Group B Streptococcus (GBS) in Pregnancy: Hold the Vancomycin?
Sunday, October 22, 2006
Kenneth F. Trofatter, Jr., MD, PhD
Far many more babies become “colonized” at delivery than ever go on to develop serious complications. The reason for this is unclear but it is probably a function of the extent of maternal colonization, the ‘quality’ of the maternal immune response to the organism (and the degree to which maternal antibody has been transferred to the fetus), and the gestational age of the baby (although serious infections can occur at any gestational age, premature babies are highly susceptible). About two-thirds of serious GBS infections are apparent at the time of delivery and 90% of babies who will develop complications do so within the first 48 hr after delivery. This is generally referred to as “early-onset” GBS infection and technically is used to define disease occurring in the first week of life. “Late-onset” disease affects another 10% of newborns, often presents as meningitis with septicemia, and rarely occurs after one month of age. Up to one-third of the survivors of GBS meningitis will develop long-term physical and/or neurological handicaps and in 1 of every 8 of these babies, the handicaps will be severe.
Because of the high morbidity associated with neonatal GBS infections, the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), and the Centers for Disease Control (CDC) endorse routine screening of all pregnant women for GBS at 35-37 weeks’ gestation, and prophylactic antibiotic treatment at the time of labor in those found to be colonized with GBS. Screening is performed by swabbing the lower vagina and rectum and culturing for the organism on ‘selective’ media. GBS may come and go, but a negative test within 5 weeks of delivery has a ‘negative predictive value’ of about 95%. This implies that only 5% of women are likely to acquire GBS between the time of screening and delivery. Interestingly, if GBS is detected at routine screening, the ‘positive predictive value’ of the bacteria actually being found at delivery is only about 87%.
The goal of prophylactic antibiotic therapy is to deliver antibiotics to the mother early enough in the course of labor that sufficient drug can be transferred across the placenta to achieve protective levels in the baby prior to birth. That means, the antibiotic selected must not only be able to kill GBS, but it must also be able to cross the placenta. Fortunately, GBS has not yet been found to have developed resistance to the antibiotic of choice, penicillin G, and this drug also readily crosses the placenta. It also has a long and proven safety record for the baby. Ideally, antibiotic therapy is begun, intravenously, at least 4 hr prior to delivery so that at least one or two doses can be administered before the baby is born.
Unfortunately, about 12% of the population report “allergies” to penicillin. If the risk of serious allergic reaction (anaphylaxis) to penicillin is deemed significant, traditionally, prophylaxis has been attempted with either erythromycin or clindamycin. Both of these cross the placenta (clindamycin much better than erythromycin), although they do so more slowly than penicillin. The larger problem with these antibiotics is that GBS resistance rates are as high as 35-40% for erythromycin and range between 15% and 30% for clindamycin. If a woman is suspected to be allergic to penicillin, and known to be a carrier, or at risk for GBS colonization, susceptibility testing should be requested at the time culture is performed for GBS.
The dilemma becomes apparent when a pregnant woman is allergic to penicillin and also has GBS that is resistant to these other antibiotics, particularly clindamycin. Vancomycin is highly active against GBS and has been suggested as an alternative under these circumstances, although effective dosage regimens are not yet clear. Dr. Joann Laiprasert recently reported at the meeting of the Infectious Diseases Society for Obstetrics and Gynecology that vancomycin, given to 13 healthy pregnant volunteers, achieved therapeutic levels in the fetuses, but not without maternal complications. An attempt was made to administer 1 gram of the drug intravenously over 60 minutes and 90 minutes. More than half of the women did not complete the full course of therapy because they developed a complication common to vancomycin recipients termed “Red Man’s Syndrome.” Symptoms include itching, rash, shortness of breath and hypotension. One woman required oxygen therapy, but no apparent fetal complications developed. More work will obviously have to be done here before vancomycin can be considered to be the ‘alternative of choice.’ By the way, did I mention what vancomycin COSTS$$$$$$$$
There are several other high risk situations in which prophylactic GBS therapy is also currently recommended including:
• Premature labor or rupture of membranes before 37 weeks
• Prolonged rupture of membranes (18 hr or longer) before delivery
• Fever in labor (100.4F or higher)
• History of GBS urinary tract infection during the pregnancy (4-fold risk)
• Previous baby affected by GBS disease (increases risk 10-fold!!!)
