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Re: GBS testing for repeat cesareanFrom: kaycnm@aol.comFri Mar 17 11:48:33 2006
-----Original Message----- From: Barbara Nicol MD <blnicol@ix.netcom.com> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> Sent: Fri, 17 Mar 2006 12:05:27 -0600 Subject: Re: GBS testing for repeat cesarean 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 I thought this was an interesting write-up. GBS Facts The study used by the CDC to establish the four hour guideline is De Cueto M, Sanchez MJ, Sampedro A, Miranda JA, Herruzo AJ, Rosa-FraileM. Timing of intrapartum ampicillin and prevention of vertical transmission of group b streptococcus. Obstet Gynecol 1998;91(1):112-14The authors gave women positive for GBS antibiotics and timed the dose to delivery intervals and then compared these times to colonization in the newborns.1. If antibiotics were given less than one hour before birth, 46% of the newborns were colonized with GBS2. If antibiotics were given between 1-2hours before birth, 29% of the newborns were colonized3. If antibiotics were given between 2-4 hours before birth, 2.9% of the newborns were colonized 4. If antibiotics were given more than 4 hours before birth, 1.2% of the newborns still were colonized. If your goal is to decrease colonization, giving the antibiotics anytime before birth is helpful because they work fast and cross the placenta fast If your goal is to assure your patient that she has only a 1% chance of passing colonization on to her newborn?..then you need at least 4 hours of antibiotic coverage before birth. GBS is kind of a numbers game... Approximately 1-2 newborns in every 100 who are colonized will get sepsis and it is a very bad sepsis...somewhere between a 2-6% mortality rate. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Kay Johnson, CNMDuluth, GA~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~"Life is too important to be taken seriously."Oscar Wilde~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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