curious about Group B strep and giving antibiotics

4jen · Aug 19, 2007

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 · Aug 19, 2007

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......

allnurses Guide · Aug 20, 2007

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, BSN · Aug 20, 2007

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 · Aug 20, 2007

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, CNM · Aug 20, 2007

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, BSN · Aug 20, 2007

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, BSN, DNP, RN, NP · Aug 20, 2007

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, CNM · Aug 21, 2007

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 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.

allnurses Guide · Aug 21, 2007

I've been reading "Pushed" by Jennifer Block, which is about "overusing medical technology at the expense of maternal and infant health".

She mentions Group B Strep in relation to the push for cesareans. . . .

"There's new worry over Group B streptococcus (a bacterium commonly found in the lady parts) causing infection in the baby - a 0.01% chance. Though screening for such conditions results in more false-positives than accurate diagnoses -and in unnecessary intervention - all women are tested. Obstetrician-gynecologists order more diagnostics than any other medical specialty. "The focus is no longer on birth as a normal life process, but an accident waiting to happen," says Maureen Corry of the Childbirth Connection. Women are so worried, in fact, that there's a new psychiatric diagnosis: tokophobia, the fear of giving birth.""

It is an interesting book . ... as a mom of 4 kids (3 vag/1 cesarean deliveries) and as an OB nurse I've had many of the same thoughts.

steph

Jolie, BSN · Aug 21, 2007

I've been reading "Pushed" by Jennifer Block, which is about "overusing medical technology at the expense of maternal and infant health".
She mentions Group B Strep in relation to the push for cesareans. . . .
"There's new worry over Group B streptococcus (a bacterium commonly found in the lady parts) causing infection in the baby - a 0.01% chance. Though screening for such conditions results in more false-positives than accurate diagnoses -and in unnecessary intervention - all women are tested.
steph

I understand your point, and don't disagree with it, but also vividly recall the deaths of 2 babies, one of whom was a full-term, lady partsl delivery with no known risk factors (PROM, maternal temp, etc.) The infant's grandfather was an OB in another area of the country, and threatened to get physical with the OB who delivered his daughter's baby, accusing him of negligent care for NOT screening her or treating for beta-strep. Of course, it wasn't protocol back then, and when asked, he admitted that he didn't screen or treat his patients either.

A large portion of this equation is legal liability. If an OB doesn't treat a strep (+) mother, s/he has no defense in the event of newborn illness. I don't think the lawyers have found a way (yet) to blame individual doctors for antibiotic resistance, even though that probably threatens more patients.