GBS infection

No universal screening

  1. only few with colonization contract infection
  2. No entirely accurate screening
  3. Babies born prematurely before screening

Risk factors

Previous baby with GBS
maternal GBS carriage Identified by Ix
Preterm birth
Prolonged Rupture of membranes
suspected maternal intrapartum Infection (Chorioamniotis)
Pyrexia

Antepartum

Previous Pregnancy with GBS

Bacteriological testing

35-37 POG
or 3-5 wk before delivery

Twins
32-34 weeks

IAP

Previous Baby with GBS

IAP

screening test for carrier status

Lower Vagina and Anorectal swabs

GBS Bacteriuria

Growth > 10 5 CFU /ml

IAP

GBS detected in
Early Pregnancy

No IAP

Found in incidental
or intentionally

IAP

Intrapartum

EL/LSCS

intact membrane
(even if preterm)

No IAP

SRM

IAP

PROM

TPROM

Carrier

carrier status unknown or Negative

No IAP

Maternal Pyrexia + unknown GBS Status

Broad spectrum
Ab covering GBS

Chorioamnionitis

IV Amoxycillin 2g 6 hrly
(or IV cefuroxime 1.5g 6 hrly)

Preterm Labour

IAP

PPROM

IAP

POG > 34 Wk
And if carrier

Onset of labour
Or Induction

IAP

< 34 wk

Overt infection

O. Erythromycin 250mg 6 hrly
Max of 10 days
or until delivery

IAP

ASAP after onset of labour
IV Benzyl Penicillin 3g stat
1.5g 4hrly until Delivery

first dose 4 hrs prior to delivery

Amoxicillin is an alternative

Penicillin Allergy

Cefuroxime 1.5 g Stat
750 mg 8 hrly

Beta Lactam Alx

Vancomycin 1g 12 hrly

Post partum

Newborn Sepsis

Symptoms

Penicillin
& Gentamycin

  • Abnormal behaviour (inconsolable crying)
  • Unusual floppy
  • Feeding difficulties
  • hypo <36 /hyperthermia >38
  • Rapid breathing
  • Change in Skin Colour

Clinically well baby

Mother received
IAP

Mother didn't

No special Observation

Signs for infection checked 0,1,2 hours & 2 hrly x 12 hours

mother with previous GBS

Antibiotics

Therapeutic

Prophylactic

GBS

Chorio amnionitis

Benzyl Penicillin

Amoxicillin

Cephalosporin

Vancomycin

Prophylactic Erythromycin 250mg 6 hrly max 10d or until delivery

GBS

Penicillin

  • Gentamycin

Chorioamnionitis

IV Amoxicillin 2g 6hrly
(IV Cefuroxime 1.5g 6hrly)
IV Metronidazole
STAT
Oral × 1wk