GBS in Pregnancy

Question 1

A 27-year-old Spanish woman G3P2 36 weeks’ gestation is found to be group B strep positive. Discuss her management now and during labour

Answer 1

Impression
GBS positive poses important risks to fetes and neonate, as early GBS infection can cause mortality; pneumonia, septicaemia, meningitis (20% mortality).

Normally, women receive lower vaginal + rectal swab then MCS/PCR test for GBS at 35-37 weeks.

20% of women are GBS carriers. GBS is normal vaginal bacteria, however if untreated can have significant implications for the newborn following NVD.

Goals
- prevent early onset GBS and neonatal infection and subsequent mortality

Question 2

GBS in pregnancy - History

Answer 2

History

• sx of infection: dysuria, polyuria, flank pain, vaginal discharge, fevers, abdominal/pelvic pain
• RISKS for transmission and EOGBS; maternal fever, onset labour <37 wks, known carriage of GBS in current pregnancy
• O&G hx: GTPAL, yellow book, other screening, scans
• PMHx, PSHx
• medications, allergies (penicillin allergies)
• psychosocial Hx

Question 3

GBS in Pregnancy - Examination

Answer 3

Examination

• General appearance + vital signs
• Systems review: evidence of systemic infection
• abdominal examination
• antenatal examination

Question 4

GBS in Pregnancy - Investigations

Answer 4

Investigations
- key/diagnostic: low vaginal + rectal swab sent for MCS (gold standard) +/- PCR, if known penicillin allergy then send for sensitivity testing for clindamycin/erythromycin

• Bedside: routine antenatal
• Bloods: routine antenatal + any additional, TOCh screen

Question 5

GBS in Pregnancy - Management

Answer 5

Management
Key componenets
- MDT care including midwives, O&G
- notably, antepartum prophylaxis shows 67% recurrence of GBS colonisation later in pregnancy
- patient education, counselling regarding risks

Intra-partum

• antibiotic prophylaxis with benzylpenicillin 3g IV + 1.8g IV 4-hourly till delivery, start treatment at the onset of labour
• if chorioamnionitis, then broad spectrum IV ABx until delivery

Post-partum

• monitor 48hrs for signs of sepsis
• septic work-up + LP, treat any infection/meningitis (benzylpenicillin)