess the prevalence of preterm births in Brazil and to identify factors associated with spontaneous preterm birth. Methods: The project consisted of a multicenter cross-sectional study plus a nested case-control study in 20 reference hospitals of three regions of Brazil. The elegible hospitals were selected, forms for data collection were prepared, an electronic system for the inclusion of cases was selected, a program for entering data was developed and the implantation process and data analysis were performed. A prospective surveillance was implemented to identify preterm births, to estimate its prevalence, subdividing into determinats conditions: spontaneous labor, prelabor rupture of membranes or therapeutic birth. Estimated prevalence rates or means, intracluster correlation coefficients, design effects and mean cluster sizes were presented for more than 250 variables. The risk of spontaneous preterm birth was estimated with Odds Ratio for several predictors and a non-conditional logistic regression analysis was then performed to identify independently associated factors. Results: Overall, 5,296 women were included in the study, being 4,150 preterm births (cases) and 1,146 term births (controls), and the total number of studied newborns was 5,752. Overall rate of preterm birth was 12.3%. Intracluster correlation coefficients were low (<0.1) in most variables, showing intracluster heterogeneity. When comparing 2,682 spontaneous preterm births to a sample of 1,146 term births, the multivariate analyzes identified as risk factors for preterm birth: a previous preterm birth, multiple pregnancy, cervical insufficiency, fetal malformation, polyhydramnios, vaginal bleeding, inadequate number of prenatal care visits, previous abortion, and urinary tract infection. Conclusions: The implementation of the Brazilian Multicenter Study on Preterm Birth was the first step of a comprehensive assessment of prematurity in the country. Intracluster correlation coefficients for the outcome variables indicate adequate sample heterogeneity. Their values can be used to calculate the sample size of further studies in the area. The preterm birth rate in tertiary facilities in Brazil was high and the proportion of therapeutic preterm births was over one third. Previous preterm birth, multiple pregnancy, cervical insufficiency, fetal malformation, polyhydramnios, vaginal bleeding, inadequate number of prenatal care visits, previous abortion, and urinary tract infection were considered risk factors to spontaneous preterm birth. Identification of these factors can be worth for planning effective measures to reduce the occurrence of preterm births / Doutorado / Saúde Materna e Perinatal / Doutora em Ciências da Saúde

Introdução: Prematuridade é a principal causa de morbimortalidade perinatal. A aplicação de um instrumento que identifique o grupo de pacientes de risco para parto pré-termo (PPT) permitirá a aplicação de estratégias de prevenção e reduzirá essa complicação. Objetivos: validar a calculadora de risco para PPT espontâneo antes da 34ª semana de gestação, disponibilizada pela Fetal Medicine Foundation (FMF), em uma amostra de mulheres brasileiras. Métodos: Estudo retrospectivo, observacional que analisou 1325 gestantes admitidas para seguimento pré-natal. Variáveis maternas de interesse foram coletadas por meio da análise de questionários, prontuários e contato telefônico. Em seguida, os dados foram inseridos na calculadora para cálculo do risco de PPT. As gestantes foram divididas em dois grupos de acordo com a ocorrência de PPT antes da 34ª semana (Grupo 1) ou parto após 37 semanas de gestação (Grupo 2). Análise de regressão múltipla foi efetuada para avaliar os efeitos das variáveis estudadas sobre a ocorrência de parto pré-termo antes da 34ª semana e para a construção de um modelo de discriminação, que foi avaliado pelo índice c. Curva ROC foi utilizada para os cálculos de sensibilidade e especificidade e, com base nesses valores, do valor de corte acima do qual o risco de PPT antes de 34 semanas foi significativamente maior em nossa amostra de pacientes. Resultados: A prevalência de PPT espontâneo antes da 34ª semana foi de 1.3%. As variáveis que apresentaram diferenças significativas entre os Grupos 1 e 2 foram: tabagismo (p=0,0002), antecedente de prematuridade de prematuridade repetitiva entre 16 - 30 semanas sem parto prévios a termo e de prematuridade eletiva (p<0,0001 e p=0,0271, respectivamente) e risco calculado de PPT antes de 34 semana (1.32% X 0.78%, p<0,01). A regressão múltipla confirmou que o tabagismo e os antecedentes de PPT aumentaram o risco de PPT espontâneo em nossa amostra. Na avaliação do desempenho do teste índice para detectar PPT antes de 34 semanas, observou-se área sob a curva significante de 0.64 e o ponto de corte acima do qual o risco de PPT aumenta significativamente foi 0.7%. Conclusões: a calculadora de risco de PPT antes da 34ª semana da FMF é um bom instrumento para rastrear gestantes em nossa amostra populacional e o valor de corte acima do qual esse risco aumenta é 0.7%. / Introduction: Prematurity is the leading cause of perinatal morbidity and mortality. The use of an instrument to identify the group of patients at risk for preterm birth (PTB) will allow the implementation of prevention strategies, therefore reducing this complication. Objectives: To validate the calculator for assessment