Beta Strep

[TLSpaz, ASN, RN]

True or False:

GBS status is not really that important for scheduled CS pts.

[ischialspines]

If they are intact, not that important. Right?

[tdmaher]

In my personal experience (and when I say this.. I've had 2 scheduled c-sections). They still treat for GBS just incase you were to go into labor early and something happened before the c-section took place. So, yes, I would say it is still important to be treated.

[Elvish, BSN, DNP, RN, NP]

If there's no rupture we don't treat. But we do watch the baby.

[TLSpaz, ASN, RN]

You have to know I already have my own answer to this question in mind, right?

I am a new grad RN...not new to OB by any means, but a new RN. My preceptor today asked me to put a patient (G2P2 s/p scheduled CS) on the greaseboard. Next to the GBS status in the chart was a question mark. I told her I was going to look for the GBS results in the computer. Mind you, this is on the mother-baby side of the unit, but all RNs on the floor are cross-trained on L&D and MBU/SCN. She said "Yeah we really don't worry about that in C-sections." I think that that statement is, well, careless, considering I am a new grad and am going to be expected to work on both units. Of course I did not say this to my preceptor, but I did try to discuss it a bit further with her, and she just kind of blew me off and said that as long as the baby doesn't descend into the birth canal, there is really no cause for concern. I disagree on theoretical grounds, based on ACOG recommendations. I was just hoping to hear from some of you "gurus" with experience. Anyone ever have a "sentinel event" in a case where a patient was scheduled for a CS, did not have SROM prior to surgery, and was GBS positive? Also, I would like to hear thoughts on how I should tactfully go about helping to correct what in my mind is an erroneous idea.

I will post a link to the ACOG recommendation momentarily....

[TLSpaz, ASN, RN]

ACOG pamphlet:

http://www.acog.org/publications/patient_education/bp105.cfm

More info here as well:

http://www.groupbstrepinternational.org/info_main.html

http://www.thejessecause.org/pages/gbs_brochure.html

[Isabelle49]

True or False:

GBS status is not really that important for scheduled CS pts.

As neurotic as I am I would say 'False'.

[klone, MSN, RN]

I'm going to say true. I don't know what ACOG's guidelines are, but at our facility, which is really good at EBP, we do not treat for C/S, even if they're ROM.j

I see I was wrong - ACOG apparently does recommend it if she's ROMed?

[TLSpaz, ASN, RN]

There are a couple of things to consider, at least as I see it, based the info I have read:

The first is that the mother herself can get an intrauterine GBS infection. GBS in the lady parts/rectum....usually ok. GBS in the uterus or in the surgical incision, not so much. (Most of our CS pts get Ancef during surgery, so they would be covered.)

The second is that if the mother has SROM prior to CS and is positive, what do you do about the baby's exposure? Giving abx to the mom will not cover the baby being delivered, as it takes about 4 hours for abx to pass from mother to fetus. My preceptor didn't believe me when I said that bacteria can theoretically ascend into the ruptured amniotic sac even if labor is not active and there is little to no cervical change.

[klone, MSN, RN]

We always give Ancef 2gm to all our c/s pts

[NicuGal, MSN, RN]

We treat all of ours too. Babies that mom's have inadequete treatment get at least 48 hours of antibiotics pending blood cultures. I've seen 4 babies die from GBS sepsis...it happens quickly.

[MKS8806]

All our c/s patients get ancef prior to surgery. They also stay 48-72 hours, so we observe the baby during that time as well. Mom's that are lady partsl deliveries, babies are required to stay 48 hours for observation.