Pocket ObGyn – Group B Streptococcal Disease

Pocket ObGyn – Group B Streptococcal Disease
See Abbreviations

Definition and Epidemiology (MMWR 59(RR10):1)

Intrapartum vertical transmission of GBS is the leading cause of infectious morbidity/ mortality in neonates; incid is ~35/1000 births
Caused by GBS infxn of fetal mucosal surfaces by GBS in amniotic fluid or birth canal
10–30% of pregnant women are colonized w/ GBS in GI tract or vagina
Risk factors for invasive perinatal dz include:

<37 w at deliv

Ruptured amniotic membranes for >12 h Intra-amniotic infxn

Young mat age Black race

Low levels of anti-GBS Ab

Pregnant women should routinely be screened by rectovaginal swab at 35–37 Culture results are valid for up to 5 w, then should be repeated at >5 w.
NAAT for GBS is currently only indicated in women w/ (1) culture data unk, (2) at term, & (3) w/o prolonged rupture of membranes or fever

Positive rectovaginal culture during this Preg

GBS bacteriuria at any time during this Preg (exempt from routine screening) H/o perinatal GBS dz in a prior Preg (exempt from routine screening)

Culture data unavailable & <37 w OR term w/ rupture of membranes >18 h or temperature >100.4°F

Intrapartum ppx NOT indicated at the time of cesarean deliv at any GA for women delivered prior to labor w/ intact membranes

Antibiotics for GBS prophylaxis at delivery
Recommended	PCN G 5 million U IV loading dose ® 2.5 million U IV q4h until deliv
Alternative	Ampicillin 2 g IV loading dose ® 1 g IV q4h until deliv
If PCN-allergic follow protocol to use cefazolin, clindamycin, or vancomycin

	Patient with a history of any of the following after receiving penicillin or a cephalosporin? · Anaphylaxis · Angioedema · Respiratory distress · Urticaria
No		Yes

Isolate susceptible to clindamycin AND erythromycin ?

Yes