Group B Streptococcus (GBS)
What Is GBS?
Group Beta Streptococcus (also called Strep B, GBS) is a type of bacteria commonly found in the lower intestine of normal, healthy adults. Because the bacteria can migrate to the vagina, there is approximately a 10-30% chance that you will have this bacterium present in the vagina. At birth, approximately 40-70% of babies born to GBS-positive clients will pick up this bacterium on their body. Of the babies who pick-up GBS, 1-2% may develop an early onset GBS infection. This means 1.8 out of 1000 babies will get a GBS infection.
What Are The Risks Associated With GBS Infection?
GBS can cause serious infections such as sepsis (blood infections), pneumonia, or meningitis in the newborn. These types of infections in infants are extremely difficult to treat and can be fatal. In the general population, the incidence of early onset infection in the first week of life has decreased to 0.41 per 1000 with the use of antibiotics during labour. For babies who develop an early infection, the death rate is approximately 5-9%. Infected babies are also at a higher risk of developing permanent neurological damage (approximately 40% of those with GBS meningitis).
GBS could cause you to develop a urinary tract infection. As well, GBS has been associated with increased rates of preterm labour and premature rupture of membranes. During pregnancy and/or the postpartum period, there is also an increased risk of uterine infection.
How Do You Screen For GBS?
Screening for GBS is quick and easy. We show you how to do a vaginal/perirectal swab between 35-37 weeks gestation. If you prefer, your midwife can do the swab for you.
What are the Options Regarding Screening and Treatment of GBS?
Screening to find out if you have GBS is your choice, however, research shows that when the guidelines are followed correctly, the same number of people will receive antibiotics regardless of whether or not they screen. To treat GBS, we recommend that you receive IV antibiotics in labour. The antibiotics enter your bloodstream, cross the placenta, and enter the baby’s bloodstream. If the infection is in the baby’s body, these antibiotics help fight the infection.
There are two different approaches for treating GBS with antibiotics. One approach is to treat based on risk factors, and the other is to treat based on a positive swab. Risk factors that would suggest the need for antibiotics in labour include: preterm labour, rupture of membranes >18 hours before the baby is born, GBS found in the urine during pregnancy, a fever during labour, or a previous baby born with GBS infection. Both methods of antibiotic treatment have been demonstrated to decrease the incidence of GBS infection in newborns. However, treating based on swab results, rather than based on risk factors, has been shown to be 50% more effective at decreasing infections for both you and your baby.
If you are known to be GBS positive and your water breaks before labour starts, an induction with oxytocin is recommended. An induction is also recommended if you do not have swab results.
What Are My Risks if I Decline Antibiotics?
How Are Babies Monitored After They Are Born?
If you require antibiotics and receive at least one dose of antibiotics 4 hours before your baby is born, your baby will not need to have routine bloodwork done, but it is strongly recommended that you and your baby stay in the hospital for at least 24 hours. The Canadian Paediatric Society recommends babies that have not received four hours of antibiotics have their blood tested for infection and stay in the hospital for 24-48 hours of observation. If at any time a baby is showing symptoms of an infection or has bloodwork results that indicate an infection, the midwife will consult with the appropriate physician and the baby will most likely be given IV antibiotics and need to be cared for in the Neonatal Intensive Care Unit. Symptoms of an infection include: fever, fast breathing, panting, nasal flaring, skin pulling in over ribs and sternum when inhaling, grunting when exhaling, and lethargy. Infections in newborns can be caused by other organisms, however, the majority of infections in newborns are caused by GBS.
Choice of Birthplace
Community Care Midwives strongly recommends a hospital birth for all clients who are GBS positive to ensure adequate access to emergency services for babies born with GBS disease.
What Are The Risks To Treatment?
For anybody receiving an antibiotic, there is a risk of an allergic reaction. The estimated risk of a serious anaphylactic reaction to penicillin is 4/10 000 to 4/100 000. About 10% of individuals have a less severe allergy to penicillin. For women who have a known penicillin allergy, an alternate antibiotic is given. The widespread use of antibiotics also contributes to the development of antibiotic resistant organisms. Both erythromycin and clindamycin have been shown to have an increased resistance to GBS.
https://www.pregnancyinfo.ca/your-pregnancy/routine-tests/group-b-streptococcus-screening/
