Group B Strep, Sepsis and Pyrexia in Pregnancy Flashcards
What is Group B streptococcus
The most common cause of neonatal sepsis is Group B Streptococcus (GBS).
GBS is a commensal of the female genital tract. In the mother, it may be associated with urinary tract infection during pregnancy, septic abortion, and postpartum endometritis. Infection can occur early or late.
It is thought around 20-40% of mothers have GBS present in their bowel flora and may therefore be thought of as ‘carriers’ of GBS. Infants may be exposed to maternal GBS during labour and subsequently develop potentially serious infections.
What are the risk factors for GBS infection of neonates
Risk factors for Group B Streptococcus (GBS) infection in neonates:
• Maternal GBS carriage discovered during pregnancy
• Prematurity
• Prolonged rupture of the membranes
• Previous sibling GBS infection
• Maternal pyrexia e.g. secondary to chorioamnionitis
Are all women screened for GBS?
Universal screening for GBS should not be offered to all women
A maternal request is not an indication for screening
How do previous cases of GBS detection or infection influence managements of the current pregnancy?
Maternal intravenous antibiotic prophylaxis should be offered to women with a previous baby with early or late onset GBS disease or if they previously tested positive for GBS.
These women should be informed that their risk of maternal GBS carriage in this pregnancy is 50%.
They should be offered maternal intravenous antibiotic prophylaxis (IAP) OR testing in late pregnancy and then antibiotics if still positive.
IV Benzylpenicillin is the antibiotic of choice for GBS prophylaxis, clindamycin if allergic
If indicated what dates should mothers have swabs for GBS at?
If women are to have swabs for GBS this should be offered at 35-37 weeks or 3-5 weeks prior to the anticipated delivery date
Which positive tests for GBS warrant treatment and which do not?
Women should be offered IAP if they test positive for GBS bacteraemia or in the urine but should not be treated antenatally from +ve rectal/vaginal swabs
Which group of women are always offered IAP?
Maternal intravenous antibiotic prophylaxis should be offered to women in preterm labour regardless of their GBS status.
If a women presents with pyrexia in labour how should they be managed?
Women with a pyrexia during labour (>38ºC) should also be given broad spectrum intravenous antibiotics which also cover GBS
How should neonates be managed where the mother was treated for GBS?
For babies born at term that are clinically well and where the mother has received IAP at the appropriate time no special observation is required.
How should babies with clinical signs be treated for GBS?
Babies with clinical sign of early onset GBS should be treated with benzylpenicillin and gentamicin within an hour of the decision being made
What is the most common cause of maternal bacterial sepsis?
Most commonly caused by Group A streptococcus. If associated organ dysfunction then the sepsis is classified as severe.
Lancefield Group A haemolytic Streptococcus
E. Coli
What are the clinical features of a maternal sepsis?
Fevers, rigors, Diarrhoea and vomiting, rash, abdominal or pelvic pain, offensive vaginal discharge, productive cough and urinary symptoms
What are the risk factors for maternal sepsis?
Obesity Diabetes Immunosuppressed Anaemia Pelvic Infection History of GBS infection Amniocentesis Prolonged rupture of membranes Group A infection in close contacts Black ethnic minority
How should a pregnant woman presenting with sepsis be investigated?
Blood Cultures (before giving the antibiotics)
Throat, high vaginal swabs and MSU
FBC, Us and Es, LFTs, CRP, Clotting and Lactate
ABG or VBG
Continuous foetal monitoring (foetal encephalopathy and cerebral palsy)
How should maternal bacterial sepsis be managed?
Tazocin within an hour
Fluid Bolus
Aim for mean arterial BP of >65
Oxygen
Immunoglobulin in severe streptococcal or staphylococcal infection
Be aware of preterm labour – warn neonatal unit
Expect foetus to by tachycardic due to increase in temp if mother febrile
Spinal block and epidural avoided (lowers BP) if CS – use GA
