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Re: Group B Strep in pregnancy

From: Harvey S. Marchbein, M.D. (anonymous@obgyn.net)
Sun, 14 Nov 1999 10:21:11 -0600 (CST)

At Fri, 12 Nov 1999, Nikki wrote: >
>I cannot believe that it is not standard practice for the OB/GYN to test
>for GBS before term. When is it going to become mandatory to test for
>this? My doc does it routinely at 36 weeks to prevent just such an
>occurrence. I was GBS positive and had PROM, just a slow trickle -
>thank God I noticed it. I had just found out I was GBS positive a half
>hour before I started trickling. I called the doctor back and was put
>in the hospital on IV penicillin for 5 days before the bag ruptured
>completely and I went into labor.
>
>Anyway, thank God my doc tested for GBS so early or I might have had a
>similar experience. I shudder to think of my baby exposed to GBS for
>those 5 days in the womb after the bag ruptured but before labor. I
>guess that's why PROM is the worst thing that can happen with GBS.
>
>I am not a doctor, but I would think that oral antibiotics prior to your
>scheduled date would be a safe route to take, in addition to the IV
>antibiotics before surgery.

We went over this on the forum before so this is the short version.

There are 3 sets of recommmendations: 1)American Academy of Pediatrics - cult GBS 24-28 weeks pro- find a lot of GBS (appproximately 25% of women would have to be treated); con- treat a lot of GBS that would not appear at term and cause a lot of resistant strains which will kill more babies than GBS does now, doesn't guarantee no GBS at delivery just because it was treated once.

2)CDC - cult at 35-37 weeks pro - find GBS prior to labor in some con - doesn't help patients delivering before 35 weeks or before results back, doesn't guarantee no GBS at delivery just because it was treated once.

3)American College of Obstetrics and Gynecology - treat high risk population - 1)preterm labor; 2)premature rupture of membranes; 3)known past GBS(+) regardless of when; 4)rupture of membranes longer than 18 hours; 5)temperature elevation in labor;

These 5 criteria have worked better than the recommendations above from the AAP and CDC, saving more babies and injuring less with unnecessary antibiotic therapy that can, as noted above, cause resistant strains that can kill more babies than are now even affected by GBS.

Hope this answers your questions. 

--
Harvey S. Marchbein, M.D. FACOG, FACS
Great Neck, New York


**Note:  Opinions expressed here are for educational purposes only
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