Some practitioners will also treat all women who present in labor and have not received prenatal care or who missed routine screening for GBS at 35-37 weeks, although the risk/benefit ratio of this approach is not necessarily proven. According to the CDC, women who are GBS positive, and not in one of the ‘high risk’ groups above, have about a 1 in 200 chance of having a baby who develops GBS disease if antibiotics are NOT given and only 1 in 4000 risk if they are given. Cesarean delivery is NOT indicated to prevent GBS transmission to the baby.
58 Comments:
At Thu May 24, 01:28:00 PM 2007,
Anonymous said…
what if you have twins less than two weeks old, one has been diagnois with meningitis.Is there a possibility the other will also have it? These babies were deliveery by c-section
At Sat May 26, 06:43:00 AM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
Hi there. I am assuming your doctors believe the baby has GBS meningitis since you have left this comment under my post on the same topic. Since this occurred within the first month after delivery,but outside the immediate post partum period, this is techincially 'late onset disease.' Yes, it is possible for the other baby to get this as well, especially, if they were a little premature. Some physicians might consider treating the other baby prophylactically with antibiotics, even if it not sick at this time, under these circumstances because the 'risk factors' are the same for both, but you will have to raise that issue with your pediatrician. I hope things turn out alright for all of you. Thanks for reading and for your question.
At Sun Aug 12, 05:06:00 PM 2007,
tbloom said…
I have been positive for GBS twice, the last time my 36 week old was stillborn. I don't know that GBS was the cause, but if it was, because I'm now pregnant again and am frightened about the possibility of the fetus contracting GBS in the womb. What can be done to prevent this since typically antibiotics are given during labor?
At Tue Aug 14, 06:50:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Aug 12: It would be very helpful to know if you lost your baby because of GBS or for some other reason. People who are chronically colonized by GBS probably do not develop a proper immune response to it or get repeatedly reinfected by another person in their environment. Although, most women who have GBS still do not have babies with problems, because of your loss, you would be someone I would screen repeatedly during another pregnancy (especially the urine) and if you become positive again, consider placing on antibiotic suppression during the latter part of the third trimester. Thanks for your question. Talk to your doctors about your concern. Dr T
At Mon Aug 20, 11:32:00 AM 2007,
Anonymous said…
Hi there Dr. T. I am 36 1/2 weeks and I just found out that I was GBS+ and I am very concerned about my baby. I wonder, why give antibiotics during labor? Why not now? I have also had many problems with yeast infections during my pregnancy and was wondering if that could have caused the GBS? I don't completely understand why I have it and what I did to get it. Is it caused from something, perhaps the heat? Not being clean enough? Please help me!
At Mon Aug 20, 05:47:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Aug 20: Such a good question! Worthy of a general post. See yourself featured in today's blog and thanks for reading.
Dr T
At Mon Aug 27, 10:50:00 PM 2007,
Anonymous said…
I tested positive for group B strep during pregnancy but an error was made in my chart and I was not treated. My baby was sent to a Children's Hospital and treated. My question is: Could she still become infected with late onset GBS?
At Tue Aug 28, 06:18:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Aug 27: Was your child sent to the Children's Hospital because she had Group B strep sepsis or for another reason? Was she premature? Although anything is possible, once she is treated it is fairly unlikely that she will develop serious "late onset disease." I hope she does well, and thank you for reading! Dr T
At Sat Sep 01, 06:07:00 PM 2007,
Anonymous said…
I am 13 weeks pregnant and tested positive for Group B strep. My doctor wrote me a prescription for Ampicillin 500mg qid. Is this really necessary if have to be tested again at 37 weeks and IV therapy during labor?
