GBS

Question 1

Where is GBS present and what can it cause?

Answer 1

Gut and genital tract
Infections - such as sepsis, meningitis and pneumonia

Question 2

What are signs of early onset GBS (0-6 days)?

Answer 2

Grunting, noisy breathing, moaning, seeming to be working hard to breathe when you look at chest or tummy.
Being very sleepy or unresponsive
Inconsolable crying
Being unusually floppy
Not feeding well or not keeping milk down
Having a high/low temp
Fast/slow heart rate or breathing rate
Having low blood pressure
Having low blood sugar

Question 3

Signs of late onset of GBS (7-90 days)?

Answer 3

Being irritable with high pitched whimpering cry or moaning
Blank staring or trance like expression
Floppy
May not like to be handled
Fretful
Tense or bulging fontanelle’s on babies head
Turning away from bright light
Involuntary stiff body
Jerking movements
Pale and/or blotchy skin

Question 4

What are the indications for IAP?

Answer 4

Positive group B strep in this pregnancy
Previous baby with group B strep
Fever during labour above 38 degrees
Pre term labour
Clinical diagnosis of chorioamnionitis

Question 5

What are the 1st line intrapartum antibiotic prophylaxis?

Answer 5

IV benzylpenicillin 3g as soon as possible after the onset of labour, followed by 1.5mg four hourly until delivery.

Question 6

Second line intrapartum antibiotic prophylaxis?

Answer 6

IV cefuroxime 1.5g followed by 750mg every 8 hours.
For women who are mildly allergic to penicillin (haven’t previously had a skin rash, anaphylactic shock, or swelling under the surface of the skin)

Question 7

Third line intrapartum antibiotic prophylaxis cover?

Answer 7

Teicoplanin 600mg every 12 hours should be used for a maximum of 4 doses
(Severe allergy to penicillin)

Question 8

Can you have a water birth with GBS?

Answer 8

Yes as long as can receive appropriate IAP

Question 9

Can you have a home birth with GBS?

Answer 9

Home birth would be against medical advice

Question 10

What would women with GBS undergoing section have?

Answer 10

Standard intraoperative antibiotics

Question 11

When is a neonatal review carried out postnatally?

Answer 11

To any babies born from a mother with previous GBS, irrespective of any subsequent negative result

Question 12

When are NEW obs carried out?

Answer 12

Baby born to women with previous GBS irrespective of any subsequent negative result

NEW obs for 24 hours in asymptomatic infant 1 hour, 2 hours, 4 hours and then every 4 hours until 24 hours old.

Question 13

Which infants are to be treated with antibiotics?

Answer 13

Any infant suspected of sepsis
any infant born to a mother with GBS positive HSV either this pregnancy or in previous pregnancy (irrespective of a further negative result) and inadequate intrapartum antibiotic cover (had it before 2 hours prior to delivery) - plus one of the following;
Premature delivery (under 37 weeks)
Maternal fever (above 38 for one hour or more)
Prolonged rupture of membrane > or equal to 18 hours.
Offensive liquor