2017 36 Prevention of EOGBS

Question 1

** How should information about GBS colonisation & risks be provided? **

Answer 1

Appropriate information leaflet
To all pregnant women

Question 2

** What antenatal screening for GBS should be undertaken? **

Answer 2

1. Universal screening not recommended, or for mat request
2. GBS in previous pregnancy: offer IAP or bacteriological testing with IAP if +ve
3. Test at 35-37/40 or 3-5 weeks prior to anticipated preterm delivery
4. If previous baby with GBS, don’t test, just IAP

Question 3

** How should GBS in pregnancy be managed? **

Answer 3

1. Treat proven UTI, then IAP
2. No treatment for vaginal or rectal, then IAP

Question 4

** How does GBS impact on IOL? **

Answer 4

1. No change
2. Not a contraindication to sweep

Question 5

** How does GBS impact on ElCS? **

Answer 5

1. No impact if intact membranes & in absence of labour
2. No IAP even if preterm

Question 6

** How is ROM managed with respect to GBS? **

Answer 6

1. Known GBS: immediate IAP & IOL
2. Unknown or -ve GBS: offer immediate IOL or wait for 24 hours

Question 7

** How is preterm labour managed with respect to GBS? **

Answer 7

1. IAP for all, regardless of GBS status
2. If <34/40, preterm risks are higher than infection risks
3. If > 34/40, expedite if known GBS

Question 8

** Can GBS positive women have a water birth? **

Answer 8

Yes, as long as on IAP

Question 9

** How should swabs for GBS be taken & managed? **

Answer 9

1. LVS & anorectum, via 1 or 2 swabs
2. Non-nutrient transport medium eg Amies or Stuart
3. Process ASAP, fridge if delayed
4. Enriched culture medium

Question 10

** Which antibiotics should be used for IAP? **

Answer 10

1. Benzylpenicillin
2. Cephalosporin if non-severe allergy
3. Vancomycin if severe allergy

Question 11

** What are the potential adverse effects of IAP & how should refusal be managed? **

Answer 11

1. Maternal anaphylaxis
2. Altered neonatal bowel flora
3. Possible abnormal child development

Very close neonatal monitoring for 12h

Question 12

** What are possible signs of EOGBS? **

Answer 12

1. Abnormal behaviour eg inconsolable
2. Floppiness
3. Feeding difficulties
4. Temp <36 or >38
5. Rapid breathing
6. Changes in skin colour

Question 13

** How should term babies be managed in terms of GBS? **

Answer 13

1. Clinically well & IAP for >4h before delivery: no special obs
2. Broad-spectrum for other indications: relevant Ix & Tx
3. GBS but no IAP, or previous baby with EOGBS: obs at 0, 1, 2 hours then 2-hourly until 12 hours
4. Asymptomatic: no PN Abx
5. Signs of EOGBS: penicillin & gentamicin
6. Encourage breastfeeding

Question 14

** Summary of who should be given IAP **

Answer 14

Vaginal birth:
1. Previous baby with GBS disease
2. Preterm labour
3. Previous GBS if not tested -ve now
4. PROM, known GBS carrier
5. GBS detected in current pregnancy

Question 15

** Summary of who should not be given IAP **

Answer 15

1. PROM with unknown or -ve GBS
2. Term labour with no risk factors
3. Caesarean, not in labour, membranes intact

Question 16

What is the overall incidence of EOGBS disease?

Answer 16

5.7%

Question 17

What are the risk factors for EOGBS disease?

Answer 17

1. Prematurity
2. Previous baby with GBS disease
3. GBS bactericida
4. Vaginal swab +be for GBS
5. Maternal temp >38 in labour
6. PROM

Question 18

What are the red flags for possible early onset neonatal infection?

Answer 18

1. Respiratory distress >4h after birth
2. Seizures
3. Need for mechanical ventilation in term baby
4. Signs of shock

Question 19

What are the incidence rates of EOGBS?

Answer 19

1. Overall: 0.57/1000
2. Term infants with no risk factors: 0.2/1000
3. GBS previous pregnancy: 0.9/1000
4. GBS current pregnancy: 2.3/1000
5. Intrapartum pyrexia >38: 5.3/1000