A. Sanchez
At Tue Sep 04, 05:05:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To A. Sanchez Aug 1: I am not going to second guess your doctor at this point. I would ask you, though, why were you checked for BBS that early in pregnancy? Did you have a complication related to GBS with a previous pregnancy? Did you have a urinary tract infection with GBS with the current pregnancy? An affirmative answer to any of those questions might explain why your doctor chose to treat you. Thanks for reading! Dr T
At Tue Sep 04, 07:51:00 PM 2007,
Anonymous said…
I recently delivered a baby via emergency c-section due to fetal distress. My water broke at 36 weeks and within an hour and a half, the baby's heartrate plummetted and the Dr. felt he had to perform the c-section under a general anesthetic because there was not time for an epidural or spinal. Anyway, when my baby was born, he was having difficulty regulating temperature, breathing, etc. and after testing, it was determined that he had GBS. Even before the cultures were back, he was transferred to the NICU and started on antibiotics right away and seems to be doing well now 6 weeks later. It seems that he likely contracted it in utero as my membranes were only ruptured for a short period of time and he was already in distress prior to delivery. Since in my situation, it would not have helped to have IV antibiotics during delivery, is there any way to prevent or monitor this in future pregnancies to keep this from happening again? Can the GBS be treated prior to delivery or is there a way to monitor the baby to make sure that it is not being infected? I am very fearful of becoming pregnant again as I don't want this to happen again and my Dr's don't seem to have a good understanding of how the baby even contracted it in the first place (since it did not happen during delivery) so I'm not sure that they will know what to do in the future. Any input would be appreciated. Thank you.
At Fri Sep 07, 06:13:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Sept 4: GBS can cross the membranes prior to their rupture and can also be transmitted to the baby across the placenta as the result of GBS bacteremia, especially with urinary tract infections. These events, as well as risk for neonatal infection seem to be more common in women who have a suboptimal immune response to GBS, ie, they don't make the right antibodies. Remember, many more women actually carry GBS than have complications related to it. Many physicians will treat for GBS prophylactically (especially if the standard screening has not been done)in any woman who presents in active labor preterm or with premature rupture of membranes. I do not know what your provider's policy is in that regard, but it sounds like you didn't give them much time to think about it either! From what you told me, the baby already had the infection in utero, hence the 'fetal distress'. The current recommendation for a subsequent pregnancy for someone in your situation is stiill NOT to treat prophylactically for GBS until labor. Of course you should be screened for evidence of GBS urinary tract infection (even if you do NOT have symptoms) and treated appropriately if that occurs during the pregnancy. But, treatemnt just because you are colonized really is not indicated. Because you have had an affected baby, you should probably receive prophylaxis during labor even if screening has been negative. Some doctors don't even bother with screening again for that very reason. By the way, there is no 'test' we can do to monitor the baby under these circumstances. If there ever is a GBS 'vaccine', you would be a good candidate to receive that! Glad things turned out okay, even if they were scary for awhile. Best of luck next time and thanks for reading! Dr T
At Mon Oct 29, 01:54:00 AM 2007,
Anonymous said…
my baby stillborn at 27 weeks due to GBS and it was my first baby. my water broke at 14 weeks i was given gentamycin as an antibiotic treatment given by my doctor. now i'm pregnant again at 7 weeks. what should i do to prevent GBS from infect my baby?
