[RealNurseWitch]

Question for all of you OB nurses. Actually, this may be better answered by those of you who work in the doctor's office...

First of all, when I was pregnant with my son my OB's did not do a Group B strep test, (I just had him back in Feb.), even though I do believe I told them that I had tested positive with my daughter, and was given antibiotics. I guess maybe I should have pushed for them to test me, but for some reason I did not.

Why do you suppose they did not test? Is Group B passed to the baby through vaginal birth? Did they not test me because I had previously had a cesearean birth, and they were pretty much planning to convince me to have another C section? I had originally wanted to try for a VBAC but it became clear to me as my pregnancy progressed that, while the doctors in the office claimed that they did do VBAC's, they as a group were far from crazy about the idea.

I'm only asking all of this out of curiousity. My son is fine; well except for his laryngomalacia that we are carefully monitoring. A user on another forum posted about a baby she recently cared for with Group B strep who is severely neurologically compromised, and I'm just genuinely curious as to why my provider didn't test me.

[4jen]

They did not test me the second time, I was actually induced because I had a very rapid delivery with my first child and was GBS +. They induced so we had enough time for antibiotics. I was disappointed about being induced however I knew my son was safer this way. So are you saying you delivered naturally and they didn't give you antibiotics? Or did they treat you as if you had it without testing.

[feebebe23]

I have been doing L&D for several years....if you were GBS pos with your first....you will usually be treated in all subsequent pregnancies.....

Although some MDs will test again....I think it is because they can bill for it

Also....we usually do not treat for GBS for a sch. C/S so if your plan was for a repeat CS then there is no reason to test....

Did you vag or CS?....and if you labored were you treated? Some doctors will treat women in labor with abx even if there GBS is unknown.....even though that is not what the CDC reccommends.

If you labored at all and were not treated.....that is an issue......

[RealNurseWitch]

No I didn't labor, I ended up scheduling a C section. I didn't decide to schedule the C section until VERY late in my pregnancy though; I was past 40 weeks and still was showing no signs whatsoever of laboring anytime soon, so decided to just go ahead and schedule the C section.

I guess if the Group B strep is spread to the baby during labor as she/he is passing through the birth canal, then it isn't really necessary to test perhaps until very close to labor time, or even as the woman is laboring? So maybe my doctors don't generally test until then, and never tested me because they figured the chance would be pretty good that I might not ever go through labor.

Seems like with my daughter, I was tested earlier in my pregnancy than right close to time for delivering.

Anyway, I was just curious as to why I never got tested, but if many OB's tend to wait until right close to the time for delivery, then it makes sense that I wasn't tested.

[Jolie]

Originally Posted by RealNurseWitch

No I didn't labor, I ended up scheduling a C section. I didn't decide to schedule the C section until VERY late in my pregnancy though; I was past 40 weeks and still was showing no signs whatsoever of laboring anytime soon, so decided to just go ahead and schedule the C section.

I guess if the Group B strep is spread to the baby during labor as she/he is passing through the birth canal, then it isn't really necessary to test perhaps until very close to labor time, or even as the woman is laboring? So maybe my doctors don't generally test until then, and never tested me because they figured the chance would be pretty good that I might not ever go through labor.

Seems like with my daughter, I was tested earlier in my pregnancy than right close to time for delivering.

Anyway, I was just curious as to why I never got tested, but if many OB's tend to wait until right close to the time for delivery, then it makes sense that I wasn't tested.

If you tested positive in a previous pregnancy, there is virtually a 100% chance that you will remain positive, so there is no need to repeat testing. Depending on the lab where cultures are sent, results can take a few days, so most OBs test their prenatal patients by 36 weeks in order to be reasonably certain of having results BEFORE mom presents to the hospital in labor. The risk of infection to the baby begins at the time the bag of waters ruptures, so with a scheduled C-section on a patient with intact membranes, the likelihood of transmitting beta strep to the baby is small. If your membranes had ruptured prior to your scheduled C-section, your doctor would most likely have given you IV antibiotics.

[vandermom]

All of our patient are cultured at 36 weeks (genital). If positive at any time anywhere during the pregnancy they are treated, during labor, with PCN q4 til delivery. Any delivery less than 4 hours after the first dose the baby is close observation for 48 hours with no early discharge.
Preterm not cultured are usually treated as if positive.
All patients who had a previous infant affected by GBS are treated as if positive.

[beckinben]

Originally Posted by Jolie

If you tested positive in a previous pregnancy, there is virtually a 100% chance that you will remain positive, so there is no need to repeat testing.

I see women regularly who tested positive in a previous pregnancy who test negative in their current pregnancy. Which is why we test almost everyone in every pregnancy, as the CDC recommends. http://www.cdc.gov/groupbstrep/

The only women we don't test are those who had group B strep in their urine prenatally and those who have had a baby with GBS disease - these get treated automatically.

I personally find it interesting that the UK has looked at all the same data that the CDC has, and they still don't recommend universal screening and only recommend treating based on risk factors. Makes me wonder if antibiotic resistance scares them more. I've heard of a couple multi-drug resistant GBS cultures.

[Jolie]

Originally Posted by beckinben

I see women regularly who tested positive in a previous pregnancy who test negative in their current pregnancy. Which is why we test almost everyone in every pregnancy, as the CDC recommends. http://www.cdc.gov/groupbstrep/

The only women we don't test are those who had group B strep in their urine prenatally and those who have had a baby with GBS disease - these get treated automatically.

I personally find it interesting that the UK has looked at all the same data that the CDC has, and they still don't recommend universal screening and only recommend treating based on risk factors. Makes me wonder if antibiotic resistance scares them more. I've heard of a couple multi-drug resistant GBS cultures.

Thanks for this info!

I am curious. In the UK, what "risk factors" warant screening and/or treatment. As an old NICU nurse, I vividly recall 2 babies who died of beta strep sepsis within hours of birth in the pre-screening days, deaths that would not occur today, given the protocols that most OBs follow.

I understand the concern of over-use of antibiotics, but don't believe that treating a mom who cultures (+) constitutes inappropriate antibiotic use.

[Elvish]

I have seen moms (one just recently) who cultured + in one pregnancy came back neg in a subsequent. Where I am, it just depends on the OB whether you're cultured again once you're +. Most of the private docs don't. They just assume & treat.

[beckinben]

Originally Posted by Jolie

I am curious. In the UK, what "risk factors" warant screening and/or treatment. As an old NICU nurse, I vividly recall 2 babies who died of beta strep sepsis within hours of birth in the pre-screening days, deaths that would not occur today, given the protocols that most OBs follow.

Same as in the US - intrapartum fever, gestational age <37, ROM >18 hours, GBS bacteruria.

I understand that GBS is a serious cause of neonatal mortality, but I just have concerns about what we will do when GBS becomes resistant because 30% of laboring women are getting antibiotics.