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22-Group B streptococcus GBS In Pregnancy > GTG > Flashcards

GTG Flashcards

1
Q

What is the organism responsible for most cases of late - onset neonatal sepsis ( > 7 days)?

A

E coli

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2
Q

What is the organism responsible for early onset neonatal sepsis ( > 7 days)?

A

Group B streptococcus

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3
Q

What is the definition of early onset neonatal sepsis?

A

Neonatal sepsis takes place;
< 72h in infants hospitalized in NICU
< 7 days in term infants

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4
Q

What is the percentage of neonatal infection developing within 48h of birth caused by GBS?

A

50 %

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5
Q

What is the percentage of GBS carriers in UK ( colonization) ?

A

25 %
20 - 40 %

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6
Q

if GBS detected in previous pregnancy ,what is the percentage of GBS carriage in this pregnancy?

A

50 %

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7
Q

When to do bacteriological testing for GBS if indicated?

A

35 - 37 w
OR 3 - 5 w before EDD
Ex: 32 - 34 w for women with twins
MCDA : 31 - 33 w
DCDA : 32 - 34 w

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8
Q

Is maternal request an indication for test carrier GBS status?

A

Not indication for bacterial screening

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9
Q

Why routine antenatal GBS screening is NOT recommended in UK ?

A

1- 25 % of GBS positive swab will be negative at delivery
2- 7 % who are GBS negative swab will be positive at delivery
3- many babies severely affected by GBS are born premature

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10
Q

What is the screening method for GBS carriage?

A

Lower vaginal + rectal
Rectal swabs: improves sensitivity 22 👉 27 % ( 5 % )

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11
Q

What is the drug treatment for GBS prophylaxis

A

🚩Drug of choice: benzyl penicillin
3 g after onset of labour then
1,5 g / 4 h until delivery
🚩known or suspected penicillin allergy: Cephalosporin
🚩any evidence of SEVERE allergy:
Vancomycin 1g /12h

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12
Q

If the patient develops any symptoms during GBS prophylaxis with penicillin (Vomiting / urticaria, RDS,angioedema ),how to manage?

A

Vomiting Only 👉 continue penicillin
Severe anaphylaxis 👉 Vancomycin
1 g / 12 h
Mild or suspected anaphylaxis 👉
Cefuroxime 1,5 g then 750g/8h

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13
Q

If GBS carriage detected antenatally in vaginal discharge or urine,
-When to treat antenatally?
-When to give intrapartum antibiotics prophylaxis IAP?

A

🚩Vaginal: Just IAP
Antenatal treatment NOT
recommended
🚩 urine: IAP
GBS < 10⁵ 👉 NO antenatal
treatment
GBS > 10⁵ 👉 antenatal
treatment recommended

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14
Q

If the patient is a GBS carrier in previous pregnancy, what is the management?

A

Options:
1- IAP or
2- testing 3 - 5 w before EDD or
3- BETTER : No action done

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15
Q

What is the management in each case;
* current pregnancy GBS bacteuria
* current pregnancy GBS vaginal
discharge
*previous baby with sepsis ( late / early)
* previous baby with sepsis swab negative for GBS

A

🚩 current pregnancy GBS bacteuria
👉 treat now + IAP
🚩 current pregnancy GBS vaginal
discharge 👉 IAP
🚩previous baby with sepsis ( late / early)👉 IAP
🚩 previous baby with sepsis swab negative for GBS 👉 IAP

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16
Q

What is the management:
GBS colonization + IUFD ?

A

No IAP

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17
Q

What is the management;
GBS colonization + CS before the onset of labour or rupture of membranes?

A

No IAP

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18
Q

What is the management:
GBS carrier + delivery by CS after spontaneous rupture of membranes?

A

IAP + category 2 or 3 CS

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19
Q

Should being a GBS carrier influence the method of induction labour?

A

Should not vary according to GBS status

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20
Q

Is being a GBS carrier a contraindication to membran sweeping?

A

Membran sweeping is not contraindicated in women who are GBS carrier

21
Q

What is the management:
Rupture of membranes at term + unknown GBS status?

A

Induction of labour immediately OR
Expectant management up to 24h
Beyond 24h induction of labour is appropriate

22
Q

Rupture of membranes at term + known GBS carrier?

A

IAP + induction of labour

23
Q

Pyrexia ( 38 / 100,4) in labour + unknown GBS status?

A

Broad spectrum antibiotics
Amoxicillin 2g / 6h
Or : cephuroxim 1,5 g /6h

24
Q

Preterm labour + unknown GBS status?

A

IAP

25
Q

Preterm planned CS without labour + unknown GBS status?

A

NOT RECOMMENDED IAP

26
Q

Is there a role for PCR or other near patient testing at the onset of labour in GBS carriers?

A

Not recommended

27
Q

Can GBS positive women have water birth?

A

Not contraindicated

28
Q

Preterm prelabour rupture of membranes < 37 + unknown GBS status?

A

IAP should be given once labour is confirmed or induced

29
Q

Preterm prelabour rupture of membranes + GBS positive?
- <34
- 34-37

A

34 -37 w 👉 IAP + expedite delivery
< 34 w 👉 expectant management

30
Q

How should known GBS colonization women who decline IAP be managed?

A

Monitor the neonate very closely for 12 h after birth

31
Q

What are the adverse effects of IAP?

A

1- maternal anaphylaxis
2- altered neonatal bowel flora
3- abnormal child development

32
Q

Should vaginal cleansing be performed in labour in GBS carriers?

A

No evidence that intrapartum vaginal cleansing will reduce the risk of neonatal GBS

33
Q

If there have been any concerns about early onset neonatal infection, what signs should prompt parents to seek medical advice?

A

1- abnormal behavior
2- unusually floppy
3- difficulties with feeding
4 - abnormal temperature ( <36/ > 38)
5- rapid breathing
6- change in skin color

34
Q

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

A

Treat as normal
Don’t require special observation

35
Q

What is the meaning of adequate IAP ?

A

First dose of IAP more than 4 hours before delivery
Minimum 2 hours

36
Q

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

A

Increased observation for 12 h
1- At birth for clinical indicators of infection
2- vital signs: 0 ,1 ,2 hours then every 2 hours until 12 h

37
Q

When postnatal antibiotics prophylaxis is not recommended?

A

Low risk - asymptomatic- term babies

38
Q

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

A

Should be treated with
Penicillin + gentamicin within an hour of decision to treat

39
Q

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

A

Increased observation
1-at birth for clinical indicators of infection
2- vital signs checked 0 ,1 ,2 h and then every 2 hours until 12 hours

40
Q

What advice should be given to women regarding breastfeeding in case of GBS carriage?

A

Breastfeeding should be encouraged

41
Q

What are the indications for increased neonatal observation in the first 12 hours regarding early detection of EOGBS?

A

1- the mother is GBS positive & hasn’t had adequate IAP
2- previous baby with EOGBS
3- the mother is GBS positive & declined IAP

42
Q

What is the prevalence of EOGBS?

A

O.5 / 1000
If intrapartum pyrexia 5 / 1000
Previous baby with EOGBS 1 / 700

43
Q

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

A

1- having a previous baby with GBS
2- maternal GBS carriage through investigations during pregnancy ( urine, vaginal discharge)
3- preterm birth
4- prolonged rupture of membranes
5- suspected maternal intrapartum infection ( eg: chorioamnionitis)
6- pyrexia in labour 38

44
Q

Mortality rate from EOGBS
- at term
- preterm

A

At term 2- 3 %
Preterm 20 - 30 %

45
Q

What is the recommendations regarding preterm prelabour rupture of membranes about antenatal antibiotics until the labour is established,?

A

Erythromycin 250 / 4 times daily for maximum 10 days
Alternative: penicillin if erythromycin is contraindicated

46
Q

Why limiting neonatal observation for EOGBS to 12 hours?

A

90 % of infants who are diagnosed with EOGBS will display signs by 12 hours

47
Q

Is IPA has any benefits in reducing the risk of late onset neonatal disease ?

A

Noo

48
Q

What proportion of neonatal infection developing within 48h caused by GBS?

A

50 %

22-Group B streptococcus GBS In Pregnancy (1 decks)

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