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Re: OB: GBS and CesareanFrom: ainsron@msn.comSun Jan 14 08:46:44 2001
At Fri, 12 Jan 2001, Geffrey Klein, MD wrote: > >we have a meeting next week to discuss the issue a GBS carriage and >planned cesarean deliveries. > >There is a push from the pediatricians to have us provide prophylaxis >for GBS carriers prior to cesarean. My reading of the literature >leads me to conclude that this is not necessary, however, if it will >spare the kid blood cultures, a CBC, and an LP, then I am willing to >give a single dose of pen G before the section. > >The problem is that the pediatricians don't consider the baby to have >been adequately prophylaxed unless they have gotten a second dose 4 >hours after the first. So, for a repeat cesarean scheduled for 0730, >I will now have to bring the patient in the night before for >antibiotics. Am I missing some science here, or should I fight the >pediatricians as planned? > >-- >_______________________ >Geffrey H. Klein, MD >_______________________ Fight with them! I've had the same discussion with our pediatricians and it is simply too problematic to bring patients in that early for scheduled cesareans unless you do them all in the afternoon. I agree that it is not mentioned in the CDC guidelines. I did read one review by Gibbs, I think, in contemporary OB/Gyn who thinks it should be done, but no evidence as to why. I've discussed this with the perinatologists at the tertiary center we use and they also agree that it is a futile waste of resources. There may be a small percent of GBS positive patients who develop a neonatal infection with intact membranes, but I would suspect that it is quite small. I would bet that most neonates delivered by cesarean section who develop GBS are community acquired.
-- Ronald E. Ainsworth, MD
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