Group B Strep: To have the test or not?

[LadyNoor]

I'm currently 33 weeks pregnant and I've decided to NOT to have it tested when I'm 36 weeks. I'm going for home birth and I know if I'm tested positive I'd have to birth in the hospital for antibiotics administer.

I've never had baby with GBS, and I have not had urinary tract infection with GBS at any time during this pregnancy.

So, only if I went into labour before 37 weeks, or having rupture of membranes more than 18 hours before birth, or have fever during labour, I have NO clinical risk factors whatsoever related to GBS. These what made me sure NOT to have the test.

I'm also aware that by closely watching the baby in the first 24 hours, and then continue monitoring for first 7 days after birth we'll be able to pick up any sign of infections.

However, I read a few stories about how babies became very sick and some died after contracted with GBS and now I'm doubting myself over my decision.

Please tell me your experience with GBS, any suggestion is welcomed.

[Mummato2]

I was GBS positive with my first pregnancy and as I understand it, GBS comes in 6 week cycles.

In my son's labour, I had a cannula inserted and anti-biotics given a few hours before he was born.

It was a pain to be honest, if the cannula got knocked it hurt, the anti-biotics stung etc.

I am this time around going through a Birthing Centre where a Home Birth is an option.

I have told them I'll test for it again, but I am not having a cannula and anti-biotics and asked if there was an alternative.

There is!! There is a chlorhexidine douche that they can use when you begin labour (but before your waters break) and this is apparently comparable in success to anti-biotics.

The way I see it is, GBS has a 4 in 1000 chance of being passed onto your baby and 1 in every 4 of those babies die. It's a slight risk - but someone has to have it happen to them to make the statistic IYKWIM?

If it were me, I'd get the swab, then if positive, manage it with the chlorhexidine douche. There is no reason a Home Birth is not possible just because of your GBS status. Better than ignoring it and something happening

HTH

[Mummato2]

Here is more information:

Vaginal Chlorhexidine for GBS Prophylaxis.- Abstracts
J Matern Fetal Neonatal Med 2002 Feb; 11(2):84-8.
Chlorhexidine vaginal flushings versus systemic ampicillin in the prevention of vertical transmission of neonatal group B streptococcus, at term. Facchinetti F, Piccinini F, Mordini S, Volpe A. Department of Gynecology, Obstetrics and Pediatric Sciences, University of Modena and Reggio Emilia, Italy.

OBJECTIVE: To investigate the efficacy of intrapartum vaginal flushings with chlorhexidine compared with ampicillin in preventing group B streptococcus transmission to neonates.

METHODS: This was a randomized controlled study, including singleton pregnancies delivering vaginally. Rupture of membranes, when present, must not have occurred more than 6 h previously. Women with any gestational complication, with a newborn previously affected by group B streptococcus sepsis or whose cervical dilatation was greater than 5 cm were excluded. A total of 244 group B streptococcus-colonized mothers at term (screened at 36-38 weeks) were randomized to receive either 140 ml chlorhexidine 0.2% by vaginal flushings every 6 h or ampicillin 2 g intravenously every 6 h until delivery. Neonatal swabs were taken at birth, at three different sites (nose, ear and gastric juice).

RESULTS: A total of 108 women were treated with ampicillin and 109 with chlorhexidine. Their ages and gestational weeks at delivery were similar in the two groups. Nulliparous women were equally distributed between the two groups (ampicillin, 87%; chlorhexidine, 89%). Clinical data such as birth weight (ampicillin, 3,365 +/- 390 g; chlorhexidine, 3,440 +/- 452 g), Apgar scores at 1 min (ampicillin, 8.4 +/- 0.9; chlorhexidine, 8.2 +/- 1.4) and at 5 min (ampicillin, 9.7 +/- 0.6;chlorhexidine, 9.6 +/- 1.1) were similar for the two groups, as was the rate of neonatal group B streptococcus colonization (chlorhexidine, 15.6%; ampicillin, 12%). Escherichia coli, on the other hand, was significantly more prevalent in the ampicillin (7.4%) than in the chlorhexidine group (1.8%, p < 0.05). Six neonates were transferred to the neonatal intensive care unit, including two cases of early-onset sepsis (one in each group).

