Group B Strep Testing

I've been asked to do a review of GBS and GBSS for my charity - we're trying to raise awareness of what it is and why women should be tested (in the UK it is not policy and the NHS thinks it is a waste of money). As background, I'd like to include policy and practice of other countries so would people please share with me what happens not just in Australia but in all the other countries we have here or that we know about? That we're not tested now may not worry people until they find out that the rest of the world is because of the seriousness of this.

Many thanks.

I was tested at 34 or 36 weeks (sorry cant remember :doh: and it was a quick swab taken during my Dr visit. (I did midwife care with a few Dr visits scattered in between). I tested positive and as a result was given anti-biotics every 4 hours during labour to prevent Isabelle getting sick. I was also told 30% of women test positive. Some hospitals dont do the test until later in pregnancy, as you may have tested positive at 36 weeks but may not have 2-3 weeks later, or some people may test negative at this test but still be positive at birth, so the whole timing of when the test is done is questioned here as well.
Not sure if that helps or not! :D

What are the rates of infection and mortality from GBS in the UK?

I was never tested. No one ever mentioned anything about it.

My friend WAS tested in the UK RF (wanted to say Ryn then!), at 34 weeks. She was brought in to be induced at 38wks, so she could have anti-b's before and during labour. Her induction failed and she was given an emergency c-section. The epidural didn't work so she had to have a general, she never managed to get DS breastfeeding (which she'd really wanted to) and was treated for PND for nearly 3 years. The on-admission-to-hospital-pre-anti-b swabs, taken 4 weeks after her +ve results, came up -ve. She was, understandably, utterly devastated. That's why they don't routinely test in the UK, it can come and go.

Bx

I was tested at 37 weeks with my DS and have just had my swab done last week with this pregnancy. Both came back +ve. I hated having the IV ab in labour and am very dissapointed to have to have it again this time. But I'm going to go with what my OB recommends and have them.

I have a girl friend who chose not have the ab, her baby became very sick 1 day after he was born and ended up requiring massive doses of ab himself. As a result his sight and hearing have been affected and it was touch and go for him actually pulling through. He is the only one who I've ever heard of having problems though and my Mum says they didn't do the swabs when she had the 4 of us. So I don't know how necessary it is.

I had tests done on my third pregnancy only cause I had a urine infection but they weren't sure at the time what it was. It came back positive for group B strep so when my son was born they stuck a tube down into his stomach and took some fluid for testing. He was also give a single shot of penecillan when he was born. I was already on a drip cause i was induced not sure if i was given anything cause i was always told it would never affect me only the baby if delivered vag naturally birth. The test was never done on my first two or my last two only that I have told the hospital that I have it. I was also told that once you have it you are always a carrier it doesnt just go away. I think it should be done as part of the first lot of test when you find out your pregnant. I met a girl who is now 21 and was born to a mother with group B strep and she was born perfect 24hrs later her life was changed forever because her mother was not tested and they never knew. She cant talk she can barely walk and also wears nappies. She just sits there all day putting beads onto chop sticks. All because a simple test was not performed.

........

In the UK, 1 in 1000 babies have a problem with Strep B and 700 babies each year die, more being disabled to some degree. Testing is suggested at about 36-38w, as that gives a decent show of if you will be strep B positive at birth.

Would it be OK if I used some of your quotes too? It will only be a short piece and I'll use some that warn of the dangers of testing too early too, but want to get permission first.

:) and don't worry, Bec, I wanted to keep calling you Hana for aaaages! Is it routine in Scotland to test then? Ooooh dear (or "oh duh-ear", as DS says) - another across the border conflict! I can hear the chuntering starting already.

Some hospitals offer it and some don't. It isn't routine (even a 2nd trimester scan isn't routine here!). To be honest i'm not sure why they tested her, i think she may even have paid to be tested herself, thinking it was a good idea. In scotland it is routine to give all women who have not given birth within 18 hours of rupture of membranes IV antibiotics to counteract risk of any infection, including Strep B and this is usually effective. You don't even have to have them IV - i gave birth at 6pm but if i'd been 9pm or later the midwives had oral anti-b's from the Ped for me to take JIC.

