Group B streptococcus (GBS)
Dr. Fatimah notes
Writer/Reviser : Alhussain Ali
Writer/Reviser : Hussain Almohammed
Fourth Year
GBS
Group B Streptococcus (GBS) is present in the vagina and the patient
does NOT have any symptoms (Asymptomatic).
So how to know about the GBS if it is positive or negative?
By routine screening (vaginal swab screening test) at 35-37 weeks of
gestation, so we confirm the diagnosis by the culture.
1- The result is negative : DO NOT give GBS prophylaxis antibiotics
2- The result is positive : give GBS prophylaxis antibiotics but
when to give? We give intrapartum أثناء الوالدةbecause there is risk
Cluster Two
of infection to the baby during delivery and we are afraid that GBS goes
from the vagina to the fetus.
3- unknown status of GBS : The result of the culture needs at least 3
weeks so take culture but when the labor happens, we give GBS
prophylaxis antibiotics
and in some cases, there is risk of infection to the baby before delivery, so
we give GBS prophylaxis antibiotics :
1- Preterm premature rupture of membranes (PPROM)
2- Preterm labor
3- Premature rupture of membranes (PROM) (ascending infection)
4- Prolonged premature rupture of membrane (PROM) 18 hours or
longer : Any patient came with PROM we do vaginal examination NOT
speculum examination and it increases the risk of infection, so we give GBS
prophylaxis antibiotics
5- Maternal fever during labor or history of GBS infection in previous
pregnancies and the baby was infected and developed pneumonia,
meningitis or others
GBS prophylaxis antibiotics : Penicillin G or ampicillin
(STDs) in pregnancy are listed in Table 24.1. Infections involving specific
organ systems and not associated with significant risk of fetal infection
(i.e., urinary tract infections) are covered elsewhere (see Chapters 11, 21,
and 22).
TABLE 24.1 SCREENING RECOMMENDATIONS FOR SEXUALLY
TRANSMITTED DISEASES IN PREGNANCY
STI Population to Be Screened
First Prenatal Visit
HIV All women (CDC/College)
Syphilis All women (CDC/College)
Hepatitis B All women (CDC/College)
Hepatitis C High risk (CDC/College)
HSV Inquire about history, no routine screening (CDC/College)
Chlamydia All women (CDC/College)
Gonorrhea High risk (CDC/College)
Third Trimester
HIV High risk or if previously undocumented (CDC/College)
Syphilis High risk (CDC/College)
Chlamydia Women aged 25 years or younger and high risk (CDC/College)
Gonorrhea High risk (CDC/College)
Group B All women at 35–37 weeks of gestation (CDC/College)
Streptococcus
Delivery/Postpartum Stay
HIV High risk or if previously undocumented (CDC/College)
Syphilis High risk or if previously undocumented (CDC)
All women (College)
Hepatitis B High risk or if previously undocumented (CDC/College)
HSV With prior history of genital HSV or new diagnosis in
pregnancy, inquire about symptoms and perform careful
inspection of lower genital tract and perineum before delivery
(College)
Note: State or local laws may supersede these recommendations. College, American College
of Obstetricians and Gynecologists; CDC, Centers for Disease Control and Prevention; HIV,
human immunodeficiency virus; HSV, herpes simplex virus.
GROUP B STREPTOCOCCUS
Group B streptococcus (GBS) (or Streptococcus agalactiae) is an
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important cause of perinatal infections. Asymptomatic lower genital tract
colonization occurs in up to 30% of pregnant women, but cultures may be
positive only intermittently, even in the same patient. Approximately 50%
of infants exposed to the organism in the lower genital tract will become
colonized. For most of these infants, such colonization is of no
consequence, but without preventive treatment, GBS sepsis occurs in
approximately 1.7 infants per 1,000 live births.
There are two manifestations of clinical infection of the newborn,
termed early onset and late onset, occurring at roughly equal frequency.
