GBS+ moms and abx before c/s

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If a pt is a scheduled c/s and is GBS+ (if the test has even been done on her), we usually do not treat her with abx before her surgery. The baby will get stuck in the nursery for a septic workup.

If the pt comes in before her scheduled date and is ruptured, does she then need abx? If she is a repeat c/s, things are happening pretty quickly to get her back there, so would it be more appropriate to get her fluid bolus or one dose of IV abx????

Getting one dose of IV abx on board is only beneficial if it is on board for 4 hours before delivery. Generally, most physicians will do the repeat section on a ruptured pt before four hours has elapsed.

Where I work it depends on the doc. Most don't do a GBS culture on scheduled c/s. If they were tested and GBS+ then a dose of antibiotics should be hung if the patient was ruptured but this is often skipped. I'm not sure of the exact criteria for a baby getting a work up but I believe it has to do with how long the patient was ruptured.

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a repeat c/s prior to labor is planned unless mom wants a VBAC. If she does TOLAC/VBAC, then the GBS protocol is put in place. Otherwise, GBS tx is not done----just one dose of Ancef during surgery to protect mom.

In the case where mom presents w/membranes ruptured or in labor, and is GBS pos, we do treat right away w/IV ABX, even if surgery is imminent (it can take an hour- plus to get everyone together for a non-emergent csection). We then watch those babies closely for any sx of GBS sickness (and I have yet to see it in these kids, touch wood).

There must somehow be some benefit to giving IV ABX even at this late time, to these women, from what it would appear.

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