I did look into it all when i was PG - giving birth at home i thought it was a better idea to cover all my bases (because there wouldn't be a paed there to check on her), but everything i read suggested i'd be increasing my risk of intervention and not making my baby any safer. Strep B is a continuous presence but not a continously active infection, you really CAN have it one week and not the next and it is not a danger to the newborn unless it is active (like HPV). I have read of women testing +ve in week 39 and -ve at delivery just a few days later. The friend in question went on to have another elective section because, she told me "My body is infected, i can't give birth to my children", once again the spinal failed, general was needed, once again BFing was made so difficult she didn't continue past day 2, and she is still suffering with PND following this second birth (bubs is 2). I would be interested to read your paper when it's done. Are you going to look at comparative intervantion rates withing groups tested or not tested as well as neonatal mortality and morbidity?

Bx

There is no firm research to support or not support routine testing for group b strep. There are two current approaches used. The first involves performing a swab on each and every woman and treating all women who test positive to GBS with antibiotics during labour. The second involves just treating women who have certain risk factors - fever during labour and birth, or a baby who has previously had GBS.

Currently, most organisations are leaning towards treating according to risk factors, as opposed to swabbing all women, because it is more cost effective. The research indicates that you need to treat a very large number of women unnecessarily, as a result of swabs, to get the same result as treating according to risk factors.

So, in essence, the NHS's view is held up by the available research. We did not swab for our pregnancies, for this reason - even if we had tested positive, there is no guarantee that we would still be positive at birth.

Actually, hang on, I tell a lie. Victoria DID test with Olivia, and came back positive. She took a lot of homeopathics remedies to boost her immune system, and also went on a low yeast diet and added acidophilus supplements to help treat an outbreak of thrush she also had at the same time. when we swabbed later on, it came back negative. So once more, it shows that the value of routine swabbing is questionable (although it did prompt Victoria to try and combat the infection at the time).

Garlic cloves as pessaries are, i have read, very effective in treating strep B.

Bx

Ooooh, that does NOT sound nice, Bec!

I admit, I looked into testing and decided against it myself while pregnant. I'm half-thinking of doing two pieces, one pro-testing, as requested, and one with my findings and why testing isn't routine. It's not a full-on paper, more a small article, but I'll do one from just the promotional leaflets and one from wider sources and see which is needed - maybe both will be used, one for Strep B awareness week and one for the charity newsletter!

To be honest i am very wary of anything that further medicalises birth. The garlic is also good for various bacterial infections and thrush, and no, it's not nice, but it sure beats the antibiotics/Pill failure/miscarriage i had the first time i had bacterial vaginosis and was misdiagnosed with Trichomoniasis.

Bx

I had the swab done at 30 weeks. I was told that if I didn't know my results or didn't have the test done, I would be treated as if I was positive. My sister in law had the test done, she never found out her results. A few days after her son was born, he had some troubles, ended up having convulsions because his body was silently starving himself, he had no energy to cry. He was taken to hospital where tests where done, turns out he had strep b. His development has been a bit slower than normal, but he is still developing. They may not know the full effect of it until he is a bit older. Fingers crossed he will be ok.

Well, thankfully DS was awake for almost 2 hours in the middle of the night, so I have been able to think about this a lot!

700 preventable deaths a year is almost 2 a day, is a largeish secondary school and the feeder primary schools all wiped out. So that's a lot of dead babies. And many more disabled to some degree or another.

But, as you say Bec, it is medicinalising birth, which was a reason why I didn't want the test. (Is medicinalising a word, btw?) But that doesn't mean it shouldn't be routinely offered and available on the NHS to all women. If even one baby dies from something preventable we should look at preventing that death. Surely the cost to the NHS will be outweighed by fewer disabilities in growing children and adults.

That said, I won't be tested next time. But mainly because that would mean telling the NHS that I'm pregnant and I'm not going to do that.

I used to work for a disability charity so I am all too well aware of the profound effects on a family's life when they have a child with a disability. Often disabilities cannot be prevented but not taking a simple test to prevent disabilities arising from Strep B related stuff is inconceivable to me. My ob tests as a matter of course and it was a simple swab that I took myself so completely non-invasive.

But the test is known to be unreliable. You can test -ve and actually be +ve and vice versa.

Those figures were good Ryn thanks. That means that the mortality is, overall, about 1.3 per 100000 live births. Which is about the same as the neonatal mortality from uterine rupture during VBAC. And clearly studies have shown despite this the risks of a section outweight those of a rupture. Do you mean, with your 1 in 1000 that 0.1% of babies have lasting damage, or have active infection. I know around 70% of babies born to Strep B +ve mums culture +ve at birth, but of those only around 1-2% become ill.