CONCLUSIONS: In this carefully screened target population, intrapartum vaginal flushings with chlorhexidine in colonized mothers display the same efficacy as ampicillin in preventing vertical transmission of group B streptococcus. Moreover, the rate of neonatal E. coli colonization was reduced by chlorhexidine.

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BMJ 1997 Jul 26;3 15(7102):216-9; discussion 220 Comment in: BMJ. 1997 Jul 26;315(7102):199-200. Effect of cleansing the birth canal with antiseptic solution on maternal and newborn morbidity and mortality in Malawi: clinical trial. Taha TE, Biggar RJ, Broadhead RL, Mtimavalye LA, Justesen AB, Liomba GN, Chiphangwi JD, Miotti PG. Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore MD 21205, USA.

OBJECTIVE: To determine if cleansing the birth canal with an antiseptic at delivery reduces infections in mothers and babies postnatally. DESIGN: Clinical trial; two months of no intervention were followed by three months of intervention and a final month of no intervention. SETTING: Queen Elizabeth Central Hospital (tertiary care urban hospital), Blantyre, Malawi. SUBJECTS: A total of 6965 women giving birth in a six month period and their 7160 babies.

INTERVENTION: Manual wipe of the maternal birth canal with a 0.25% chlorhexidine solution at every vaginal examination before delivery. Babies born during the intervention were also wiped with chlorhexidine.

MAIN OUTCOME MEASURES: Effects of the intervention on neonatal and maternal morbidity and mortality.

RESULTS: 3635 women giving birth to 3743 babies were enrolled in the intervention phase and 3330 women giving birth to 3417 babies were enrolled in the non-intervention phase. There were no adverse reactions related to the intervention among the mothers or their children. Among infants born in the intervention phase, overall neonatal admissions were reduced (634/3743 (16.9%) v 661/3417 (19.3%), P < 0.01), as were admissions for neonatal sepsis (7.8 v 17.9 per 1000 live births, P < 0.0002), overall neonatal mortality (28.6 v 36.9 per 1000 live births, P < 0.06), and mortality due to infectious causes (2.4 v 7.3 per 1000 live births, P < 0.005). Among mothers receiving the intervention, admissions related to delivery were reduced (29.4 v 40.2 per 1000 deliveries, P < 0.02), as were admissions due to postpartum infections (1.7 v 5.1 per 1000 deliveries, P = 0.02) and duration of hospitalization (Wilcoxon P =0.008).

CONCLUSIONS: Cleansing the birth canal with chlorhexidine reduced early neonatal and maternal postpartum infectious problems. The safety, simplicity, and low cost of the procedure suggest that it should be considered as standard care to lower infant and maternal morbidity and mortality.

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Int J Antimicrob Agents 1999 Aug;12(3):245-51 Vaginal disinfection with chlorhexidine during childbirth. Stray-Pedersen B, Bergan T, Haf@tad A, Normann E, Grogaard J, Vangdal M. Department of Gynecology and Obstetrics, Aker Hospital, University of Oslo, Norway.

The purpose of this study was to determine whether chlorhexidine vaginal douching, applied by a squeeze bottle intrapartum, reduced mother-to- child transmission of vaginal microorganisms including Streptococcus agalactiae (streptococcus serogroup B = GBS) and hence infectious morbidity in both mother and child.

A prospective controlled study was conducted on pairs of mothers and their offspring. During the first 4 months (reference phase),the vaginal flora of women in labor was recorded and the newborns monitored. During the next 5 months (intervention phase), a trial of randomized, blinded placebo controlled douching with either 0.2% chlorhexidine or sterile saline was performed on 1130 women in vaginal labor.