At Mon Oct 29, 01:44:00 PM 2007,
Anonymous said…
i was diagnosed with GBS when i was pregnant with my child. A year later my child is fine without any complications. although i am not! i feel sick all the time and i don't know if this is a cause of this strept b i was told about. what are the effects on the women with strept b? the infections are really painful and constant i don't know what to do at times i just feel like all the doctors are just ignoring my issues. please help. email is kernnapril@aol.com
At Thu Nov 01, 11:42:00 AM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Oct 29 0154: I am not so much worried about the GBS as I am about why you ruptured membranes at 14 weeks with your last pregnancy. Do your doctors have any idea why that happened. Many women are colonized by GBS and most have no trouble at all. I doubt the GBS caused you to rupture your membranes that early because if you had had an intrauterine infection at 14 weeks, you would have delivered LONG before 17 weeks, even with the antibiotic therapy. With the current pregnancy, we do not recommend tryin g to 'cure' the GBS you may still be carrying. You should be treated if you develop a GBS urinary tract infection and you should be given prophylactic antibiotics when you go into labor or rupture your membranes. I wish you the best of luck this time and thank you for reading. Dr T
At Thu Nov 01, 11:45:00 AM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Oct 29 0144: Before I can offer any suggestions, you need to give me more specific information regarding your symptoms. Also, can you tell me more about your pregnancy and delivery? I can tell you with relative CERTAINTY, the problems you are having now are not related to GBS! Thanks for reading. Dr T
At Mon Nov 19, 12:07:00 PM 2007,
Anonymous said…
I am 23 years old and I just went for my yearly appointment. They told me I was strep B positive. I was wondering how you get this and if you can get rid of it before you decided to have kids? I do know about the risk if you are to get pregnant but I asked my doctor and she said since I wasn't having any problems with the GBS that she wasn't going to treat it. So should I not treat it even if in the future I want to have children?
At Mon Nov 26, 06:17:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Nov 19: About 30-40% of people are GBS positive and are chronic carriers. There is no sense 'treating' it now, or even if you become pregnant unless you have a urinary tract infection with GBS or are in labor. Your immune system needs to learn how to keep it in check and both you and your baby (once you get pregnant) are at fairly low risk for complications if the accepted protocols for treatment and prophylaxis are followed. Besides, the next time you are checked, you may be GBS-negative! I am curious though, why were you checked for GBS at your annual exam, or did you have a GBS urinary tract infection? Thanks for reading, and let us know wghen you get pregnant! Dr T
At Fri Dec 07, 10:23:00 AM 2007,
Anonymous said…
hi there i am 32 weeks pregnant and have just tested positive for strep b profuse growth! can u tell me how i caught this please and tell me if my baby will be fine?
thankyou
At Thu Dec 13, 11:43:00 AM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Dec 7: As I have pointed out above, 30-40% of folks are simply 'colonized' with GBS. They carry it in their gastrointestinal tracts and can also have colonization of their vagina. So you didn't really "catch it" from anyone. You might have been a carrier since you were very young. Not all women who carry GBS place their babies at risk. However, it does appear that heavier colonization and urinary tract infections with GBS might indicate that your immune system has not responded well to the bacterium and MAY put you baby at greater risk. The important thing from your standpoint is that you KNOW you have tested positive for GBS and you should receive antibiotic prophylaxis if you go into labor or rupture your membranes. Urinary tract infections should be TREATED and then you should be rechecked to make sure the infection has been cleared from your bladder. Good luck to you! Chances are that things will turn out just fine! Dr T
At Fri Dec 28, 05:13:00 PM 2007,
Anonymous said…
I recently lost my baby girl - she was stillborn at 30 weeks. She had a true knot in her umbilical cord and also had the umbilical cord wrapped around her neck twice. It was also picked up from swabs taken imediately after the birth that both her and I carried Strep B. Because Strep B was picked up they cannot rule out the fact that it could have played a part in her death. I had never heard of this before and Strep B is not routinely tested for in New Zealand. My obstrician has advised for any future pregnancies I would be tested regularly throughout pregnancy and given antibiotics if Strep B is picked up again. Regardless of whether Strep B is present I would be given antibiotics in labour. Whilst this is something that I think about alot I am very grateful that it was picked up and that I can be tested and treated for future pregnancies. I think this website has very good information on Strep B and how it can effect babies. I would like to know how Strep B can effect babies before they are born?