I suppose for me it's about managing risk factors. I wouldn't test for it because if you test -ve you STILL get the IV antibiotics if you have ROM >18 hours before birth or have a fever during labour, and if you test +ve you cannot have a home birth, have to have IV antibiotics no matter what and have bubs taken away for observation right after birth in some hospitals, even if they seem fine. And on top of all of that you can be +ve and test -ve and vice versa. I just don't see the point in a test which is diagnostically unreliable when it can so dramatically change how your baby "has" to be birthed. In addition, StrepB was cited to my friend many times as a reason she shouldn't seek VBAC, and she is now convinced her body is infected and dirty and her vagina isn't fit for a baby to travel down it. I imagine that would happen to many women seeking VBAC with either historical or current GBS +ve test results.

What is the mortality rate in the US or in AUS where testing is routine? There are going to be many many women who are StrepB +ve whose babies are -ve or +ve but have no difficulties and women who test StrepB-ve who are actually +ve at the time of birth and whose babies will get ill. Birth is a risky business.

I can't help feeling, given the nature of the infection, that it'd be more useful to dramatically reduce the use of ARM in inductions and VE's to a bare minimum (i.e. none) than to test everyone with a dodgy test.

Bx

I hear what you're saying Hoobley and each to their own but personally, regardless of the unreliability of the test, the actual birth experience is just not that important to me to risk having a child with a disability. I have met parents who still have to get up hourly through the night in order to keep their teenage daughter alive. So basically they have a 15-year-old daughter who has the needs of a newborn baby. In comparison to that, a somewhat restricted labour with a drip pales into insignificance. But like I said, each to their own. We all have choices in life and as long as we are given all the facts we have to make our own choices and live by our decisions.

Yes, of course, everyone must make their own choices on that regard, but would you want the same restricted labour if you tested GBS -ve? Just in case, since the test is unreliable? I mean, shouldn't we ALL then be having the full anti-GBS intervention? It's not that i think GBS isn't a problem, it's more that i can't see how the test does anything to solve the problem.

Bx

Maybe we should just give every woman a 3-week course of antibiotic pessaries to clear up an infection before birth (longer if you go overdue)... no drip and an infection that wasn't picked up or acquired later doesn't happen.

Then the Strep B gains an immunity... but that could happen with the drip anyway. It's a very tough call, but that doesn't mean the test, along with the data, shouldn't be available.

The data is slightly biased, I feel, by the fact it's from the group that wants testing to be made compulsary; I do not dispute the figures, but that's all I can really double-check right now.

Yep, I see what you're saying Hoobley and I don't know enough about the medical ins and outs. Presumably even though Strep B can come and go the chances of it appearing after a negative test are absolutely minimial or yes, they might as well not test anyone and give us ALL the drip. I guess having been so close to parents/families/people with a disability I would do absolutely anything within my power to minimise the risk even if that meant me having a very restricted labour. Labour is only one day and I would rather have the labour from hell and give a baby the best shot at life. Seven hundred babies a year sounds awfully high to me - I've just read figures that says 500 babies die of SIDS in the UK every year.

Wow, Fiona, you had a short labour! 2 days for me (33 hours). Yup, we have lots of dead babies and it's never something that the profesionals can do anything about... maybe have midwives ask where and how the baby sleeps could catch some, but who cares that they don't? Same with outdated advice from our healthcarers and doctors.

Bec, where did you get the info on the garlic? I'd like to include that if possible, but need a reference for it (even just the name of a homeopath or whatever).

It's in my Homeopathic and Natural Medicine For The Family book Ryn but i've seen it lots of places - try googling "vaginal infection garlic pessary" and see what you get.

fionas i just found a study which says that it found that among women tested at 26-28weeks only 65% of those who tested +ve were still +ve when they gave birth and 8% of those who tested -ve at 28 weeks were +ve when they gave birth. The optimal time to test is reported to be 35-37 weeks but the study admits some women will have given birth before the results come back which lowers the efficacy of the testing programme.

The danger of treating all women with antibiotics for 3 weeks before birth is that a) in 20 years we will have SuperGBS which cannot be treated and overall there will be more deaths and b) men can be GBS +ve too and one would have to refrain from sex after the anti-b's had been given. And we ALL know how handy sex can be to either get labour started or fill time until it starts ;) Also GBS lives in the rectum too so i think it'd need to be oral anti-b's, for the systemic effect.

