Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Bushra's obstetrics > Group B Streptococcal Disease, Early-onset > Flashcards

Group B Streptococcal Disease, Early-onset Flashcards

1
Q

What information should women be given about group B streptococcal (GBS) colonisation of the motherand the risk of neonatal infection, during pregnancy and after delivery?

A
  • All pregnant women should be provided with an appropriate information leaflet. [New 2016]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Antenatal screening

Should all pregnant women be offered bacteriological screening for GBS?

A
  • Universal bacteriological screening is not recommended.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Antenatal screening

What are the clinical risk factors that affect the risk of GBS disease?

A
  • Clinicians should be aware of the clinical risk factors that place women at increased risk ofhaving a baby with early-onset GBS (EOGBS) disease.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Antenatal screening

Should women be offered intrapartum antibiotic prophylaxis (IAP) if GBS was detected in a previouspregnancy, irrespective of carrier status this pregnancy?

A
  • Explain to women that the likelihood of maternal GBS carriage in this pregnancy is 50%. Discussthe options of IAP, or bacteriological testing in late pregnancy and then offer of IAP if stillpositive.
  • If performed, bacteriological testing should ideally be carried out at 35–37 weeks of gestationor 3–5 weeks prior to the anticipated delivery date, e.g. 32–34 weeks of gestation for womenwith twins.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Antenatal screening

Should women with a previous baby affected by GBS disease be offered IAP irrespective of carrierstatus this pregnancy?

A
  • IAP should be offered to women with a previous baby with early- or late-onset GBS disease.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What screening tests (if any) should be offered if a woman requests testing for carrier status?

A
  • A maternal request is not an indication for bacteriological screening.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Antenatal care

How should GBS bacteriuria in the current pregnancy be managed?

A
  • Clinicians should offer IAP to women with GBS bacteriuria identified during the current pregnancy.
  • Women with GBS urinary tract infection (growth of greater than 105cfu/ml) during pregnancyshould receive appropriate treatment at the time of diagnosis as well as IAP.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Antenatal care

Should women be treated before the onset of labour if GBS carriage is detected incidentally earlier in thepregnancy?

A
  • Antenatal treatment is not recommended for GBS cultured from a vaginal or rectal swab.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Antenatal care

Should the management differ if the detection of GBS is incidental or following intentional testing, and if so, how?

A
  • Where GBS carriage is detected incidentally or by intentional testing, women should be offeredIAP.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Should being a GBS carrier influence the method of induction?

A
  • Method of induction should not vary according to GBS carrier status.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Is being a GBS carrier a contraindication to membrane sweeping?

A
  • Membrane sweeping is not contraindicated in women who are carriers of GBS.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How should planned caesarean section in women with known GBS colonisation be managed?

A
  • Antibiotic prophylaxis specific for GBS is not required for women undergoing planned caesareansection in the absence of labour and with intact membranes.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of term labour (including rupture of membranes) to reduce the risk of EOGBS disease

How should rupture of membranes in a woman at term (37+0weeks of gestation) with known or unknown GBScarrier status be managed?

A
  • Women who are known GBS carriers should be offered immediate IAP and induction of labouras soon as reasonably possible.
  • In women where the carrier status is negative or unknown, offer induction of labourimmediately or expectant management up to 24 hours. Beyond 24 hours, induction of labour isappropriate.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How should labour in a woman with a temperature of 38°C or greater and without known GBS colonisation bemanaged?

A
  • Women who are pyrexial (38°C or greater) in labour should be offered a broad-spectrumantibiotic regimen which should cover GBS in line with local microbiology sensitivities.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How should labour in a woman with a temperature of 38°C or greater and without known GBS colonisation bemanaged?

How should preterm labour be managed in women without known GBS colonisation?

A
  • IAP is recommended for women in confirmed preterm labour.

- IAP is not recommended for women not in labour and having a preterm planned caesareansection with intact membranes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How should labour in a woman with a temperature of 38°C or greater and without known GBS colonisation bemanaged?

Is there a role for polymerase chain reaction or other near-patient testing at the onset of labour?

A
  • Polymerase chain reaction or other near-patient testing at the onset of labour is notrecommended.
17
Q

How should labour in a woman with a temperature of 38°C or greater and without known GBS colonisation bemanaged?

Can GBS-positive women have a water birth?

A
  • Birth in a pool is not contraindicated if the woman is a known GBS carrier provided she isoffered appropriate IAP.
18
Q

Management of preterm labour (including rupture of membranes) to reduce the risk of EOGBSdisease

  • Women with preterm rupture of membranes

How should known or unknown GBS carrier status be managed in women with preterm prelabour rupture ofmembranes?

