Prevention of Group B

Streptococcal Early-Onset
Disease in Newborns
ACOG 2019 Recommendations
Group B Streptococcus (GBS)
● Streptococcus agalactiae
● Facultative gram-positive organism
● Colonizer of the gastrointestinal and genitourinary tracts
● Vaginal-rectal colonization may be intermittent, transitory or persistent
● Can transition from asymptomatic commensal member of the mucosal
biome to a pathogenic bacterium
● Important cause of perinatal morbidity and mortality in newborns
GBS Early Onset Disease
● Presents within 7 days after birth (most likely within 12-48 hours after
birth)
● Occurs secondary to vertical transmission, fetal, or neonatal aspiration
● Characterized by sepsis, pneumonia, or meningitis
GBS Late Onset Disease
● Presents between 7 days after birth and 2-3 months of age
● Acquired by horizontal transmission from the mother or from hospital
sources
● Characterized by bacteremia, meningitis, organ or soft tissue infection
Risk Factors associated with GBS Early Onset Disease

● Vaginal-rectal colonization during intrapartum period

● Age of gestation <37 weeks
● Very low birth weight
● Prolonged rupture of membranes
● Intraamniotic infection
● Young maternal age
● Heavy vaginal-rectal colonization
● GBS bacteriuria
● Previous newborn affected by GBS
Universal Antepartum Screening
● ALL pregnant women should undergo antepartum culture-based
screening for GBS at 36 0/7 - 36 6/7 weeks AOG regardless of planned
mode of birth
● Provides a 5-week window for valid culture results (include births up to 41
weeks)
Procedure for Preterm Culture-Based Screening
● A single swab is used to obtain the culture specimen first from the lower
vagina (near the introitus) and then from the rectum (through the anal
sphincter) without using a speculum
● Aside from culture-based screening, direct latex agglutination tests or
nucleic acid amplification testing (NAAT) may also be used
Intrapartum Antibiotic Prophylaxis
● Targeted intravenous antepartum antibiotic prophylaxis has
demonstrated efficacy for prevention of GBS early-onset disease in
neonates born to women with positive cultures and those with risk
factors for intrapartum GBS colonization
Indications for Intrapartum Antibiotic Prophylaxis
Management of patients with Preterm Prelabor Rupture of Membranes
Management of patients with Preterm Labor
Unknown Culture Status During Time of Labor at Term
● Intrapartum use of maternal risk factors
● Molecular based testing
● Known GBS Status in previous pregnancy
Antimicrobial Agents
Intrapartum Obstetric Management
● Highest effectiveness noted when antibiotic prophylaxis is administered 4
hours or more before delivery → obstetric interventions should not be
delayed when necessary just to reach 4 hours
Obstetric Procedures
● Membrane sweeping does not appear to be associated with adverse
outcomes in women colonized with GBS
● No recommendation can be made for or against timing of antibiotic
prophylaxis in women colonized with GBS undergoing mechanical cervical
ripening
● Immersion in water during labor or birth is not contraindicated for
women colonized with GBS (as long as with appropriate intrapartum
antibiotic prophylaxis)
Obstetric Procedures
● There are conflicting results with regards to the effect of frequent vaginal
examinations during labor in women colonized with GBS
● In women receiving intrapartum antibiotic prophylaxis, vaginal
examination should be performed when clinically indicated
● Currently, there is no data suggesting that artificial rupture of membranes
increases the risk of neonatal disease when appropriate intrapartum
antibiotic prophylaxis is given
Obstetric Procedures
● There are no data to suggest that intrauterine monitoring increases the
risk of neonatal disease when appropriate intrapartum antibiotic
prophylaxis is given
THANK YOU!