GBS becteria live low in the vagina, VE's carry a very high risk of spreading infection. I wonder how much lower GBS rates would be if no VE's were given once membranes had ruptured...?

Ryn you might also want to look into prematurity. GBS is the leading cause of pneumonia and sepsis in premature babies. In fact i'd be willing to bet that quite a high proprtion of the 700 annual deaths are premmies. Prematurity is a big risk factor.

Are you also going to cover late-onset GBS? It seems about half of the 700 annual deaths would be from late-onset GBS, which antibiotics before/during labour have no effect on. That takes the preventable mortality rate by us testing significantly lower once again doesn't it?

fionas i seem to have given you the impression that my labour mattered more to me than my baby. It's not the case at all. It's just that the treatment for GBS raises the risk of intervention. Continuous fetal monitoring and inability of mum to move around (because of monitoring and drip etc.) have both been shown to increase the risk of assisted delivery and c-section, procedures which carry their own risks, some higher than that of GBS. If i DO have GBS and i'm not treated my baby has a 1.3 in 100,000 chance of dying. If i am treated for the GBS i have and the treatment results in a section, my baby has a 1 in 100 chance of dying. Thus if i MIGHT NOT have GBS i am certainly NOT going to risk my baby by having unecessary treatment which might jeapordis his/her life.

Bx

Here in Ontario, Canada, women are generally tested at 35-37 weeks. I was told that they expect those results to be good for about 5 weeks, since GBS is transient. What I was told about the disease is that something like 15-40% of women will test positive, and a small percentage of those will pass that infection on to their baby. Generally, if the baby is infected, it will be a minor infection, but in a small percentage again, the disease can become serious enough to be fatal.
The testing is not completely standard, though. I think that some doctors will opt not to test you unless you are at high risk for passing the infection on to your baby. (ie. - premature baby, previous GBS infection, etc.) Women may also refuse the test if they want.
Treatment is IV antibiotics in labour. Some areas permit midwives to administer the IV at home in early labour, and other areas require the IV to be administered in hospital during labour.
Results thus far are showing apparently that when every woman is screened and every positive result is treated, the number of neonatal deaths from this infection is cut in half.

:

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Results thus far are showing apparently that when every woman is screened and every positive result is treated, the number of neonatal deaths from this infection is cut in half.

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Sorry for being the ever-present pedant! Is this compared to risk-factor only treatment or no treatment?

Bx

One of the factors that needs to be considered here, as well, is the impact on the mother (and to a certain extent, the unborn baby) of the use of antibiotics. In recent reviews of the literature surrounding GBS in Australia, it was determined that we would need to treat 20000 women to prevent one case of GBS; however, this would result in around 2 cases of anaphylaxis, a life-threatening allergic reaction to antibiotics. In addition, the widespread use of penicillin as an atibiotic for GBS leads to penicillin-resistant e. coli infection in the newborn, another serious form of sepsis. This is necessitating a switch to different antibiotics, which also have the potential to select for antibiotic-resistant flora in both the mother and the unborn baby.

It is for these reasons that it is impossible, so far, to advocate for one method or the other. I am aware of the Canadian evidence, and it was taken into consideration in the Australian review, however because the numbers in this and other studies are low (GBS infection is, thankfully, quite a rare complication) and because GBS is quite a common organism in the vagina and, as such, so many women will test positive and thus require treatment under the universal treatment approach, exposing them to other risk factors besides the GBS, in Australia, it is up to the woman and her health care provider.

Hi,

I had my bubs only 3 months ago.
I was tested for strep B at 36 weeks here. It is routine in Victorian public hospitals. My hospital actually provides you with the swab, and tels you to do it at home and take it to pathology yourself.

As I said I tested positive, my membranes ruptured and nothing happened so I was put on antibiotics at the same time as being induced.
I was told I would have 3 or 4 courses during the labor every 4 hours, however my labor only lasted 4 hours. I was told that due to only one course our minimum stay in hospital would be 48 hours which was required for monitoring bubs, as a Strep B infection can cause Pneumonia. They took his temp every couple of hours to make sure it didn't fluctuate and become very high.

I am one of those people schmickers mentioned that can't have penicillin, and it seems to run in our family, so future generation may increase the amount of people with allergies to penicillin. I had a different anti-biotic.