During childbirth, bacteria were isolated from 78% of the women. Vertical transmission of microbes occurred in 43% of the reference deliveries. In the double blind study, vaginal douching with chlorhexidine significantly reduced the vertical transmission rate from 35% (saline) to 18% (chlorhexidine), (P < 0.000 1, 95% confidence interval 0.12- 0.22). The lower rate of bacteria isolated from the latter group was accompanied by a significantly reduced early infectious morbidity in the neonates (P < 0.05,95% confidence interval 0.00-0.06). This finding was particularly pronounced in Str. agalactiae infections (P< 0.0 1). In the early postpartum period, fever in the mothers was significantly lower in the patients offered vaginal disinfection, a reduction from 7.2% in those douched using saline compared with 3.3% in those disinfected using chlorhexidine (P < 0.05, 95% confidence interval 0.01-0.06).

A parallel lower occurrence of urinary tract infections was also observed, 6.2% in the saline group as compared with 3.4% in the chlorhexidine group (P < 0.01, 95% confidence p interval 0.00-0.05). This prospective controlled trial demonstrated that vaginal douching with 0.2% chlorhexidine during labor can significantly reduce both maternal and early neonatal infectious morbidity.

The squeeze bottle procedure was simple, quick, and well tolerated. The beneficial effect may be ascribed both to mechanical cleansing by liquid flow and to the disinfective action of chlorhexidine.

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Lancet 1992 Jul 11;340(8811):65-9. Comment in: Lancet. 1992 Sep 26;340(8822):791; discussion 791-2. Lancet. 1992 Sep 26;340(8822):792.

Prevention of excess neonatal morbidity associated with group B streptococci by vaginal chlorhexidine disinfection during labor. The Swedish Chlorhexidine Study Group. Burman LG, Christensen P, Christensen K, Fryklund B, Heigesson AM, Svenningsen NW, Tullus K. National Bacteriological Laboratory, Stockholm, Sweden.

Streptococcus agalactiae transmitted to infants from the vagina during birth is an important cause of invasive neonatal infection. We have done a prospective, randomized, double-blind, placebo-controlled, multi-centre study of chlorhexidine prophylaxis to prevent neonatal disease due to vaginal transmission of S. agalactiae.

On arrival in the delivery room, swabs were taken for culture from the vaginas of 4483 women who were expecting a full- term single birth. Vaginal flushing was then done with either 60 ml chlorhexidine diacetate (2 g/l) (2238 women) or saline placebo (2245) and this procedure was repeated every 6 h until delivery.

The rate of admission of babies to special-care neonatal units within 48 h of delivery was the primary end point. For babies born to placebo- treated women, maternal carriage of S. agalactiae was associated with a significant increase in the rate of admission compared with non-colonized mothers (5.4 vs 2.4%; RR 2.31,95% Cl 1.39-3.86; p = 0.002).

Chlorhexidine reduced the admission rate for infants born of carrier mothers to 2.8% (RR 1.95, 95% Cl 0.94-4.03), and for infants born to all mothers to 2.0% (RR 1.48, 95% Cl 1.01-2.16; p n 0.04). Maternal S. agalactiae colonization is associated with excess early neonatal morbidity, apparently related to aspiration of the organism, that can be reduced with chlorhexidine disinfection of the vagina during labor.

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Eur J Obstet Gynecol Reprod Biol 1989 Apr;31(1):47-51 Prevention of group 8 streptococci transmission during delivery by vaginal application of chlorhexidine gel Kollee LA, Speyer I, van Kuijck MA, Koopman R, Dony JM, Bakker JH, Wintermans RG. Department of Pediatrics, University Hospital, Nijmegen, The Netherlands.

In a prospective study in 227 parturients, carriership of group B streptococci was established to be 25%. In carriers, transmission of streptococci to the newborn occurred in 50%. 10 ml of a chlorhexidine gel containing hydroxypropylmethylcellulose was introduced into the vagina during labor in 17 parturients, who were known to be carriers of group B streptococci from the first trimester of pregnancy. In none of the newborns from these mothers colonization by group B streptococci did occur.

