group b strep

[Leanna]

Surprisingly I tested positive for group b strep. I didn't have it when I was pregnant with David. Anyway they didn't really give me any details except "its no big deal and normal" and so can someone tell me what this means for pregnancy, and labor and delivery? Do they give you a shot while in labor or some kind of antibiotic? Is there a way to do it without giving me an IV? The IV hurt last time, and I was sore after they took it out for a while. I don't want one. My plan has been to labor at home until its pretty intense (close to time), should I no longer do that?

 

[RoseofLima]

Do you mean they tested you right NOW for group B strep??

If you are at term and test group B+...they will want to give you either one, preferably two course of antibiotics several hours apart.

You of course are free to refuse those antibiotics.

I don't test for group B strep and I'll share with you why I make that choice. Most women have group B strep exposure, it is not at all an aout of the ordinary kind of occurance. The other huge issue I have is that normally the test is given at 36 weeks- there is no way to know if the majority of women are GBS+ at birth or not---there is a four week inrterim!!! That is huge-even two weeks is huge.

I have also decided that I feel comfortable accepting the risks of GBS. I have decided that although baby's with this who develop complications can have a really hard time...that the statistical chnace is so minimal, that I feel at ease accepting those odds.

 

[Naomi4Christ]

There are two approaches approved by the ACOG. One is to test all women at 36 weeks and actively manage any GBS in labour - typical high dose IV antibiotics.

The other is to expectantly manage it. No testing at 36 weeks. GBS is a problem in premature babies (<37 weeks) with a long duration of ruptured membranes. Identify those infants and watch for signs of GBS and give anti-biotics as required (prophylactic antibiotics are also OK in these situations).

GBS testing is not routine in the UK, so I first encountered it when I was pregnant in the US. Given my obstetric history - 4 babies all born at 40 weeks, spontaneous onset of labour, quick first stage with SROM at full dilation, followed by short second stages - the risk of GBS was very low. Add to that that I am allergic to penicillin (the ab of choice), there was little need to know whether I was carrying GBS or not, as there was nothing I would do with the information.

With any intervention in pregnancy and labour, you have to apply the BRAN line of questioning:

What are the benefits of the testing or treatment?
What are the risks of the testing or treatment?
What are the alternatives?
What happens if you do nothing?

 

[nursejess]

Here, look at this site.

http://www.dhpe.org/infect/strepb.html

 

[Leanna]

Well, so are you saying that if they retest me at 36 weeks I may not be group b strep positive anymore? Yes, they did test me already. I don't know why, I didn't even know they were doing it, they must have done it at the same time as the gestational diabetes test, which they do early and then at 28 weeks. If there is a way I won't test positive then, maybe I can take some probiotics and make this go away. It might explain why I keep getting yeast infections over the last three months AND a UTI.

 

[RoseofLima]

There are two approaches approved by the ACOG. One is to test all women at 36 weeks and actively manage any GBS in labour - typical high dose IV antibiotics.

The other is to expectantly manage it. No testing at 36 weeks. GBS is a problem in premature babies (<37 weeks) with a long duration of ruptured membranes. Identify those infants and watch for signs of GBS and give anti-biotics as required (prophylactic antibiotics are also OK in these situations).

GBS testing is not routine in the UK, so I first encountered it when I was pregnant in the US. Given my obstetric history - 4 babies all born at 40 weeks, spontaneous onset of labour, quick first stage with SROM at full dilation, followed by short second stages - the risk of GBS was very low. Add to that that I am allergic to penicillin (the ab of choice), there was little need to know whether I was carrying GBS or not, as there was nothing I would do with the information.

With any intervention in pregnancy and labour, you have to apply the BRAN line of questioning:

What are the benefits of the testing or treatment?
What are the risks of the testing or treatment?
What are the alternatives?
What happens if you do nothing?

I was also going to add, but didn't ---that I would have closer monitoring of the baby if I had PROM, prolonged second stage, or a premie. I would probably alos have the eye drops/goop given to baby is these circumstances, because the eyes are a likely mode of transmission.

It is so cool to hear about the differences in you care Naomi, it always helps me to know that there is far more than one standard of care...

 

[RoseofLima]

Well, so are you saying that if they retest me at 36 weeks I may not be group b strep positive anymore? Yes, they did test me already. I don't know why, I didn't even know they were doing it, they must have done it at the same time as the gestational diabetes test, which they do early and then at 28 weeks. If there is a way I won't test positive then, maybe I can take some probiotics and make this go away. It might explain why I keep getting yeast infections over the last three months AND a UTI.

Yes- there is a very good chance that you won't be positive anymore--and you can also refuse the test. They test for diabetes now too??? The glucola junk? (hee, hee- I refuse that, too). GBS might be present because of the UTI and yeast infections normally mean that your body's natural flora is screwy. My personal recommendation would be acidopholous and grapefruit seed extract.

Another thing to think about, of course, is that many babies who end up being GBS+-- do not have moms who test positive.....

