CBL 6_GBS screening and prophylaxis_prepping for birth Flashcards
How do you store GBS swab?
4 degrees Celsius
Processed within 24 hours of collection.
What does CBC look for?
Broadly: hemoglobin, mean corpuscular volume, and platelets and some other biz
When do we repeat anemia screening?
28 weeks
Why do we repeat anemia screening?
Hemodilution of the blood; screening for risk of tolerance to hemorrhage
Lab value hemoglobin first/third trimester?
<110 g/L
Lab value hemoglobin second trimester?
<105 g/L
Lab value ferratin diagnostic of iron deficiency in first trimester?
<15 µg/L
How common is anemia in pregnancy in Canada?
30 %
Lab value indicative of probable iron deficiency (begin mgmt. with oral supplementation)?
<30 µg/L
What are the risk of anemia in pregnancy? (7)
Preterm birth
Low birth weight
Placental abruption
Pre-eclampsia
PPH
Transfusion
Depression
How does WHO define anemia?
Hb < 110 in 1st trimester
Hb < 105 in 2nd trimester (due to hemodilution)
Postpartum HB < 100
What is the oral supplementation recommendation for anemia?
a standard therapeutic dose of 100 mg elemental iron per day
What is the calculating dose to administer IV iron?
Iron needs (mg iron) = body weight (kg) * (target Hb – actual Hb) * 2.4 + depot iron need (mg iron)
Labs recommended 0-14 weeks? 11
Blood group and antibody screen
CBC – hematology profile
Ferratin
TSH *risk factors but not really
HIV
Syphilis
Hep B
Hep C *risk factors
Rubella antibody titre *if first preg
Chlamydia/Gonorrhea
Urine C&S (UTI)
Labs recommended 24-28 weeks?
Repeat antibody screen in Rh negative clients
Gestational diabetes screen
CBC and ferritin at 28 weeks
Labs recommended 35-37 weeks?
Group B strep Screen
When RhoGam administered?
28 weeks
When use Edinburgh perinatal/postpartum depression scale?
In between 28-32 weeks prenatally
6-8 weeks pp
(anytime is valid)
Do we use EPDS universally?
Yes
Scoring breakdown of EPDS?
Less than 8 – depression not likely
9-11 – depression possible
12-13 – fairly high possibility of depression
14 and higher - probable depression
Positive score on question 10 – suicidality risk
What are the 4 principles of TIC approach?
Having trauma awareness
Establishing safety and trustworthiness
Ensuring choice, collaboration, connection
Building on strengths
What is GBS?
Group B streptococcus – bacteria found in gut, vagina, anus
Not an STI, not a sign of cleanliness
Transient bacteria
What is the incidence of GBS in pregnancy ?
1.5-4/10 – very common
What is the incidence of GBS infection for baby?
2.3/10 000 (rare)0.2 %
What is the incidence of a baby dying from EOGGBDS?
1.15/100 000 (very rare) 0.001 percent
Community standard managing positive GBS swab?
IV admin of prophalytic antibiotics every 4 hours till birth of bb starting when membranes rupture or during active labour (whatever comes first)
Who does SOGC recommend Abx to for GBS? (3)
- any woman positive for group B streptococcus by vaginal/rectal swab culture screening done at 35 to 37 weeks’ gestation (II-2B);
- any woman with an infant previously infected with group B streptococcus (II-3B);
- any woman with documented group B streptococcus bacteriuria (regardless of level of colony-forming units) in the current pregnancy. (II-2A)
Chances of EOGBDS following community standard?
3/1000
Chances of death from EOGBSD following community standard?
3/10,000
Chances of EOGBDS following risk factor approach?
5/1000
Chances of death following risk factor approach?
5/10,000
Chances of EOGBDS taking no abx?
10/1000
Chance of death taking no abx?
10/10,000
Risk factor approach to GBS positive? (4)
Taking abx:
ROM more than 18 hours
Preterm labour
Previous child with GBS disease
Fever above 38 degrees
Signs of newborn with EOGBSD? (5)
Fever
Lethargic
Poor feeding
Central cyanosis
Stop breathing
When are fetal movements typically felt?
Usually by 20-22 weeks
How many fetal movements should a pregnant person feel at the end of pregnancy?
Six movements within 2 hours
What’s maternal colonization rate of GBS (comp. mid)?
10-35 %
Colonization rate of GBS among newborns who are colonized and not treated (comp mid)?
50 %
Rate of early onset GBS disease among colonized newborns (comp mid)?
1-2 %
Average risk of any baby in the population having early onset disease (comp mid)?
0.2 %
How much does screening and abx reduce the rates of EOGBSD? (comp mid)?
65-85%
How much does risk factor mgmt. of GBS reduce the rates of EOGBDS ((comp mid)?
51-75%
When does EOGBSD happen?
1-7 days
When does late onset GBS disease happen?
7-31 days
When do we start measuring fundal height?
12 weeks
What is the most accurate way to see if SFH is normal?
Plotting on curve
