GBBS to treat or not to treat

NPinWCH · Mar 28, 2011

The OBs I worked with usually retested at 35-36 weeks and then based treatment on those results. If no results from that time period were available then treatment was done as if GBS status was unknown.

tablefor9, RN · Mar 28, 2011

GBS has to be between 35-37 weeks gestation, or a rapid GBS obtained at onset of labor, in my neck of the woods.

Otherwise, we treat prophyactically.

klone, MSN, RN · Mar 28, 2011

We do not treat prophylactically. If a pt is GBS unknown, we do not treat with abx (assuming she's term). I believe that's current evidence-based practice to not treat GBS unknown without the presence of risk factors.

Elvish, BSN, DNP, RN, NP · Mar 29, 2011

The only reason we'd do a GBS on a mom that early is if there were a threatened preterm delivery. If negative, we'd probably retest at 36ish if she's still undelivered. If she comes back +, we'd probably go ahead and treat during labor, whether it occurred at term or before. And if she were a private pt, our private docs would probably treat her in subsequent labors too. I've seen plenty of women with a hx of +GBS be negative with in later pregnancies but that's their current protocol.

Honestly, though, I can't remember any scenario at my place that mirrors yours. If we have someone come in at term with unknown GBS, we don't treat. Preterm, the scenario changes a bit and it depends as much on who the doc is as anything whether they choose to treat.

I just attended a webinar on neonatal sepsis and the statistic the presenting neonatologist quoted was that somewhere around 80% of neonatal GBS sepsis cases are from infants whose mothers tested negative. So in the OP scenario it may not be a 'false negative' as much as a later conversion to positive.

verock · Mar 29, 2011

Thanks for the feedback!

Hushi05 · Mar 29, 2011

http://www.cdc.gov/groupbstrep/guidelines/downloads/indications.pdf

Elvish, BSN, DNP, RN, NP · Mar 29, 2011

I don't know if it is still this way, but a Canadian nurse friend of mine told me that moms who were +GBS did not get treated; rather, they just watched the babies for sepsis. I find that interesting, because for all we know our term unknown GBS moms here are positive as well, and all we do is watch babies x 48hrs, no blood cultures.

Hopefully someone who works in Canada can clarify this for me.

My fear is that we treat people so often - and believe me, I understand why -that we are going to eventually end up with GBS that isn't susceptible to any of the current recommended treatment modalities.

tablefor9, RN · Mar 30, 2011

Yep, klone, you're right. But, the wheels of change move slowly in OB units in the Deep South...we've only changed from NPO x ICE to clears in labor this last year, in this particular hospital.

We battle on.

klone, MSN, RN · Mar 30, 2011

Yep, klone, you're right. But, the wheels of change move slowly in OB units in the Deep South...we've only changed from NPO x ICE to clears in labor this last year, in this particular hospital.
We battle on.

Oh, I hear you. Prior to my current job, I worked at a small community hospital with a very strong "Good Ole' Boy" network. The OBs were very old-school and did things their way because that's the way they were taught. Now I work at a very progressive place and there's NO WAY I could ever go back. I would probably get fired for constantly questioning the doctors and pi$$ing them off.

tablefor9, RN · Mar 31, 2011

You wouldn't believe the amount of Cochrane Review material I've left lying out in the doc lounge, on the labor desk...copies of recent journal articles...

and I've never been one to keep silent... :cool:

I may get a lot of blank stares, but not fired, yet.