Infectious Diseases - Group B Strep & UTI pregnancy

Question 1

What type of bacteria are streptococci?

Answer 1

Gram +ve
Capsulated, aerobic

Question 2

What is Lancefield grouping based on?

Answer 2

Method of grouping catalase -ve, coagulase -ve bacteria based on carbohydrates composition of bacterial antigens found on the cell walls

Question 3

What types of bacteria is Lancefield Group B? Where is it found? What can it cause in the neonate?

Answer 3

S. algalactiae, isolated from vaginal, perineum and rectim
Neonatal septicaemia and meningitis

Question 4

What is the most common cause of severe neonatal sepsis in 1st 7 days of life?

Answer 4

• Streptococcus Agalactiae

Question 5

Which racial group has highest levels of GBS?

Answer 5

– highest in black African and lowest in South Asian ancestry

Question 6

What is the incidence of Early Onset GBS (EOGBS) disease in the UK?

Answer 6

0.57/1000 births

Question 7

What % of EOGBS where preterm?
What % have a risk factor?

Answer 7

22%

35% had risk factor
(a previous baby affected by GBS disease
GBS bacteriuria
a vaginal swab positive for GBS
maternal temperature of 38°C or greater in labour)

Question 8

Of EOGBS
- What % have disability
- What % fatality

Answer 8

• 7.4%
• 5.2%

Question 9

What % of women with a +ve swab at 35-37 weeks will have a negative swab at delivery?

Answer 9

17-25%

Question 10

What % of women who have a negative swab at 35-37 weeks will have a +ve swab at delivery?

Answer 10

5-7%

Question 11

What are risk factors for GBS?

Answer 11

• Previous GBS baby
• GBS carrier (urine/HVS)
• Preterm birth
• PROM
• Suspected maternal intrapartum infection
• Pyrexia

Question 12

If GBS in previous pregnancy, what % will be carriers for GBS in this pregnancy?

Answer 12

50%

Question 13

Risk of EOGBS, if GBS on swab in this pregnancy?

Answer 13

1 in 400

Question 14

Risk of EOGBS, if GBS on swab in previous pregnancy?

Answer 14

1/700-800

Question 15

If no GBS on swab risk, of EOGBS

Answer 15

1/5000, so if negative can choose to avoid IAP

Question 16

If GBS testing is performed, when should it occur?

Answer 16

3-5 weeks before anticipated delivery dates
Ie 35-37 weeks, or 32-34 weeks in twins

Question 17

If a mother has had a previous baby effected by GBS, what should be offered?

Answer 17

IAP

Question 18

Should AN treatment be offered if GBS on vaginal/rectal swab?

Answer 18

No, AN treatment only required if on urine sample

Question 19

Is method of IOL effected by GBS status?

Answer 19

No, can offer usual IOL and sweeps

Question 20

If women is planned to be delivered by CS and SROMs, what should be offered?

Answer 20

IAP
Cat 2/3 EMCS

Question 21

If term and SROM, and aiming for vaignal delivery, what should be offered?

Answer 21

IAP
Immediate IOL

Question 22

What is risk of EOGBS if maternal temp >38 in labour?

Answer 22

5.3/1000, therefore should be offered IV Abx

Question 23

What antibiotics can be used in labour to previous EOGBS?

Answer 23

IV Ben Pen 3g then 1.5g 4 hourly
if mild allergy use cephalosporin (e.g. cefuroxime 1.5g then 750mg 8 hourlly)
severe allergy vancomycin (1g 12 hourly)

NotE resistant rates of clindamycin 17%

Question 24

What is the risk of EOGBS in preterm infants? What is mortality rate?

Answer 24

2.3/1000
Mortality rates increased 20-30% vs 2-3%

Question 25

Is birth pool contraindicated in GBS carriers

Answer 25

No

Question 26

If PROM and GBS carrier when should IOL be considered from?

Answer 26

34 weeks

Question 27

Parents should be advised to seek urgent medical advice if the baby…

Answer 27

is showing abnormal behaviour (for example, inconsolable crying or listlessness), or
is unusually floppy, or
has developed difficulties with feeding or with tolerating feeds, or
has an abnormal temperature unexplained by environmental factors (lower than 36°C or higher than 38°C), or
has rapid breathing, or
has a change in skin colour

Question 28

If baby is term, had IV Abx from >4 hours pre-delivery, does the baby need extra monitoring?

Answer 28

No

Question 29

Well babies at risk of EOGBS, need to have their vital signs checked at what times?

Answer 29

0,1,2 and then 2 hourly for 12 hours

Question 30

If baby shows signs of EOGBS, what are they treated with?

Answer 30

Penicillin and gent

Question 31

What is untreated upper UTI associated with in pregnancy?

Answer 31

• Low birth weight
• Prematurity
• Preterm labour
• PIH/PET
• Maternal anaemia

Question 32

Risk of pyelonephritis if UTI untreated in pregnancy?

Answer 32

30-50%

Question 33

Most common bacteria to cause UTI/acute pyelonephritis?

Answer 33

E.Coli

Question 34

What % of women found to have incidental UTI in pregnancy?

Answer 34

6%

Question 35

What infections are screened for routinely in pregnancy?

Answer 35

• Asymptomatic bacteria, urine dip at each app
• Hep B
• HIV
• Rubella
• Syphilis

Question 36

What advice is given to avoid toxoplasmosis?

Answer 36

1) washing hands before handling food

2) thoroughly washing all fruit and vegetables, including ready prepared salads, before eating

3) thoroughly cooking raw meats and ready prepared chilled meals

4) wearing gloves and thoroughly washing hands after handling soil and gardening

5) avoiding cat faeces in cat litter or in soil.