CBL 6_GBS screening and prophylaxis_prepping for birth

Question 1

How do you store GBS swab?

Answer 1

4 degrees Celsius
Processed within 24 hours of collection.

Question 2

What does CBC look for?

Answer 2

Broadly: hemoglobin, mean corpuscular volume, and platelets and some other biz

Question 3

When do we repeat anemia screening?

Answer 3

28 weeks

Question 4

Why do we repeat anemia screening?

Answer 4

Hemodilution of the blood; screening for risk of tolerance to hemorrhage

Question 5

Lab value hemoglobin first/third trimester?

Answer 5

<110 g/L

Question 6

Lab value hemoglobin second trimester?

Answer 6

<105 g/L

Question 7

Lab value ferratin diagnostic of iron deficiency in first trimester?

Answer 7

<15 µg/L

Question 8

How common is anemia in pregnancy in Canada?

Answer 8

30 %

Question 8

Lab value indicative of probable iron deficiency (begin mgmt. with oral supplementation)?

Answer 8

<30 µg/L

Question 9

What are the risk of anemia in pregnancy? (7)

Answer 9

Preterm birth
Low birth weight
Placental abruption
Pre-eclampsia
PPH
Transfusion
Depression

Question 10

How does WHO define anemia?

Answer 10

Hb < 110 in 1st trimester
Hb < 105 in 2nd trimester (due to hemodilution)
Postpartum HB < 100

Question 11

What is the oral supplementation recommendation for anemia?

Answer 11

a standard therapeutic dose of 100 mg elemental iron per day

Question 12

What is the calculating dose to administer IV iron?

Answer 12

Iron needs (mg iron) = body weight (kg) * (target Hb – actual Hb) * 2.4 + depot iron need (mg iron)

Question 13

Labs recommended 0-14 weeks? 11

Answer 13

Blood group and antibody screen
CBC – hematology profile
Ferratin
TSH *risk factors but not really
HIV
Syphilis
Hep B
Hep C *risk factors
Rubella antibody titre *if first preg
Chlamydia/Gonorrhea
Urine C&S (UTI)

Question 14

Labs recommended 24-28 weeks?

Answer 14

Repeat antibody screen in Rh negative clients
Gestational diabetes screen
CBC and ferritin at 28 weeks

Question 15

Labs recommended 35-37 weeks?

Answer 15

Group B strep Screen

Question 16

When RhoGam administered?

Answer 16

28 weeks

Question 17

When use Edinburgh perinatal/postpartum depression scale?

Answer 17

In between 28-32 weeks prenatally
6-8 weeks pp

(anytime is valid)

Question 18

Do we use EPDS universally?

Answer 18

Yes

Question 19

Scoring breakdown of EPDS?

Answer 19

Less than 8 – depression not likely
9-11 – depression possible
12-13 – fairly high possibility of depression
14 and higher - probable depression
Positive score on question 10 – suicidality risk

Question 20

What are the 4 principles of TIC approach?

Answer 20

Having trauma awareness
Establishing safety and trustworthiness
Ensuring choice, collaboration, connection
Building on strengths

Question 21

What is GBS?

Answer 21

Group B streptococcus – bacteria found in gut, vagina, anus
Not an STI, not a sign of cleanliness
Transient bacteria

Question 22

What is the incidence of GBS in pregnancy ?

Answer 22

1.5-4/10 – very common

Question 23

What is the incidence of GBS infection for baby?

Answer 23

2.3/10 000 (rare)0.2 %

Question 24

What is the incidence of a baby dying from EOGGBDS?

Answer 24

1.15/100 000 (very rare) 0.001 percent

Question 25

Community standard managing positive GBS swab?

Answer 25

IV admin of prophalytic antibiotics every 4 hours till birth of bb starting when membranes rupture or during active labour (whatever comes first)

Question 26

Who does SOGC recommend Abx to for GBS? (3)

Answer 26

* any woman positive for group B streptococcus by vaginal/rectal swab culture screening done at 35 to 37 weeks’ gestation (II-2B); * any woman with an infant previously infected with group B streptococcus (II-3B); * any woman with documented group B streptococcus bacteriuria (regardless of level of colony-forming units) in the current pregnancy. (II-2A)

Question 27

Chances of EOGBDS following community standard?

Answer 27

3/1000

Question 28

Chances of death from EOGBSD following community standard?

Answer 28

3/10,000

Question 29

Chances of EOGBDS following risk factor approach?

Answer 29

5/1000

Question 30

Chances of death following risk factor approach?

Answer 30

5/10,000

Question 31

Chances of EOGBDS taking no abx?

Answer 31

10/1000

Question 32

Chance of death taking no abx?

Answer 32

10/10,000

Question 33

Risk factor approach to GBS positive? (4)

Answer 33

Taking abx: ROM more than 18 hours Preterm labour Previous child with GBS disease Fever above 38 degrees

Question 34

Signs of newborn with EOGBSD? (5)

Answer 34

Fever Lethargic Poor feeding Central cyanosis Stop breathing

Question 35

When are fetal movements typically felt?

Answer 35

Usually by 20-22 weeks

Question 36

How many fetal movements should a pregnant person feel at the end of pregnancy?

Answer 36

Six movements within 2 hours

Question 37

What’s maternal colonization rate of GBS (comp. mid)?

Answer 37

10-35 %

Question 38

Colonization rate of GBS among newborns who are colonized and not treated (comp mid)?

Answer 38

50 %

Question 39

Rate of early onset GBS disease among colonized newborns (comp mid)?

Answer 39

1-2 %

Question 40

Average risk of any baby in the population having early onset disease (comp mid)?

Answer 40

0.2 %

Question 41

How much does screening and abx reduce the rates of EOGBSD? (comp mid)?

Answer 41

65-85%

Question 42

How much does risk factor mgmt. of GBS reduce the rates of EOGBDS ((comp mid)?

Answer 42

51-75%

Question 43

When does EOGBSD happen?

Answer 43

1-7 days

Question 44

When does late onset GBS disease happen?

Answer 44

7-31 days

Question 45

When do we start measuring fundal height?

Answer 45

12 weeks

Question 46

What is the most accurate way to see if SFH is normal?

Answer 46

Plotting on curve