2. Streptococcus agalactiae
Gram positive, beta hemolytic bacteria
Colonisation
Asymptomatic and intermittent
Intestinal (<30% of adults)
Vaginal (<25% of women)
Infection
Newborn babies
Adults: the elderly, pregnant/postpartum women, others
with underlying disease s
3. “Early onset” 0-6 days (~75% cases)
90% show within 12 hours
Usually septicaemia and pneumonia
11% mortality, 7% morbidity
90% preventable IV Penicillin
“Late onset” 7-90 days (~25% cases)
Usually meningitis and septicaemia
8% mortality, 21% morbidity (up to 50% with meningitis)
No current prevention: good hygiene/education
Vaccine: future hope for both late & early onset
4. Source: Heath PT, Balfour G, Weisner AM, Efstratiou A, Lamagni TL,Tighe H et al. Group B
streptococcal disease in UK and Irish infants younger than 90 days. Lancet 2004;
363(9405):292-294.
5. Photo courtesy of Dr. Carol Baker
Baylor College of Medicine, Houston,TX
6.
7. US guidelines
all women colonised with GBS at 35–37 weeks of
gestation should be offered IAP(intrapartum antibiotic
prophylaxis
8. 10% - 30% of women
Higher proportion in African Americans and
nonsmokers
GBS usually live in gastrointestinal tract but can spread
to the genital tract
No symptoms or signs on examination
Colonization comes and goes over months
Not a sexually transmitted infectio
9. Previous Invasive GBS baby 10 x
GBS bacteriuria current pregnancy 4 x
GBS found current pregnancy 3 x
Maternal intrapartum fever (>380C) 3 x
PROM >18 hours before birth 3 x
Preterm labour 3 x
10. Not recommended
Routine bacteriological screening of all
pregnant women for antenatal GBS carriage
▪ cost-effective
Antenatal treatment IAP is before the onset of
labour.
screening for GBS or the administration of IAP
to women in whom GBS carriage was detected
in a previous pregnancy
11. IAP to women with GBS bacteriuria during the
current pregnancy
higher risk of chorioamnionitis and neonatal disease
urinary tract infection (growth of greater than 105
cfu/ml) during pregnancy
IAP should be offered if GBS is detected on a vaginal
swab in the current pregnancy.
If GBS is present in a vaginal swab, it is likely that the
risk of neonatal disease is increased(risk 2.3/1000)
12. Antibiotic prophylaxis specific for GBS is not required for
women undergoing planned caesarean section in the
absence of labour and with intact membranes.
Immediate induction of labour and IAP should be offered
to all women with prelabour rupture of membranes at
37+0 weeks of gestation or more.
13. If chorioamnionitis is suspected, broad-spectrum
antibiotic therapy including an agent active
against GBS should replace GBS-specific IAP and
induction of labour should be considered
14. • Intramuscular antibiotics pre-labour
• May eradicate GBS colonisation for up to 6 weeks
• Small studies & no GBS infection in control or treated
group
• Vaginal flushing with Chlorhexidine
• No evidence it reduces EOGBS infection
• Oral Antibiotics
• No evidence it reduces EOGBS infection (treats GBS
UTI)
15. In preterm labour with intact membranes with no
other risk factors for GBS should not routinely be
offered IAP unless they are known to be colonised
with GBS
risk of EOGBS infection is higher in preterm than
in term infants
ORACLE trial
16. IAP should be offered to women who are
pyrexial in labour (>38 C). should be offered
broad-spectrum antibiotics including an
antibiotic for prevention of neonatal EOGBS
disease
IAP for women with term prelabour rupture
of membranes is unclear and NICE
recommends that it is not given, unless there
are other risk factors
at term should be offered immediate induction of
labour or induction after 24 hours
17. IAP should be offered to women with a
previous baby with neonatal GBS
disease(neonatal sepsis)
Subsequent infants born to these women are
likely to be at increased risk of GBS disease
18. IAP, benzylpenicillin should be administered
as soon as possible after the onset of labour
and given regularly until delivery.
