Group B streptococcal disease guideline

Group B Streptococcal Disease, Early-onset (Green-top Guideline No 36) | The Royal College of Obstetricians and Gynaecologists. 

Group B Streptococcal Disease (GBS) is recognised as the most frequent cause of severe early-onset infection in newborn infants. GBS is present in the bowel flora of 20–40% of adults (colonisation) and those who are colonised are called ‘carriers’. This includes pregnant women. There is variation in practice across the UK regarding the best strategies to prevent EOGBS disease.

In 2015, the incidence of EOGBS in the UK and Ireland was 0.57/1000 births (517 cases), a significant increase from the previous surveillance undertaken in 2000 where an incidence of 0.48/1000 was recorded.

The purpose of this guideline is to provide guidance for obstetricians, midwives and neonatologists on the prevention of early-onset (less than 7 days of age) neonatal group B streptococcal (EOGBS) disease and the information to be provided to women, their partners and families.

Group B Streptococcal Disease, Early-onset (Green-top Guideline No 36)

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Azithromycin Prophylaxis for Cesarean Delivery

Rothaus, C. The New England Journal of Medicine. Published online: September 29th 2016

Cesarean delivery is the most common major surgical procedure and is associated with a rate of surgical-site infection (including endometritis and wound infection) that is 5 to 10 times the rate for vaginal delivery. Tita et al. assessed whether the addition of azithromycin to standard antibiotic prophylaxis before skin incision would reduce the incidence of infection after cesarean section among women who were undergoing nonelective cesarean delivery during labor or after membrane rupture. In this new Original Article involving women who received standard antibiotic prophylaxis for nonelective cesarean section, the risk of infection after surgery was lower with the addition of azithromycin than with placebo.

Clinical Pearl

• How does pregnancy-associated infection rank as a cause of maternal death in the United States?

Globally, pregnancy-associated infection is a major cause of maternal death and is the fourth most common cause in the United States.

Clinical Pearl

• How often do postoperative infections occur after nonelective cesarean delivery?

Despite routine use of antibiotic prophylaxis (commonly, a cephalosporin given before skin incision), infection after cesarean section remains an important concern, particularly among women who undergo nonelective procedures (i.e., unscheduled cesarean section during labor, after membrane rupture, or for maternal or fetal emergencies). As many as 60 to 70% of all cesarean deliveries are nonelective; postoperative infections occur in up to 12% of women undergoing nonelective cesarean delivery with standard preincision prophylaxis.#

Read the full Now@NEJM Blog post here

Read the original research article here

Group B Streptococcus: Compliance with the information in prenatal card records and knowledge of pregnant women.

This study aimed to determine the rate of compliance on prenatal cards and the women’s knowledge and feelings regarding Group B Streptococcus (GBS) screening in a maternity ward in São Paulo City, Brazil. Structured interviews and a review of prenatal card records of 391 women were performed. The GBS screening was not recorded in more than half of prenatal cards (51.4%, n = 201); 169 women reported no knowledge or not remembering the GBS screening.

Reference: Group B Streptococcus: Compliance with the information in prenatal card records and knowledge of pregnant women. de Mello DS, Tsunechiro MA, Mendelski CA, et al Am J Infect Control. 2015 Feb 18.