Vaginal application of chlorhexidine may prevent transmission of group B streptococci, and serve as an alternative to intrapartum prophylaxis using antibiotics. A large multicenter randomized controlled study should be performed to confirm this hypothesis.

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Eur J Obstet Gynecol Reprod Biol 1985 Apr;19(4):231-6. Chlorhexidine forprevention of neonatal colonization with group B streptococci. III. Effect of vaginal washing with chlorhexidine before rupture of the membranes. Christensen KK, Christensen P, Dykes AK, Kahimeter G.

A single vaginal washing with 2 g/l of chlorhexidine was performed before rupture of the membranes in 19 parturients who were urogenital carriers of group B streptococci (GBS).

Two (11%) of the infants became colonized immediately after birth, in contrast to 16 of 41 (39%) infants to controls (P= 0.02). A significant reduction of GBS colonization of the ear (P= 0.02) and umbilicus (P = 0.01) was noted.

Taken together, 2 of 57 (4%) cultures obtained at birth were positive in the chlorhexidine group, in contrast to 30 of 123 (24%) among the controls (P less than 0.01). These findings raise hope for the design of a simple washing procedure which might prevent serious infections in the early neonatal period with GBS but also with other chlorhexidine-sensitive organisms.

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Vaginal disinfection with chlorhexidine during childbirth.
Stray-Pedersen B, Bergan T, Hafstad A, Normann E, Grogaard J, Vangdal M.
Int J Antimicrob Agents 1999 Aug;12(3):245-51

"Vertical transmission of microbes occurred in 43% of the reference deliveries. In the double blind study, vaginal douching with chlorhexidine significantly reduced the vertical transmission rate from 35% (saline) to 18% (chlorhexidine),. . . . This prospective controlled trial demonstrated that vaginal douching with 0.2% chlorhexidine during labour can significantly reduce both maternal and early neonatal infectious morbidity. The squeeze bottle procedure was simple, quick, and well tolerated. The beneficial effect may be ascribed both to mechanical cleansing by liquid flow and to the disinfective action of chlorhexidine."

[LadyNoor]

Corey,
Thank you for your detailed reply. I will discuss it with my midwife. It's good to know there's another option beside antibiotics during labour.

Hey, my due date is just a week after you!

[Heaven]

Good luck LadyNoor

I was never even offered the test, wasn't even mentioned.

[LadyNoor]

Thanks, Heaven.

Yes, you see I read that in some countries pregnant women don't get routine screen for GBS, i.e UK. So in a way it's like adding fear towards birth, which isn't necessary...

Argh, I'm so confused... But will have a good discussion about it, and I have 3 weeks before making an absolute decision.

[Heaven]

Yeah, I'm in Australia though! Weird.

[LadyNoor]

Lucky you never had to make such a decision!

[BellyBelly]

When I used an Ob for my first born I asked why he wasn't offering the test to me (not that I wanted it!), he said that he would only bother with ab's if the baby was premature, the waters had been broken for some time or if I was showing signs of infection - so he didn't believe in a preventative approach, but a wait and see one which I was happy for. He also said that he could usually tell if a baby had strep b by smelling it, they had a distinct odour to them. As you also know, they can check the baby's temp post birth too. So I never had the test with my two children, but I did birth in hospital, and I will do the same next time. He said it's one of those things that goes in and out of fashion a little, it doesn't happen often, then a case will pop up so everyone will be majorly vigilant again. I'd assume you'd have alot of contact with your IM and you can always do temp checks from home? Either way chat to your IM and see what she thinks.

Have you seen the thread in the natural therapies forum for the garlic procedure for vaginal infections? You're at the perfect time to start doing it

[LadyNoor]

Kelly, thanks for sharing your experience with your OB. Yes, my midwife explained to me basically the same thing your OB told you. She, of course, doesn't want to decide for me that's why I've been doing some readings about GBS - that's when I came across a story when a situation went bad. It is, however, as I understand very rare.

