2017 36 Prevention of EOGBS Flashcards
** How should information about GBS colonisation & risks be provided? **
Appropriate information leaflet
To all pregnant women
** What antenatal screening for GBS should be undertaken? **
- Universal screening not recommended, or for mat request
- GBS in previous pregnancy: offer IAP or bacteriological testing with IAP if +ve
- Test at 35-37/40 or 3-5 weeks prior to anticipated preterm delivery
- If previous baby with GBS, don’t test, just IAP
** How should GBS in pregnancy be managed? **
- Treat proven UTI, then IAP
- No treatment for vaginal or rectal, then IAP
** How does GBS impact on IOL? **
- No change
- Not a contraindication to sweep
** How does GBS impact on ElCS? **
- No impact if intact membranes & in absence of labour
- No IAP even if preterm
** How is ROM managed with respect to GBS? **
- Known GBS: immediate IAP & IOL
- Unknown or -ve GBS: offer immediate IOL or wait for 24 hours
** How is preterm labour managed with respect to GBS? **
- IAP for all, regardless of GBS status
- If <34/40, preterm risks are higher than infection risks
- If > 34/40, expedite if known GBS
** Can GBS positive women have a water birth? **
Yes, as long as on IAP
** How should swabs for GBS be taken & managed? **
- LVS & anorectum, via 1 or 2 swabs
- Non-nutrient transport medium eg Amies or Stuart
- Process ASAP, fridge if delayed
- Enriched culture medium
** Which antibiotics should be used for IAP? **
- Benzylpenicillin
- Cephalosporin if non-severe allergy
- Vancomycin if severe allergy
** What are the potential adverse effects of IAP & how should refusal be managed? **
- Maternal anaphylaxis
- Altered neonatal bowel flora
- Possible abnormal child development
Very close neonatal monitoring for 12h
** What are possible signs of EOGBS? **
- Abnormal behaviour eg inconsolable
- Floppiness
- Feeding difficulties
- Temp <36 or >38
- Rapid breathing
- Changes in skin colour
** How should term babies be managed in terms of GBS? **
- Clinically well & IAP for >4h before delivery: no special obs
- Broad-spectrum for other indications: relevant Ix & Tx
- GBS but no IAP, or previous baby with EOGBS: obs at 0, 1, 2 hours then 2-hourly until 12 hours
- Asymptomatic: no PN Abx
- Signs of EOGBS: penicillin & gentamicin
- Encourage breastfeeding
** Summary of who should be given IAP **
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
** Summary of who should not be given IAP **
- PROM with unknown or -ve GBS
- Term labour with no risk factors
- Caesarean, not in labour, membranes intact