Who is at risk of passing on GBS to their baby; Premature babies born before 37 weeks of pregnancy but especially before

35 weeks may be more at risk. If your waters break and you do not go into labour for 18 hours or more your baby may be more at risk. Women who have had a previous baby with GBS disease may be more at risk for this to happen again. If you have a fever of more than 38 degrees centigrade in labour you may be at risk. If GBS is found in your urine during pregnancy you may have a higher risk. If you are a young, under 21 years, first time mother you may not have as many antibodies in your body to fight GBS
If you have any of the above risk factors you may also want to consider the following; Having vaginal examinations may increase the risk of taking GBS into the vagina especially if your waters have already broken. Having internal monitoring of your baby (with a clip on baby’s head) during labour, particularly if there are other risk factors present, may increase the risk of infection. NB If the circumstances warrant it these procedures may be advised despite the small risk of GBS. NB. The risk increases the more of these risk factors you have. Some factors have a higher risk than others,. For some, more that one factor is needs to be present for there to be a significant risk to the baby.

You can get more information at the following websites:
https://www.nzma.org.nz/journal/117-1200/1023/ NZCOM Consensus: http://www.midwife.org.nz/index.cfm/3,108,271/group-bstrep-nzcom.pdf RANZCOG: http://www.ranzcog.edu.au/publications/statements/Cobs19.pdf UK GBS: www.gbss.org.uk

Group B Streptococcus

New Zealand Medical Journal:

Implications for pregnancy and the newborn baby in Aotearoa/ New Zealand.

USA GBS: www.groupbstrep.org
References: Campbell N, Eddy A, Darlow B, Stone P, Grimwood K. The prevention of early-onset neonatal group B streptococcus infection: technical report from the New Zealand GBS consensus working party. N Z Med J 2004;117(1200):U1023. Grimwood, K., Darlow, B.A., Gosling, I.A., Green, R., Darlow, B.A., Lennon, D.R., Martin, D.R. Late antenatal carriage of group B Streptococcus by New Zealand women. Australian and NZ Journal of Obstetrics and Gynaecology, 43, (2), 182-186 Green, R., Lennon, D.R., Martin, D.R., Stone, P.R., (2002). Early-onset neonatal group B streptococcal infections in New Zealand 1998-1999. Journal of Paediatrics and Child Health, 38 (3) 272-277. Kimura, K., et al. (2008). First molecular character of group B Streptococcus with reduced penicillin susceptibility. Antimicrobial Agents and Chemo-

therapy, 52, (8), 2890-2897,
Mullaney, D.M., (2001), Group B streptococcal infections in newborns. Journal of Obstetrics Gynecology and Neonatal Nursing, 30 (6), 649-658. Kenyon.,S.L., Taylor, D.J., Tarnow-Mordi, W., (2001).: The Oracle II randomized trial. The Lancet. 357, 989 -994. Schuchat, A., (1998). Epidemiology of group B streptococcal disease in the United States: Shifting paradigms. Clinical Microbiology Reviews 11 (3), 497-513

Author Carolyn McIntosh Midwife, 8 St Andrew Place Balclutha Email: cardacs@gmail.com
This pamphlet is licensed under a Creative Commons License. You are free to share, distribute or remix this pamphlet. Please attribute original to the author.  

Group B Streptococcus: Group B Streptococcus is a bacteria which is found normally in the human body. It is usually found in the bowel but can also be found in the vagina or urinary tract. Women’s bodies naturally encounter Group B Streptococcus and produce antibodies to it. The more antibodies a woman has the more protection she has against Group B Streptococcus. This means women usually have more protection as they get older. Group B streptococcus can be found in the genital tract in 10-30% of all pregnant women. Because of the low incidence of Infection, and relatively high incidence of colonization in New Zealand, it is not recommended to screen all pregnant women for Group B Strep [ Grimwood et al, 2002; Campbell et al, 2004.] Group B Streptococcus is often referred to as Group B Strep or GBS. Occasionally GBS is an aggressive strain and causes serious infection in newborn babies. When this happens it is called Group B Streptococcal disease of the newborn. Group B Strep disease of the newborn can either be; Early onset disease, which develops in the first 7 days of a baby’s life, but most often with 24-48 hours. or Late onset, which is very rare, and occurs between 7 days and 3 months of age.

Rates of GBS disease; 1 out of every 2000 babies born in New Zealand will have some Group B Streptococcal disease. 1-2% of these babies will become extremely sick and die. This gives a total rate of babies who are likely to die because of this disease of about 1 of every 100,000 babies born in New Zealand. These figures indicate that the babies of most women who carry GBS bacteria will not become sick. Signs of Group B Streptococcal disease in Babies:
• • • • • •

Antibiotics for GBS; Women who are at increased risk of GBS disease are offered antibiotics in labour which will help to prevent GBS in 90% of the babies who would become sick with GBS. You will need to decide if you should have these antibiotics and should discuss this with your LMC. Once labour is established antibiotics will be given into a vein. If the woman is not allergic to Penicillin then Penicillin G at a dose of 1.2 grams will be given initially, and every 4 hours afterwards 600 milligrams will be given until the baby is born. It is best if the antibiotics are given at least 4 hours before the baby is born.. If the woman is allergic to penicillin Erythromycin or Clindamycin will be given.

Nostrils flare as the baby breathes. Baby chest sucks in with breathing. Baby makes grunting noises with breathing. Baby has trouble keeping warm. Baby might be sleepy and not feed well. Baby might be pale and floppy

Problems with antibiotics; About 1 in every 10 women will experience a mild reaction to penicillin for example a rash may develop. 1 in every 10,000 women will have a severe reaction or anaphylaxis; this is a serious condition and can cause death in 1 in 50,000 to 1 in 100,000 women. (Salkind,A.R., et al., (2001), JAMA 285. 2498-2505) There is increasing concern about bacteria becoming resistant to antibiotics. It is estimated that if all women with risk factors have antibiotics then 16% of all women in labour will be given intravenous antibiotics. Some strains of GBS are now known to have reduced susceptibility to antibiotics (Kimura et al., 2008) other bacteria which may also be present in the woman’s system are developing resistance. These bacteria could cause increasing problems in the future and may be difficult to treat..

NB: The outcome for babies is much better if they are treated quickly so it is important that you seek help for your baby if you have any concerns or he/she displays any of these symptoms

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