2017 36 Prevention of EOGBS Flashcards

1
Q

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

A

Appropriate information leaflet
To all pregnant women

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2
Q

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

A
  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
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3
Q

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

A
  1. Treat proven UTI, then IAP
  2. No treatment for vaginal or rectal, then IAP
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4
Q

** How does GBS impact on IOL? **

A
  1. No change
  2. Not a contraindication to sweep
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5
Q

** How does GBS impact on ElCS? **

A
  1. No impact if intact membranes & in absence of labour
  2. No IAP even if preterm
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6
Q

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

A
  1. Known GBS: immediate IAP & IOL
  2. Unknown or -ve GBS: offer immediate IOL or wait for 24 hours
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7
Q

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

A
  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
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8
Q

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

A

Yes, as long as on IAP

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9
Q

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

A
  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
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10
Q

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

A
  1. Benzylpenicillin
  2. Cephalosporin if non-severe allergy
  3. Vancomycin if severe allergy
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11
Q

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

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

Very close neonatal monitoring for 12h

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12
Q

** What are possible signs of EOGBS? **

A
  1. Abnormal behaviour eg inconsolable
  2. Floppiness
  3. Feeding difficulties
  4. Temp <36 or >38
  5. Rapid breathing
  6. Changes in skin colour
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13
Q

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

A
  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
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14
Q

** Summary of who should be given IAP **

A

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

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15
Q

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

A
  1. PROM with unknown or -ve GBS
  2. Term labour with no risk factors
  3. Caesarean, not in labour, membranes intact
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16
Q

What is the overall incidence of EOGBS disease?

A

0.57 per 1000 births

17
Q

What are the risk factors for EOGBS disease?

A
  1. Prematurity
  2. Previous baby with GBS disease
  3. GBS bactericida
  4. Vaginal swab +ve for GBS
  5. Maternal temp >38 in labour
  6. PROM
18
Q

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

A
  1. Respiratory distress >4h after birth
  2. Seizures
  3. Need for mechanical ventilation in term baby
  4. Signs of shock
19
Q

What are the incidence rates of EOGBS?

A
  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