Yes, I read about the garlic treatment. I have to admit I'm scared of putting anything in down there. Believe it or not I could never use a tampon!! I think I have a really weird phobia about putting things in there...

[Mummato2]

Hey, my due date is just a week after you!

Arrggh - it's getting way too close hey? I don't know where the time in this pregnancy has gone, with my son it seemed to drag on LOL

There's a due date forum on here as well - feel free to pop in and have a peak around

[tan32]

I was GBS + in my last pregnancy.
I birthed in a birthing unit at my local hospital, my labour was to quick for any antibiotics to be administered. ( 55 minutes)
Bubs was just monitored for 24 hours for his temp.

[JellyBean]

If you start supplementing with probiotics (friendly bacteria) day and night, the chances of you having strep B are next to none.
Just head to your nearest health shop - they need to be kept in fridge. Brilliant for babies immunity too - will enhance their absorption of nutrients when passed on via breastmilk. This probiotic bacteria is what is killed off when you or bubs are administered antibiotics, by the way - a major contributor to digestive issues for newborns - definitely something you want to avoid!

XX

[LadyNoor]

Corey, that is so true. Second time around pregnancy seem to go quicker.. I'll peek around on the forum - thanks

Tan32, thanks for sharing. Glad everything went smoothly with your last birth. I have always wished to birth in a birth centre, but now since the choice is hospital birth or homebirth I choose the latter

Tania, thanks for the tips. I've been taking Fast-tract probiotics in the past 2 weeks and will continue to do so (if my second order arrive soon!!) at least until birth. I do so to get rid of the lingering thrush/itch I have with this pregnancy (I started another thread about this). Fast-tract seem to prevent the thrush to a full blown, and I manage the external itch by applying canesten cream once-twice daily as suggested by one of bellybelly member forum.

[Boopa]

Hi,
Ladynoor I was in the same position 20 months ago and I made the decision no to have the test. I'm allergic to Penicillin and didn't want the alternative AB's at home.
The test isn't overly reliable either.

My membranes ended up rupturing about 30 hrs before I went into labour and i didn't feel stressed at all. I was still quite happy to wait 3-4days( if everything was fine) and check my Temp. Technically if i was in hospital I would have had AB's at 18-24hrs but such is the beauty of birthing at home.
Anyway to cut a long story short , everything was fine with daughter.

Some hospital don't even swab for GBS and work on risk factors such as prematuriy and prolonged ROM with no difference to outcomes when compared to prophylactic AB"s from a positive swab.
Good Luck with your decision

[Kazmar]

I was + with both pregnancies. I wanted to leave the next day with Lucy but the only reason I couldn't was that they only got one dose of medicine during my labour. My labour was only 2hrs.
We had to stay another night just to keep an eye on Lucy. Know matter how much I wanted to leave, I had the blues so bad in hospital, I knew it was best for Lucy they kept an eye on her.
I would have the test as I know of a baby who died from group b step.

[Tegam]

Im guessing that there is one thing that you dont mind being stuck up there or you wouldnt be needing a HB LOL!

I was GBS+ for my first, hospital birth, IVAB, Baby temp checked....
GBS+ for 2nd pregnancy, born within 2hrs, no ABs, went home 4hrs after birth and just did temp at home!
Didnt bother testing for 3rd bub and wasnt worried at all. r\

Read a study that mentioned that the biggest risk for a baby to get GBS is not the mother having GBS but the trauma it faces in a hospital birth. You think about it, being taken away from its mother. weighted on those cold scales, needles at birth! If you have seen what a baby goes thru then you understand. Whereas a HB baby cuddles mum! On her chest, calm, peaceful, almost the way it should be!


Hey Kelly, do i understand from your post that you would have another hospital birth? Or did you mean you would have the AB again? I would have thought you would love to get the chance to have a baby at home?

[CinderToriella]

I have to do the test for my next appoitment next week

still dont know what to do, reason being is that i want to have a water birth and be able to move around when ever i want to , but does having the antibiotics restrict this?

How do they give u the antibiotics etc?