At Fri Jan 04, 06:44:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Dec 28: I am so sorry that you lost your baby. And, you are also correct, we will probably never know which (if either) contributed more to the loss, the GBS or the knot in the cord. It is very unlikely that the cord around the neck caused the problem. To answer your question, GBS can cause an ascending or blood-borne (often from the urinary tract) infection of the placenta and the membranes that can eventually get across to the baby. GBS is a bacterium that makes toxins that can put the baby into septic shock (you might want to query that on the internet to find out what that means) and induce significant brain damage or death without the mother even being aware that a problem is occurring (i.e., you might not even have a fever or tenderness of the uterus). Thank you so much for reading and I wish you the best of luck in the future.
At Fri Feb 15, 03:43:00 PM 2008,
Anonymous said…
I tested postive for gbs during my last pregnancy 5 years ago I was treated with the iv during labor and everything was fine I am now pregnant again since I was positive 5 years ago does that mean I will be positive again?
At Tue Feb 26, 06:18:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Feb 15. No it does not mean you will be positive again and if you and had no complications related to GBS in the previous pregnancy, and test negative during this pregnancy, you will not even need antibiotics in labor. Thanks for reading! Dr T
At Sat Apr 19, 07:48:00 PM 2008,
Anonymous said…
I am a week late. Should I push the issue of being induced and what would the complications be if I were to be induced when positive with strep b?
At Mon Apr 21, 05:46:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous Apr 19: Most providers will push on to delivery by the time you hit 42 weeks (providing the pregnancy dating is good). The routine would be to begin GBS prophylaxis when it looks like you are getting into labor to allow time for the medication to get across to the baby. I prefer to do that before artificially rupturing membranes. Good luck and let us know how things turn out. Dr T
At Sat May 24, 09:21:00 PM 2008,
Anonymous said…
Dear Doctor - in 2000 my son contracted strep b and it wasn't diagnosed until he was 5 weeks old. It was in his spinal fluid by then. He exhibits some symptoms of autism (such as delay in communication skills and anxiety and inability to look most people in the eye). It is beginning to become a problem with his education because his teachers can't assess his learning. We had an RtI and they've placed him in summer school. What can I do to help him develop and be successful?
At Tue May 27, 06:24:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous May 24: One of the things I learned a long time ago is to be honest with patients, especially with regard to my own shortcomings. Your child needs to be thoroughly evaluated by experts in child development and neurobehavior and then started as soon as possible in a program that is suited to his special needs based on that evaluation. If he is indeed compromised, there are special education and funding sources to help maximize his potential. Beyond that, I am sorry, but I can't really help. Best wishes and thank you for reading. Dr T
At Sun Jun 08, 06:18:00 AM 2008,
Anonymous said…
I'm 32 weeks pregnant and had a gbs test, will the results be accurate.
At Sat Jun 14, 09:51:00 AM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous June *: If the test was done properly (swabbing the lower third of the vagina and the rectum, and was cultured on the proper media for detection of GBS, and, of course, if you are a carrier, more than 90% of cases chould be detected. However, even if it is, that does not necessarily mean that you will have it at the time of delivery or have any complications whatsoever related to it; and, the corallary of this is that even if it is not found now, there is still a chance you could have it at the time of delivery and it might cause some problems. Things are NEVER as simple as they seem! Best wishes! Dr T
At Wed Jun 18, 01:28:00 PM 2008,
Anonymous said…
what do you think about this quotes
1."And speaking of totally pointless and harmful practices -- can silly OBs (ok, mostly residents) and L&D nurses PLEASE stop using fetal scalp electrodes without good indication (which is exceedingly rare) in cases of GBS positive? Sure, deadly bacteria, here's a direct portal to the baby... go for it... Most haven't even thought about the connection!! It drives me batty."
http://neonataldoc.blogspot.com/2006/10/gbs.html
how do so many gbs babies survive at home when using home theropy techniques like cut garlic clove?
garlic tecnique
http://www.gentlebirth.org/archives/gbsCohain.html
2.I'm resurrecting this thread as it's not terribly old and I'd like to keep the info in one place.
I tested GBS positive at 36 weeks and was told the results at 37weeks. I requested to be proactive for two weeks and be recultured at 39weeks and my OB said he'd be happy to re-swab. (It would be very difficult to find an antibiotic I could tolerate.)