A
  • Bacteriological testing for GBS carriage is not recommended for women with preterm ruptureof membranes. IAP should be given once labour is confirmed or induced irrespective of GBSstatus.
  • For those with evidence of colonisation in the current pregnancy or in previous pregnancies,the perinatal risks associated with preterm delivery at less than 34+0weeks of gestationare likely to outweigh the risk of perinatal infection. For those at more than 34+0weeks ofgestation it may be beneficial to expedite delivery if a woman is a known GBS carrier.
19
Q

Bacteriological considerations

What are the appropriate swabs if testing for carrier status is to be undertaken?

A
  • When testing for GBS carrier status, a swab should be taken from the lower vagina and theanorectum. A single swab (vagina then anorectum) or two different swabs can be used.
20
Q

Bacteriological considerations

How quickly should the swabs be transported to the laboratory, in what medium and at what temperature?

A
  • After collection, swabs should be placed in a non-nutrient transport medium, such as Amies orStuart. Specimens should be transported and processed as soon as possible. If processing isdelayed, specimens should be refrigerated.
21
Q

Bacteriological considerations

What culture medium should be used if testing for GBS carriage is to be undertaken?

A
  • Enriched culture medium tests are recommended. The clinician should indicate that the swab isbeing taken for GBS.
22
Q

Bacteriological considerations

Which antibiotic should be used for IAP?

A
  • For women who have agreed to IAP, benzylpenicillin should be administered. Oncecommenced, treatment should be given regularly until delivery.
23
Q

Bacteriological considerations

Which antibiotic should be used in women with known or suspected penicillin allergy?

A
  • Provided a woman has not had severe allergy to penicillin, a cephalosporin should be used. Ifthere is any evidence of severe allergy to penicillin, vancomycin should be used.
24
Q

Bacteriological considerations

How should known GBS colonisation in women who decline IAP be managed?

A
  • Women with known GBS colonisation who decline IAP should be advised that the baby shouldbe very closely monitored for 12 hours after birth, and discouraged from seeking very earlydischarge from the maternity hospital.
25
Q

Bacteriological considerations

How should known GBS colonisation in women who decline IAP be managed?

A
  • Women with known GBS colonisation who decline IAP should be advised that the baby shouldbe very closely monitored for 12 hours after birth, and discouraged from seeking very earlydischarge from the maternity hospital.

What are the adverse effects of IAP (maternal anaphylaxis, altered neonatal bowel flora and abnormal childdevelopment)?
- Clinicians should be aware of the potential adverse effects of IAP.

26
Q

Should vaginal cleansing be performed in labour and does this differ according to GBS carrierstatus?

A

There is no evidence that intrapartum vaginal cleansing will reduce the risk of neonatal GBSdisease.

27
Q

How should a newborn baby be managed?

  • If there have been any concerns about early-onset neonatal infection, what signs should prompt parents and carersto seek medical advice?
A
  • Parents and carers should seek urgent medical advice if they are concerned that the baby:

is showing abnormal behaviour (for example, inconsolable crying or listlessness), or
is unusuallyfloppy, or
has developed difficulties with feeding or with tolerating feeds, or
has an abnormal temperature unexplained by environmental factors (lower than 36°C or higherthan 38°C), or
has rapid breathing, or
has a change in skin colour.

28
Q

How should term babies whose mothers have received adequate IAP be managed?

A
  • Term babies who are clinically well at birth and whose mothers have received IAP for preventionof EOGBS disease more than 4 hours before delivery do not require special observation.
  • The babies of women who have received broad-spectrum antibiotics during labour forindications other than GBS prophylaxis may require investigation and treatment as per the NICEclinical guideline on early-onset neonatal infection.
29
Q

How should well babies at risk of EOGBS disease whose mothers have not received adequate IAP be monitored?

A
  • Well babies should be evaluated at birth for clinical indicators of neonatal infection and havetheir vital signs checked at 0, 1 and 2 hours, and then 2 hourly until 12 hours.
30
Q

Should postnatal antibiotic prophylaxis be given to low-risk term babies?

A
  • Postnatal antibiotic prophylaxis is not recommended for asymptomatic term infants withoutknown antenatal risk factors.
31
Q

How should a baby with clinical signs of EOGBS disease be managed?

A
  • Babies with clinical signs of EOGBS disease should be treated with penicillin and gentamicinwithin an hour of the decision to treat.
32
Q

How should the baby of a mother who has had a previous baby with GBS disease be managed?

A
  • Babies should be evaluated at birth for clinical indicators of neonatal infection and have theirvital signs checked at 0, 1 and 2 hours, and then 2 hourly until 12 hours.
33
Q

What advice should be given to women regarding breastfeeding?

A
  • Breastfeeding should be encouraged irrespective of GBS status.

Bushra's obstetrics (54 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions