Infectious Diseases - Group B Strep & UTI pregnancy Flashcards
What type of bacteria are streptococci?
Gram +ve
Capsulated, aerobic
What is Lancefield grouping based on?
Method of grouping catalase -ve, coagulase -ve bacteria based on carbohydrates composition of bacterial antigens found on the cell walls
What types of bacteria is Lancefield Group B? Where is it found? What can it cause in the neonate?
S. algalactiae, isolated from vaginal, perineum and rectim
Neonatal septicaemia and meningitis
What is the most common cause of severe neonatal sepsis in 1st 7 days of life?
- Streptococcus Agalactiae
Which racial group has highest levels of GBS?
– highest in black African and lowest in South Asian ancestry
What is the incidence of Early Onset GBS (EOGBS) disease in the UK?
0.57/1000 births
What % of EOGBS where preterm?
What % have a risk factor?
22%
35% had risk factor
(a previous baby affected by GBS disease
GBS bacteriuria
a vaginal swab positive for GBS
maternal temperature of 38°C or greater in labour)
Of EOGBS
- What % have disability
- What % fatality
- 7.4%
- 5.2%
What % of women with a +ve swab at 35-37 weeks will have a negative swab at delivery?
17-25%
What % of women who have a negative swab at 35-37 weeks will have a +ve swab at delivery?
5-7%
What are risk factors for GBS?
- Previous GBS baby
- GBS carrier (urine/HVS)
- Preterm birth
- PROM
- Suspected maternal intrapartum infection
- Pyrexia
If GBS in previous pregnancy, what % will be carriers for GBS in this pregnancy?
50%
Risk of EOGBS, if GBS on swab in this pregnancy?
1 in 400
Risk of EOGBS, if GBS on swab in previous pregnancy?
1/700-800
If no GBS on swab risk, of EOGBS
1/5000, so if negative can choose to avoid IAP
If GBS testing is performed, when should it occur?
3-5 weeks before anticipated delivery dates
Ie 35-37 weeks, or 32-34 weeks in twins
If a mother has had a previous baby effected by GBS, what should be offered?
IAP
Should AN treatment be offered if GBS on vaginal/rectal swab?
No, AN treatment only required if on urine sample
Is method of IOL effected by GBS status?
No, can offer usual IOL and sweeps
If women is planned to be delivered by CS and SROMs, what should be offered?
IAP
Cat 2/3 EMCS
If term and SROM, and aiming for vaignal delivery, what should be offered?
IAP
Immediate IOL
What is risk of EOGBS if maternal temp >38 in labour?
5.3/1000, therefore should be offered IV Abx
What antibiotics can be used in labour to previous EOGBS?
IV Ben Pen 3g then 1.5g 4 hourly
if mild allergy use cephalosporin (e.g. cefuroxime 1.5g then 750mg 8 hourlly)
severe allergy vancomycin (1g 12 hourly)
NotE resistant rates of clindamycin 17%
What is the risk of EOGBS in preterm infants? What is mortality rate?
2.3/1000
Mortality rates increased 20-30% vs 2-3%
Is birth pool contraindicated in GBS carriers
No
If PROM and GBS carrier when should IOL be considered from?
34 weeks
Parents should be advised to seek urgent medical advice if the baby…
is showing abnormal behaviour (for example, inconsolable crying or listlessness), or
is unusually floppy, or
has developed difficulties with feeding or with tolerating feeds, or
has an abnormal temperature unexplained by environmental factors (lower than 36°C or higher than 38°C), or
has rapid breathing, or
has a change in skin colour
If baby is term, had IV Abx from >4 hours pre-delivery, does the baby need extra monitoring?
No
Well babies at risk of EOGBS, need to have their vital signs checked at what times?
0,1,2 and then 2 hourly for 12 hours
If baby shows signs of EOGBS, what are they treated with?
Penicillin and gent
What is untreated upper UTI associated with in pregnancy?
- Low birth weight
- Prematurity
- Preterm labour
- PIH/PET
- Maternal anaemia
Risk of pyelonephritis if UTI untreated in pregnancy?
30-50%
Most common bacteria to cause UTI/acute pyelonephritis?
E.Coli
What % of women found to have incidental UTI in pregnancy?
6%
What infections are screened for routinely in pregnancy?
- Asymptomatic bacteria, urine dip at each app
- Hep B
- HIV
- Rubella
- Syphilis
What advice is given to avoid toxoplasmosis?
1) washing hands before handling food
2) thoroughly washing all fruit and vegetables, including ready prepared salads, before eating
3) thoroughly cooking raw meats and ready prepared chilled meals
4) wearing gloves and thoroughly washing hands after handling soil and gardening
5) avoiding cat faeces in cat litter or in soil.
