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Re: GBS testing for repeat cesareanFrom: Barbara Nicol MD (blnicol@ix.netcom.com)Fri Mar 17 11:04:25 2006
Yeah, but it still might make a difference to the outcome for the baby, right? The goal is to prevent GBS sepsis, not to prevent pediatric intervention. ROM is a known risk factor - why not give the prophylaxis while setting up for the CS? The relevant paragraph from the full version of the CDC guidelines, quoted below, is probably helpful. As I read it, it pretty much tells us to use chemoprophylaxis for labor or ROM, and the last remaining question is whether to wait 4 hours after initiating antibiotics or not. As I say, in our institution, we do not wait, feeling that the risk of infection from other bacteria in the case of ROM, or the risk of uterine rupture with continued labor in a patient who is not a VBAC candidate, outweigh the benefit of waiting a full 4 hours. - Barb (CDC quote follows) Planned Cesarean Delivery Because GBS can cross intact amniotic membranes, a cesarean delivery does not prevent mother-to-child transmission of GBS. Moreover, because cesarean delivery itself is associated with health risks for mother and newborn, GBS colonization of the mother is not an indication for cesarean delivery, and cesarean delivery should not be used as an alternative to intrapartum antibiotic prophylaxis for GBS prevention. However, although a risk does exist for transmission of GBS from a colonized mother to her infant during a planned cesarean delivery performed before onset of labor in a woman with intact amniotic membranes, it is extremely low, based on a retrospective study at a single hospital (99) and a review of CDC active, population-based surveillance data from the 1990s. Thus, in this specific circumstance, in which the risk for disease is extremely low, the individual risks to a mother and her infant from receiving intrapartum antibiotic prophylaxis may balance or outweigh the benefits. Intrapartum antibiotic prophylaxis to prevent perinatal GBS disease is, therefore, not recommended as a routine practice for women undergoing planned cesarean deliveries in the absence of labor or amniotic membrane rupture, regardless of the GBS colonization status of the mother. Patients expected to undergo planned cesarean deliveries should nonetheless still undergo routine vaginal and rectal screening for GBS at 35--37 weeks because onset of labor or rupture of membranes may occur before the planned cesarean delivery. In rare situations in which patients or providers opt for intrapartum prophylaxis before planned cesarean deliveries, administration of antibiotics at the time of incision rather than at least 4 hours before delivery may be reasonable (100). - Barb
At Fri, 17 Mar 2006, ainsron wrote:
>
-- Barbara Nicol MD St. Luke's Health Care Center San Francisco CA USA
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