Re: GBS
From: Charlie Chambers (cchamber@gorge.net)
Sat Aug 13 20:53:02 2005
I think that is a point well taken. I make it quite clear that the
antibiotics reduce the risk significantly but does not eliminate that
risk.
************************************************************************
****
Charlie Chambers
--
Hood River, OR USA
cchamber@alumni.rice.edu
"...not because I regard fishing as being so terribly
important but because I suspect that so many of the other
concerns of men are equally unimportant-and not nearly
so much fun."
John Voelker
************************************************************************
*****
On Aug 13, 2005, at 6:25 PM, splaz@cyllene.uwa.edu.au wrote:
> Quoting Charlie Chambers <cchamber@gorge.net>:
>> I
>> certainly respect patient autonomy but carefully explain that the
>> chance of infection is low, but should a neonate contract GBS, the
>> potential for major morbidity or possibly mortality is quite high. Is
>> that risk worth exerting your will upon one's medical care? If you
>> want
>> to experiment with your own health, then we are all adults and we can
>> accept that responsibility regardless of outcome. But why subject a
>> newborn child with no immune system to a severe GBS infecdtion?
>>
>> I would discuss those issues with your patient with the prior GBS
>> infection who refuses antibiotics. Is that risk worth it to her?
>>
>> Good luck.
>>
> Recently I was called to help with a newborn resuscitation - having
> just
> finished delivering a new baby. This woman had previous baby with GBS.
> Therefore when admitted in labour - she was commenced on iv penicillin.
> Labour progressed nicely with a normal delivery - baby was alive and
> cried immediately. Then it went flat.
>
> I did not know this history when called to help. I suggested immediate
> UV
> cannulation with blood culture and iv penicillin as we continue to
> resuscitate. I was told that is not necessay as mom had been on
> penicillin. We gave the penicillin as I insisted and baby survived.
> Final
> culture results confirmed GBS septicaemia.
>
> The point is - a lot of people (parents to be and the health
> professionals) tend to dismiss the possibility of GBS when:
> 1. there is a negative set of swabs - there is a 20% false negative
> 2. penicillin treatment has been instituted for mom during labour.
>
> SO - I explain to my patients about the ACOG/RACOG guidelines, the
> fallibility of medicine including "evidence based" medicine and the
> fallibility of humans. And I instruct all my patients to remind the
> attending accouchers about possibility of GBS if something should go
> wrong with their newborn.
>
> James Lie
> Albany Australia
>
