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Labour & Delivery Prevention Guidelines for Neonatal Early Onset Group B Streptococcal Disease (EOGBSD) in Babies

 
Negative sensitive¹ (Enriched Culture Medium) test within five weeks of delivery
Negative standard test AND no sensitive1 ECM test result within five weeks of delivery
Any test result positive for GBS during the current pregnancy
Any test result positive for GBS BEFORE the current pregnancy
No risk factors for GBS infection in the baby No IV antibiotics in labour indicated against EOGBSD No IV antibiotics in labour indicated against EOGBSD Offer IV antibiotics in labour against EOGBSD No IV antibiotics in labour indicated against EOGBSD
Caesarean sections: without signs of labour or membrane rupture No IV antibiotics in labour indicated against EOGBSD
after labour has started or membrane rupture Offer IV antibiotics in labour against
EOGBSD

ONE of:

  • Preterm labour or membrane rupture (<37 weeks of pregnancy)
  • Prolonged rupture of membranes (> = 18 hours before delivery)
  • Maternal pyrexia during labour* (37.8°C or higher).

*In the presence of an epidural, a slightly raised temperature may be of less significance than in women without.

 Offer IV antibiotics in labour against EOGBSD Strongly recommend IV antibiotics in labour against EOGBSD Offer IV antibiotics in labour against EOGBSD

TWO OR MORE of:

  • Preterm labour or membrane rupture (<37 weeks of pregnancy)
  • Prolonged rupture of membranes (> = 18 hours before delivery)
  • Maternal pyrexia during labour* (37.8°C or higher).

*In the presence of an epidural, a slightly raised temperature
may be of less significance than in women without.

 Strongly recommend IV antibiotics in labour against EOGBSD Strongly recommend IV antibiotics in labour against EOGBSD
Previous baby with GBS infection Offer IV antibiotics
in labour against
EOGBSD
 
Recommended Intrapartum antibiotics 3g (or 5MU) Penicillin G intravenously initially, then 1.5g (2.5MU) at 4-hourly intervals until delivery. For penicillin-allergic women, 900mg clindamycin intravenously every eight hours until delivery. IV antibiotics should be given for at least 4 hours before delivery where possible, though lesser times have proven beneficial. *If chorionamnionitis is diagnosed or suspected or where there is preterm prolonged rupture of membranes, broad spectrum intravenous antibiotics which include adequate GBS cover should be given. A full history must be taken before administering the antibiotics to establish whether the pregnant woman has an allergy to penicillin or any other antibiotic.
After delivery – mother received LESS THAN 4 hours of intravenous antibiotics before delivery The baby should be examined thoroughly and investigated by a paediatrician as appropriate and started on intravenous antibiotics until it is known that the baby is not infected, unless the baby is completely well as determined following a robust baby examination carried out by a trained individual.
After delivery – mother received 4 OR MORE hours of intravenous antibiotics before delivery paediatrician should carefully assess the baby – if completely healthy, no antibiotics are required for the baby. A period of monitoring (12–24 hours) may be appropriate for those at highest risk of infection.

Sensitive¹ – Sensitive tests for detecting GBS colonisation using enriched culture media (ECM) to culture swabs taken from the lower vagina and rectum, recognised as optimal for detecting GBS carriage late in pregnancy by the RCOG and the HPA but which are not routinely or widely available in the NHS, although they are available privately. The standard HVS test is NOT sufficiently sensitive – it gives a falsely negative result to up to half of GBS carriers (though a positive result is highly reliable).

References
Law MR, Palomaki G, Alfirevic Z et al. The prevention of neonatal group B streptococcal disease. J Med Screening 2005;12:60–8. Heath PT, Balfour G, Weisneer AM et al. Group B streptococcal disease in UK and Irish infants younger than 90 days. Lancet 2004;363:292–4. RCOG Clinical Green Top Guidelines. Prevention of early onset neonatal group B streptococcal disease [36] November 2003. www.rcog.org.uk/resources/public/pdf/groupb_strep_no36.pdf. Centers for Disease Control & Prevention. Prevention of perinatal group B streptococcal disase: Revised guidelines from CDC. MMWR August 2002;51(RR11):1–22 www.cdc.gov/mmwr/preview/mmwrhtml/rr5111a1.htm. Yancey MK, Schuchat A, Brown LK et al. The accuracy of late antenatal screening cultures in predicting genital GBs colonization at delivery. Obstet Gynecol 1996;88:811–5. Benitz WE, Gould JB, Druzin ML. Risk factors for early-onset group B streptococcal sepsis: estimation of odds ratios by critical literature review. Pediatrics. 1999 Jun;103(6):e77. Oddie S, Embleton N. Risk factors for early onset neonatal group B streptococcal sepsis: case-control study. BMJ 2002; 325: 308.

Group B Strep Support is a national charity providing accurate and up-to-date information on GBS for families and health professionals.

GBSS wants to see sensitive GBS testing available to all pregnant women on the NHS. Until it is, GBSS supports the Royal College of Obstetricians and Gynaecologists’ national guidelines to identify women and babies at risk of GBS infection through identification of risk factors.

All leaflets are downloadable from the website.

Group B Strep Support has no financial links with any laboratory.

More information about GBS, including copies of this poster, can be found on the Group B Strep Support (GBSS) website www.gbss.org.uk and easily downloaded, or contact:

Group B Strep Support, PO Box 203,
Haywards Heath, West Sussex RH16 1GF
E-mail: info@gbss.org.uk
Tel: 01444 416176
Fax: 0870 803 0024 (calls charged at national rates)
www.gbss.org.uk
Registered charity number: 1112065
Registered company number: 5587535