 

[RoseofLima]

They would have to swab you to test for GBS- so it would have been done at the same time as your pap smear. Personally I would be irate that they tested me for something without allowing me to give informed consent.....

 

[Leanna]

Well I have been taking acidophillus, I don't have a yeast infection anymore but it took me a long time to get rid of it a couple months ago. We even TTC while I had one. Grrr. It was annoying. I guess I have to read more about what this means for the baby, from what I've seen though it is something I should be concerned about in which case I don't have anything against antibiotics, just using an IV to give them to me. They need a pill or a shot.

 

[Leanna]

Are you sure? Well then what on earth did I test positive for, because all they had was blood samples and urine. They didn't even do a pap until this last visit. I wonder if I have the wrong name...

 

[Naomi4Christ]

Another thing to think about, of course, is that many babies who end up being GBS+-- do not have moms who test positive.....

The figure is about 50% from mothers who screen negative, I believe. It can leave you with a false sense of security.

If you are in a high risk group because of the type of labour you have - premature with long duration of ruptured membranes - then you need to be watching the baby closely, regardless of the GBS testing you have had.

The other thing about testing a 36 weeks is that it could be negative and you relax. But at 40 weeks, it might be a different story. IMO, it is best not to rely on the screening. It is really quite inconclusive, which is why it is not public policy in the UK.

 

[Naomi4Christ]

Are you sure? Well then what on earth did I test positive for, because all they had was blood samples and urine. They didn't even do a pap until this last visit. I wonder if I have the wrong name...

It's quite common to get a full blood count, iron levels and a rubella test. Some US states may have additional things they screen for, such as syphilis.

Urine is usually to test protein and sugar, and is done at every visit.

You can screen for fetal abnormalities using blood, but you positively have to consent to those.

GBS is a swab test.

 

[Leanna]

Huh.... I guess I'll have to ask at my next visit, I tested positive for something....

 

[Linnis]

According to what I read there are two options, antibiotics for 2 weeks to kill it and or IV antibiotics for 4 hours prior to delivery. The Youth Pastor's wife at my church, tested positive and they made her do both.

In Canadian hospitals or at least the 3-4 friends I've had who've had babies didn't have IV antibiotics for it, they took the script.

 

[HeKnowsMyName]

I'd take the meds they give you if you find out you do have it. A friend of ours had it and didn't know and her baby almost died. I don't know how common that is though.

 

[~Nikki~]

Here, look at this site.

http://www.dhpe.org/infect/strepb.html

The link that nursejess posted said that they test for GBS either by a blood test or spinal fluid.

I know that a swab is also a way of testing, but maybe Leanna, your doctor got your results from your blood test???

Anyway, I had a routine blood test at 36 weeks so I'm assuming they'll be checking for GBS in that blood test in that case. Hopefully it is something they check because I'd like to take all the necessary precautions if I do have it. I'll make sure I ask them when I see the consultant on Wednesday...

 

[Leanna]

According to what I read there are two options, antibiotics for 2 weeks to kill it and or IV antibiotics for 4 hours prior to delivery.

I hope you're right, maybe I can take the antibiotics starting at 36 weeks... that would be a much better option for me!

 

[RoseofLima]

I'd take the meds they give you if you find out you do have it. A friend of ours had it and didn't know and her baby almost died. I don't know how common that is though.

extapolating from the site that nursejess posted 1 in 8,000 babies will get it, 5 -15% of those babies who contract it will die. So 5-15 babies per 800,000 live births? Did I do the math right? The statitisitics fail to show which babies were preterm or had PROM or mom;s had fevers during labor--or the other rick-based factors. The CDC's website states that 80 babies will die each year as a result.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5111a1.htm
This table is interesting, again from the CDC-

That table to me say that sepsis caused by non GBS is nearly as problematic...

 

[~Mrs. A2J~]

I tested positive for GBS in the urine sample I gave them at my first prenatal appointment. At this point my husband and I are leaning towards not getting the antibiotics during labor. From the research I've done I believe the risk of transmission to the baby is only 0.5% in woman who test positive for GBS. Also from what I've read mothers who receive the the antibiotics during labor and then their babies go on to contract GBS these babies do far worse than babies whose mothers didn't receive the antibiotics during labor. So I think right now hubby and I are more confortable treating the problem if a problem arises rather than expose both the baby and I to potentially unnecessary antibiotics for something I may not even have at the time of the birth.

Here is some extra reading:
http://www.hpakids.org/holistic-health/articles/172/1/Treating-Group-B-Strep
http://www.mothering.com/articles/pregnancy_birth/birth_preparation/group-b.html

 

[RoseofLima]

According to the March of DImes http://www.marchofdimes.com/pnhec/188_679.asp (urgh I dislike them).. women who test positive have a 1% (which I think means they can't read because the CDC link they provide places it at 1 in 1000- so that's .5%) chance of passing it on to their baby, and 5 % of that 1% will die.

Prophylactic intrapartum antibiotics have been shown ineffective treatment for late-onset GBS disease in newborns. Late onset GBS disease is more likely to result in meningitits, which has long term issues and complications.