corinna

So, in this area, some OBs and pediatricians have a new approach; for cases of prolonged rupture of membranes, they're only giving antibiotics if the mom runs a fever. Otherwise, they just do a simple blood test on the baby (can be done from cord blood or a heelstick if they miss the cord blood opportunity) to check for C-reactive protein. This is an indicator of an acute infection. If it's negative, everyone can be reassured that baby's fine, even though mom didn't get antibiotics; if it's positive (for whatever reason!), then baby will be appropriately treated for an acute infection. This has great potential for focusing the treatment where it is most needed and not exposing all the others to unnecessary side effects and increased risks from resistant bacteria. HURRAY for progress!

"We analyzed surveillance data on group B streptococcus (GBS) infection in Finland from 1995 to 2000 and reviewed neonatal cases of early-onset GBS infection in selected hospitals in 1999 to 2000. From 1995 to 2000, 853 cases were reported (annual incidence 2.2-3.0/100,000 population). We found 32-38 neonatal cases of early-onset GBS disease per year (annual incidence 0.6-0.7/1,000 live births). In five hospitals, 35% of 26 neonatal cases of early-onset GBS infection had at least one risk factor: prolonged rupture of membranes, preterm delivery, or intrapartum fever. Five of eight mothers screened for GBS were colonized. In one case, disease developed despite intrapartum chemoprophylaxis. Although the incidence of early-onset GBS disease in Finland is relatively low, some geographic variation exists, and current prevention practices are suboptimal. Establishing national guidelines to prevent perinatal GBS is likely to reduce the incidence of the disease."

Main results: Five trials were included. Overall quality was poor, with potential selection bias in all the identified studies. Intrapartum antibiotic treatment reduced the rate of infant colonization (odds ratio 0.10, 95% confidence interval 0.07 to 0.14) and early onset neonatal infection with group B streptococcus (odds ratio 0.17, 95% confidence interval 0.07 to 0.39). A difference in neonatal mortality was not seen (odds ratio 0.12, 95% confidence interval 0.01 to 2.00).

There were 11 early onset GBS cases (1.4/1000), which the presenter commented was about the same incidence as is usually reported. (So does that mean that even though 70% had antibiotics, the rate of GBS was no different than if nobody got them, or does it mean that the 1.4/100 is what is expected when antibiotics are given?) They did find less GBS in those who had intrapartum antibiotics vs those who had prepartum antibiotics (10% vs 32%). It still leaves me wondering if this experiment (lots of antibiotics to a wide range of moms in the name of prevention, vs tx) is really working out when you look at the big picture, or will this too fall by the wayside as more is known?

Bacteriuria in pregnancy was prospectively studied in 569 women, with specific reference to group B streptococcal infection. Forty-six patients (8%) had bacteriuria, including 14 with group B streptococcal infection; group B streptococci (GBS) were exceeded in frequency only by Escherichia coli. Two thirds of the bacteriuric patients remained asymptomatic. The outcome of pregnancy was studied in 41/46 bacteriuric patients, including all those with group B streptococcal infection. Two pregnancies ended in intrauterine fetal death, and one neonate developedgroup B streptococcal sepsis; all three complications occurred in the 14 women with group B streptococcal bacteriuria. Diabetes mellitus appeared to increase the risk of group B streptococcal bacteriuria. This study revealed that group B streptococcal bacteriuria is more common in pregnancy than was previously suspected and suggests that culture methods to detect GBS should be used in bacteriuria screening programs done in pregnancy. In terms of perinatal infection risk, screening for group B streptococcal bacteriuria at or near the time of delivery may be more meaningful than other group B streptococcal surveillance culture studies.

We investigated the role of maternal antibody in neonatal Group B streptococcal infection with a radioactive antigen-binding assay employing a purified polysaccharide antigen with both Type III and Group B determinants. Serums from seven women who gave birth to infants who had invasive Group B streptococcal infection with Type III strains were all deficient in antibody. In contrast, serums from 22 of 29 pregnant Type III vaginal carriers whose infants were healthy contained antibody with a prevalence significantly different from that in women delivering infants with Type III disease (P less than 0.01). Three healthy neonates born to women with antibody in serums had demonstrable antibody in umbilical-cord serum. These data suggest that transplacental transfer of maternal antibody protects infants from invasive Group B streptococcal infection with Type III strains.

"We believe that the key issue for prevention of EOGBS infection is knowledge-if a pregnant woman knows she carries GBS, or has other risk factors present that increase the risk of her baby developing EOGBS infection, she can be offered IAP to protect her baby from this potentially devastating condition. Of course, women don't have to accept the recommended intravenous antibiotics in labour (or an ECM test, either privately or if available on the NHS) if they choose not to. But surely they should have access to good-quality information so they can make an informed choice about what is right for them and for their unborn baby? And midwives are in the perfect position to ensure that pregnant women have such information, resulting in appropriate treatment, which will minimise the number of babies suffering needlessly from EOGBS infection."

"Vertical transmission of microbes occurred in 43% of the reference deliveries. In the double blind study, vaginal douching with chlorhexidine significantly reduced the vertical transmission rate from 35% (saline) to 18% (chlorhexidine),. . . . This prospective controlled trial demonstrated that vaginal douching with 0.2% chlorhexidine during labour can significantly reduce both maternal and early neonatal infectious morbidity. The squeeze bottle procedure was simple, quick, and well tolerated. The beneficial effect may be ascribed both to mechanical cleansing by liquid flow and to the disinfective action of chlorhexidine."

I live in a state where midwifery isn't licensed. I'm planning a homebirth but tested positive for GBS in a previous pregnancy. I'm not at all sure what to do. My midwife can't prescribe antibiotics. Do I have any alternatives other than planning a hospital birth?

I will be continuing with plans to birth my 2 clients at home. After trying to make arrangements for a home IV (a royal pain for all!) we opted (we, as in I the client and my back-up doc and his new CNM partner) to treat with antibiotics IM. Both clients went in this week for their pre-birth injections. I did not have to deal with giving them the meds during labor (for which I am grateful) and they are covered for 30 days after the injections (yes, 4 injections were needed to give the full dose!!). I researched the exact med and dosage and relayed that to my back-up and they then ordered up the meds and my clients called and went in for their injections. I now have a new client due in Dec. who is GBS+ and we will have a plan of action already in place for her. I am glad to have a workable solution to this dilemma! Thanks to the person who posted the abstract on IM coverage for GBS, we used that formula. Hope you all can use this info if you come up against this problem.

Yes, we often place HLs (like if the mom needs antibiotics for some reason--Mitral Valve Prolapse, Group B Strep Carrier etc.) and don't hook them up to an IV. Only needs to be flushed every 8-12hrs with saline to keep it open, and after medication is administered through it. And a HL DOESN'T have to be placed in an inconvenient place like the back of the hand, wrist or inner elbow. it can easily be placed on the forearm out of the way. it can be covered with saran wrap and be immersed in tub/shower. And there is NO needle left in an IV or HL....so no fear of re-poking with mvnt.

RESULTS: Abuse was significantly related to STDs, and ethnicity emerged as a significant variable for the Hispanic women participating in this study. Findings indicated that infection with group B was also related to abuse status ( r=.60, p < or =.002) and to presence of herpes simplex virus-2 (r =.468, p

About 10 years ago. I remember watching it happen. In Woman's Day and Redbook there started appearing articles by women who said "My baby could have been saved if my doc had performed this simple test." The medico-legal world responded to the "suage" (suits) by imposing this new standard.

corinna

See Also