Group B strep: Is it time pregnant women were offered screening?

When i was pregnant with my fourth child I was swabbed as I had thrush.It was only because of this that it was found I was B strep positive.Thanks to that one swab I was able to be given anti-biotics during my labour and was kept in hospital for 24 hours so they could do hourly checks on my newborn.
I think all should be checked and anti-biotics given as necessary,after all what price do you put on a healthy baby?

My first pregnancy and delivery was completely normal and our daughter, Rosie, was born at full-term, weighing a healthy 7lb 6oz. I didn\'t have any of the risk factors identified by the RCOG guidelines and so there was nothing to indicate that she was at risk of Group B strep infection. However, she soon became very ill and was rushed to the neonatal unit, where she was put on a ventilator to help her to breathe and pumped full of antibiotics to try and save her life. After extensive tests, the doctors told us that they didn\'t think that Rosie could breathe on her own and, even if she could, there was no longer any activity in her brain. Rosie died in my arms when she was four days old.

I had never heard of Group B strep before Rosie became ill and I agree with the earlier comments that that education is key. In Rosie\'s case the infection was so aggressive that it was too late to save her and in some cases Group B strep causes stillbirth - prevention has to be better than cure. In any event, my understanding is that screening would be offered to pregnant women - everyone has a different view of risk and anyone that felt that strongly against it could decline.

The argument that screening could result in use of strong IV antibiotics and intrusive monitoring in up to 40% of births doesn\'t wash - the National Screening Committee report estimates that 21% of women in the UK are colonised by GBS antenatally. This is less than the 22% of women that had at least one risk factor and should, in theory, receive IAP if the RCOG guidelines are followed as they are now proposed. The NSC report highlights that a third of Early Onset Group B strep cases might be born to women with no known risk factors for Group B strep (as Rosie was) and so, without screening, we\'re left with a situation where antibiotics are being given to women who aren\'t colonised with Group B strep, while other babies who are at risk are left unprotected.

6 months after Rosie died, I was lucky enough to fall pregnant again and this time I was given antibiotics during labour. It took 5 minutes to insert the cannula in my hand and a maximum of about 15 minutes to administer the antibiotics. The rest of the time I was free to move around and the delivery was no different to when I had Rosie. Our second daughter, Victoria, was born free from Group B strep infection and is now a healthy and happy 6-year old.

No no no! I asked to be screened, because I read an article about somebody whose baby was very ill. I tested positive, and spent the whole of my labour being monitored and on four-hourly IV strong antibiotics. It turns out that 40% of the population carries strep B. That's nearly half. Whilst strep B can be very serious, screening could result in use of strong IV antibiotics and intrusive monitoring in up to 40% of births in response to a 1/2000 (=0.0005%) risk.

Excellent, well balance article. All the evidence from other countries which screen shows that the number of these devastating infections in newborn babies is reduced massively.

Whilst there will always be concern about anaphylaxis and antibiotic resistance developing whenever antibiotics are used, thankfully these concerns have not been realised (see http://jms.rsmjournals.com/content/12/2/60.full.pdf).

One of the other positive side effects of antenatal group B Strep screening (on top of the significant reduction in illness, disability and death in newborn babies) would be the massively increased awareness and knowledge about group B Strep amongst both expectant/new parents and their health professionals. Some current myths are:

1. GBS comes & goes so often it's not worth testing for - Nope. Research has shown that, whatever the result of a sensitive test for GBS, the GBS status is hugely likely to be the same for the next 5 weeks. After that, the predictiveness wanes a bit - though it doesn't plummet like a stone - which is why when testing is done, it's recommended at 35-37 weeks of pregnancy. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=8885919&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

2. A cannula to deliver the antibiotics in labour for women found to carry GBS during their current pregnancy does not mean a woman can't have an active birth, a water birth or indeed a normal birth. It simply means that, every 4 hours (assuming she's being given penicilliin) she'll need a top up of the antibiotics which is given by slow injection or drip over 5-30 minutes. She doesn't have to be attached to a drip the whole time, or indeed strapped to a bed!

3. The use of garlic, or antibacterial wipes, have not been shown to reduce the incidence of group B Strep infection in newborn babies. A recent trial of over 8,000 women found antibacterial wipes ineffective at preventing these infections. http://www.ncbi.nlm.nih.gov/pubmed/19846212

As the previous poster rightly points out, education is key - for pregnant women, new parents and their health professionals.

GBS is a transient bacteria that lives quite normally in the bowl. You can test someone everyday for GBS in the vagina area and get different results everyday. More problems are associated with the giving of antibiotics with resistance and anaphalaxis. Further to this the antibiotics have to be given a certain time in labour to guarantee them to work so if a baby arrives to quick (and this never happens right) they are a waste of time and the woman has had all her birth options removed. If we give antibiotics then a cannula needs inserting, baby needs constant monitoring and out goes the use of Midwifery led care, active birth, water birth or normal birth as all these factors increase the risk of CS therefore the risk of infection. The way to reduce GBS (and so not forget the others such as Group A Strep) is to good antenatal education, one to one midwifery care, subtle antibacterials such as garlic regimes. Reduce the risk of infection - stay away from places that harbour them - hospitals, reduce internal examinations - take your own basal body temperature 4 hourly after membranes ruptured and only act if the body is showing signs of infection. When baby is born, do not dump on a busy postnatal ward with staff to busy give the care needed.