Clindamycin should be administered to those
women allergic to benzylpenicillin
as soon as possible after the onset of labour
the efficacy of IAP, the first dose should be given at
least 2 hours prior to delivery
minimum inhibitory concentration for GBS as early as
1 hour after maternal administration
Oral antibiotics for IAP are not recommended
19. no evidence that intrapartum vaginal
cleansing will reduce the risk of neonatal
GBS disease
20. Universal screening of pregnant women for GBS at 35-37 weeks
gestational age(only in US)
Intrapartum antibiotic prophylaxis for:
GBS positive screening test
GBS colonization status unknown with
Delivery <37 weeks
Temperature during labor >100.4˚ F (>38.0˚ C)
Rupture of membranes >18 hours
Previous infant with GBS disease
GBS in the mother’s urine during current pregnancy
Penicillin preferred drug for IAP
Ampicillin acceptable alternative
Cefazolin preferred for penicillin-allergic at low risk of
anaphylaxis
21. Colonization with GBS during a previous pregnancy
•
GBS bacteriuria during a previous pregnancy
•
Negative vaginal and rectal GBS screening test during the
current pregnancy
•
Cesarean delivery performed before labor onset on a woman
with intact amniotic membranes
•
•
22. In a UK study of invasive GBS disease,
89% of early-onset cases were identified on day 1.
Most cases (65–67%) have one or more risk factors
prior to or during labour.
A significant number will also have had signs of fetal
distress, an emergency delivery and low Apgar scores.
The majority of early-onset cases in these studies
presented with
▪ sepsis (79.4%),
▪ 11.8% had meningitis,
▪ 7.8% had pneumonia and
▪ 1% focal infection
23. Well infants at risk of EOGBS should be
observed for the first 12–24 hours after birth
with regular assessments of general
wellbeing, feeding, heart rate, respiratory rate
and temperature
great majority of infants (89–94%) who develop
EOGBS infection develop signs within the first 24
hours after birth
the majority of such infants (65–67%) will have had
one or more ‘conventional’ risk factors evident in or
before labour.
24. Postnatal antibiotic prophylaxis is not recommended
for asymptomatic term infants without known
antenatal risk factors.
Infants with clinical signs of EOGBS should be
treated promptly with appropriate antibiotics
25. For a well infant whose mother has had a previous
infant with GBS disease, either clinical evaluation
after birth and observation for around 24 hours
are necessary, or blood cultures need to be
obtained and the infant treated with
benzylpenicillin until the culture results are
available.
26. It is not necessary to perform routine surface
cultures or blood cultures on well infants
no evidence to discourage breastfeeding
27. • grunting;
• lethargy;
• irritability;
• poor feeding;
• very high or low heart rate;
• low blood pressure;
• low blood sugar;
• abnormal (high or low) temperature; and
• abnormal (fast or slow) breathing rates with
blueness of the skin due to lack of oxygen
(cyanosis).
28. Typical signs of late onset
GBS infection
• fever;
• poor feeding and/or vomiting;
• impaired consciousness;
• fever, which may include the hands and
feet feeling cold, and/or diarrhoea;
• refusing feeds or vomiting;
• shrill or moaning cry or whimpering;
• dislike of being handled, fretful;
• tense or bulging fontanelle (soft spot on
the head);
29. • involuntary body stiffening or jerking
movements;
• floppy body;
• blank, staring or trance-like expression;
• abnormally drowsy, difficult to wake or
withdrawn;
• altered breathing patterns;
• turns away from bright lights; and
• pale and/or blotchy skin.
34. 25/g4p3 @ 39/52 ANC 1.Hx of neonatal sepsis
in previous pregnancy secondary to GBS
But current pregnancy no HVS taken
Pt came with c/o contraction pain,LL @
28/7/2013 FM good
DOA 29/7/2013
Ve os 2 cm cx 2cm st -12 MI clear liquor seen
vx no cord no placent
UR mx??
35. 27 g2p1 @ 38/52 (SOD)scan correspond to
date(correspond to edd)
unbooked unscreened
c/o contraction pain.LL @ 25/4/2013 @
0640am,FM good
DOA 25/4/2013 1200am
Ve os 4 cm cx 0.5 cm st -1 MI clear liquor
seen.vx
Ur Mx?
36. 27 g1p0 @ 28 week clo contraction pain and
LL @25/6/2013 0800am, FM good,diagnosis
PPROM.DOA:26/6/2013
Ve os 1 cm cx 2 cm st -2 MI clear liquor seen
Contraction 2;10
Ur management?
37. CDC -Overview of CDC Prevention
Guidelines, 2010
▪ National Center for Immunization and Respiratory
Diseases
Division of Bacterial Diseases
Green top guideline no 36
Prevention of early neonatal group B
streptococcus
http://www.gbss.org.uk/epetitio