of risk for spontaneous delivery before 34 weeks of pregnancy, provided by the Fetal Medicine Foundation (FMF) for a group of Brazilian women. Methods: This retrospective and observational cohort study comprised 1,325 women undergoing routine antenatal care. Maternal variables were collected through the analysis of questionnaires, medical records and telephone calls. Then the data were inserted in the software to calculate the risk of PTB. The patients were divided in two groups according to the occurrence of PTB before 34 weeks (Group 1) or birth after 37 weeks of pregnancy (Group 2). Multilevel regression analysis was used to determine the effects of maternal characteristics on the occurrence of PTB before 34 weeks and to build a discrimination model which was evaluated by the index c. ROC curve was used to determine sensitivity and specificity, and the cutoff value above which it the risk of PTB before 34 weeks was significantly higher in our patient sample. Results: The prevalence of spontaneous PTB before 34 weeks was 1.3%. Variables that showed significant differences between groups 1 and 2 were: smoking (p=0.0002), history of repetitive PTB between 16-30 weeks without prior term and elective PTB (p<0.0001 and p=0.0271, respectively), and the risk of PTB before 34 week (1.32% vs. 0.78%, p<0.01). Multilevel regression analysis confirmed that smoking and history of PTB increased the risk of spontaneous PTB in our patient sample. On the assessment of performance index test to detect PPT before 34 weeks there was a significant area under the curve of 0.64 and the cutoff above which it the risk of PTB before 34 weeks was significantly higher was 0.7 %. Conclusions: the calculator for assessment of risk for spontaneous delivery before 34 weeks of pregnancy is a good tool for screening pregnant women in our population sample and the cutoff value above which it the risk increases is 0.7%.

Orientador: Renato Passini Junior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T01:25:35Z (GMT). No. of bitstreams: 1 Nomura_MarceloLuis_D.pdf: 838174 bytes, checksum: a795b39457b62a18ecb17c4609ece12d (MD5) Previous issue date: 2004 / Resumo: Objetivos: Identificar a taxa de prevalência e fatores de risco de colonização materna por estreptococo do grupo B (EGB) em gestantes com trabalho de parto prematuro (TPP) e/ou ruptura prematura pré-termo de membranas (RPM). Métodos: Foram colhidos dois swabs anais e vaginais de 203 gestantes atendidas no CAISM-UNICAMP. Um swab de cada local foi colocado em meio de transporte e enviados para cultura em placas de ágar-sangue, os outros dois foram incubados por 24 horas em meio de Todd-Hewitt para posterior semeadura em placas de ágar-sangue. Resultados: A prevalência de colonização materna por EGB foi de 27,6% (56 gestantes). As taxas de colonização por diagnóstico foram 34,7% para RPM, 25,2% para TPP e 17,8% para TPP + RPM. As variáveis raça branca, baixo nível de escolaridade e infecção urinária foram associadas a maiores taxas de colonização na análise multivariada. A presença de infecção urinária foi a única variável significativamente associada à colonização materna na análise multivariada. A taxa de detecção do estreptococo do grupo B foi significativamente maior com o uso do meio seletivo e com a associação de coleta de culturas anais e vaginais. A taxa de colonização neonatal foi de 3,1%. Ocorreram dois casos de sepse precoce por EGB nesta amostra, com prevalência estimada de 10,8 casos por mil nascidos vivos e mortalidade de 50%. Conclusão: A amostra avaliada apresenta altas taxas de colonização materna por Streptococcus agalactiae. É necessário o uso de meio de cultura seletivo e a associação de culturas anorretais e vaginais para aumentar a taxa de detecção do EGB. A incidência de sepse neonatal precoce foi elevada nesta população / Abstract: Objective: to study group B streptococcus maternal colonization rates and risk factors in women with preterm labor (PTL) and preterm premature rupture of membranes (PROM). Methods: Vaginal and anal swabs (two of each) were colected from 203 women followed at CAISM-UNICAMP. One of each swab was placed in transport media and then cultured in blood-agar plates, the other swabs were incubated in Todd-Hewitt selective media for 24 hours and then subcultured in blood-agar plates. Results: Maternal colonization rate was 27.6% (56 women). Colonization rates by admission diagnosis were 34.7% in PROM, 25.2% in PTL and 17.8% in PTL and PROM. White race, less than elementary education level and urinary tract infection were associated with maternal colonization in the univariate analysis. Urinary tract infection was the only variable associated with maternal colonization in a multivariate analysis. GBS detection rates were significantly higher with the use of selective culture media and with sampling of both vaginal and anorectal sites. Neonatal colonization rate was 3.1%. There were two cases of early-onset neoanatal sepsis caused by GBS, with an estimated prevalence of 10.8 cases per thousand live borns and a mortality rate of 50%. Conclusions: This sample of women had high GBS colonization rates. The use of selective culture media and collection of both anal and vaginal samples is necessary in order to maximize GBS detection rates. Early-onset neonatal sepsis incidence was high in this population / Doutorado / Tocoginecologia / Doutor em Tocoginecologia