8A) Antenatal Care: Group B Streptococcus Flashcards

1
Q

Type of organism Group B Streptococcus (6 facts)

A
  • Gram positive coccus bacteria
  • Forms chains
  • Catalase negative
  • Facultative anaerobe
  • Lancefield group B
  • Beta-haemolytic
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2
Q

Real name Group B Streptococcus

A

Streptococcus agalactiae

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3
Q

Incidence of GBS carriage at delivery (overall, with previous colonisation, if test at 36 weeks positive, if test at 36 weeks negative)

A

Overall carriage rate: 20-40%
Previous GBS colonisation: 50%
+ve test at 36/40: 75%
-ve test at 36/40: 5%

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4
Q

Ethnicity with highest and lowest GBS carriage

A

Highest: Black African
Lowest: SE Asian

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5
Q

Risk factors for developing early-onset GBS disease (EOGBS)

A
  • Previous EOGBS
  • Known GBS colonisation
  • Preterm labour
  • PROM
  • Pyrexia in labour
  • Suspected maternal infection
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6
Q

Incidence of EOGBS (overall, with previous colonisation, if test at 36 weeks positive, if test at 36 weeks negative, if colonisation known and IAP given, preterm labour, pyrexia in labour)

A
Overall risk: 1 in 1750
Previous GBS colonisation: 1 in 800
\+ve test at 36/40: 1 in 400
\+ve test and receive IAP: 1 in 4000
-ve test at 36/40: 1 in 5000
Preterm labour: 2 in 1000
Pyrexia in labour: 5 in 1000
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7
Q

Mortality and disability associated with EOGBS

A

7.5% disability

5% mortality

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8
Q

Intrapartum antibiotic prophylaxis regime

A
  • 3 gram benzylpenicillin loading dose and then 1.5gram 4 hourly until delivery

Penicillin allergy:

  • 1.5 gram cefuroxime loading dose and then 750mg TDS
  • Vancomycin 1 gram BD
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9
Q

Management of patient with GBS colonisation in previous pregnancy

A

Offer either testing at 35-37 weeks or IAP.

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10
Q

Management of patient with GBS disease in previous pregnancy

A

Offer IAP

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11
Q

Management of patient with GBS on urine sample in this pregnancy

A

Treat UTI and offer IAP

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12
Q

Management of patient with GBS on vaginal/rectal swab in this pregnancy

A

Offer IAP

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13
Q

Management of patient with rupture of membranes:

  • Term and known GBS
  • Term and GBS status unknown/negative
  • Preterm and known GBS
  • Preterm and GBS status unknown/negative
A
  • Term and known GBS: Offer immediate augmentation and IAP.
  • Term and GBS status unknown/negative: Offer augmentation after 24 hours.
  • Preterm and known GBS: Erythromycin, offer augmentation and IAP from 34/40.
  • Preterm and GBS status unknown/negative: Erytromycin and IAP once in labour
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14
Q

Management of pyrexia in labour

A

Broad spectrum antibiotics e.g. amoxicillin 2 gram QDS or cefuroxime 1.5gram QDS

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15
Q

Management of baby at risk of EOGBS

A
  • Term + IAP: No special considerations
  • Risk of EOGS and no IAP: Obs 1 hourly until 2 hours and then 2 hourly until 12 hours
  • Clinical signs of EOGBS: Penicillin + gentamicin within 1 hour
  • Previous EOGBS: Obs 1 hourly until 2 hours and then 2 hourly until 12 hours.
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16
Q

Mortality associated with EOGBS in PTB

A

Increased to 20-30% in PTB