Early-onset infection manifests as septicemia and septic shock,
pneumonia, or meningitis and occurs during the first week of life. Early-
onset infection is much more common in preterm infants than in term
infants. Late-onset infection occurs later, by definition, in infants older
than 6 days (but has been reported beyond 3 months). GBS disease in
newborns may occur as a result of vertical transmission or nosocomial or
community-acquired infection.
With prevention strategies, current rates of early-onset GBS disease of
the newborn have decreased to approximately 0.24 per 1,000 live births.
Currently, the Centers for Disease Control and Prevention (CDC) and the
American College of Obstetricians and Gynecologists (College)
recommend universal screening for GBS between 35 and 37 weeks of
gestation. All women who are GBS positive by rectovaginal culture should
receive antibiotic prophylaxis in labor or with rupture of membranes.
If a patient’s culture status is unknown, then prophylaxis should be
given if any of the following conditions exists:
• Preterm labor (less than 37 weeks of gestation)
• Preterm premature rupture of membranes (less than 37 weeks of
gestation)
• Rupture of membranes 18 hours or longer
• Maternal fever during labor (at or above 38°C [100.4°F])
Women with GBS bacteriuria during their current pregnancy or women
who have previously given birth to an infant with early-onset GBS disease
also are candidates for intrapartum antibiotic prophylaxis. When culture
results are not available, intrapartum prophylaxis should be offered only
on the basis of the presence of intrapartum risk factors for early-onset GBS
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disease. CDC and the College Guidelines include recommended
medication regimens.
In the mother, significant postpartum fever may indicate postpartum
endometritis; sepsis; and, rarely, meningitis, which may be caused by
infection with GBS. With endometritis, the onset is often sudden and
within 24 hours of delivery. Significant fever and tachycardia are typically
present; sepsis may follow.
HERPES
Herpes simplex virus (HSV) is a double-stranded DNA virus that can be
differentiated into HSV type 1 (HSV-1) and HSV type 2 (HSV-2). HSV-1
is the primary etiologic agent of herpes labialis (fever blisters),
gingivostomatitis, and keratoconjunctivitis. Most genital infections with
HSV are caused by HSV-2, but genital HSV-1 infections are becoming
increasingly common, particularly among adolescent and young women.
Up to 80% of new genital infections among women may be due to HSV-1,
with the highest rates occurring in adolescents and young adults. Herpes
infections are categorized as follows:
• Primary occurs in a woman with no evidence of prior HSV infection
(seronegative to both HSV-1 and HSV-2).
• Nonprimary first episode occurs in a woman with a history of
heterologous infection (e.g., first HSV-2 infection with a prior HSV-1
infection).
• Recurrent disease occurs in a woman with clinical or serologic
evidence of prior genital herpes (of the same serotype).
The primary form poses the greatest risk to the fetus. The fetus/neonate is
infected either from ascending infection following spontaneous rupture of
membranes or from passage through an infected lower genital tract at
delivery. With a primary infection at the time of delivery, the risk of
neonatal infection approaches 50%; it is far lower (less than 1%) with
recurrent infection, because the size of the inoculum is much decreased.
In utero fetal infection can occur, although this is much less common.
Most infants with localized herpes infection ultimately do well; as a rule,
infants with disseminated infection do very poorly.
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Quiz !
Q1) Which screening test is Q2) At what gestational week
recommended for a 30-year- is GBS prophylaxis typically
old woman at 35 weeks of administered?
gestation? A. 36 weeks
A. Oral glucose tolerance test B. 28 weeks
B. Group B Streptococcus (GBS) C. 19 weeks
vaginal swab D. 9 weeks
C. GBS blood test Slides
D. Indirect Coombs test
221 C1 QB
Q3) Which of the following is Q4)Write question here
NOT an indication for GBS A. Choice 1
prophylaxis? B. Choice 2
A. Prolonged rupture of membranes C. Choice 3
(PROM)
D. Choice 4
B. Maternal fever of 39°C
Source
C. Prolonged labor
D. All of the above are indications
Slides
2- A 3- D 4- 1- B
Thank you !