GBS infection
No universal screening
- only few with colonization contract infection
- No entirely accurate screening
- 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