I've been doing vaginal garlic this past week, but how the heck do you keep it up there? I have no need of sewing floss to it--no matter how far I push it up, my pelvic floor muscles eject it within an hour, whether I'm awake or asleep. I do my kegel exercises pretty much unconsciously while I'm awake, so boom--out it comes. If I put the garlic in before bed, it falls out in my hand the first time I get up to pee.
I'm also doing oral garlic oil and I'll start some oral probiotics. I don't mind doing vaginal yogurt suppositories--I just forgot about that route. ;)
I've thought about GSE and bee propolis, but I really don't want to go for overkill. Echinacea isn't an option (allergic). I get plenty of vitamin C from OJ and Emergen-C.
Has anyone successfully CHANGED their status with garlic alone? I'm 38 weeks today.
http://www.mothering.com/discussions/archive/index.php/sections/about_us/t-644638.html
garlic oil?
oral probiotics?.
yogurt suppositories?
3.
I'm continuing co-care at a birth center while planning a HB, and my hb midwife recommended using the following during the week or so leading up to the test:
probiotics (sounds like you already do that)--both orally and vaginally
garlic--both orally and vaginally
grapefruit seed oil extract (she rec'd pill form, not liquid, for whatever reason)
blueberries
vit c
echinacea
http://www.mothering.com/discussions/archive/index.php/sections/about_us/t-644638.html
4a.When women are treated with antibiotics, the GBS returns soon after antibiotics regime is finished. The same is probably true with garlic. Therefore, if you culture positive and then use garlic to get a negative culture, you might consider inserting garlic once a week until you deliver the baby.
4.The level of garlic "smell" is a very poor indication of the real amount of allicin (active ingredient) that is generated. The olfactory receptors of the average person are so sensitive that even 1 mg of allicin molecules in the air will saturate the receptors so our nose and seem the same as 100 mg.
5."Allicin is gradually produced in the crushed clove for about 2 hours after the clove is damaged and simultaneously degraded. Once in contact with the mucosa or bacteria it degrades rapidly. No one knows how long it can be active when in contact with mucosa. We know that if you drink pure allicin within 5 minutes you can not detect it anymore because it all got adsorbed through the mucosal lining."
6."Bacteria are about 30 times more sensitive to allicin than human cells but at high concentrations also human cells suffer so in conclusion it would be more effective as an antibacterial and less toxic to the mucosa if women would use smaller amounts of crushed garlic with more frequent changes."
http://www.gentlebirth.org/archives/gbsCohain.html
so what do you think about quotes 1-6 give an opinion...
At Sat Jun 21, 06:24:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous June 18: Interesting thread. The truth is that MNAY more women carry GBS than will be at risk for transmitting a serious infection to their baby, but do you want to take that chance?!? I am not sure what benefit, if any, the baby would derive from any of the therapies you have mentioned, The important thing in reducing risk to a baby is to have antibiotic therapy on board PRIOR to delivery. Although I am a BIG fan of garlic (my 96 year old grandmother confided in me just before she died that it was the KEY to life), I am not sure the baby would derive the same benfit that you might from its use. Good luck! Dr T
At Wed Jul 02, 12:00:00 PM 2008,
Anonymous said…
Hi,
I am 29 weeks pregnant with my second one and in my urinalysis dr found something and so sent my urine to lab. The results came back as gbs +ve and my dr feels i do not have uti as i dont have any other symptoms. She did not prescribe any medication to me and said that during c-section ( i have planned c-section due to my previous c-section).
I am freaked out as my first baby did not live longer than 7 days due to other problems. I never had gbs +ve in my first one. For the second one, in my 29 weeks they found out. So my questions are as follows:
a) is my baby at the high risk for contacting bacteria from me in the womb? or the risk is only during delivery?
b) Should i be taking any medication now to stop/reduce bacteria considering urine culture found gbs +ve?
c) What chances are for the baby to get infected inside the womb?
I am freaked out to death as I have lost one baby and do not want anything wrong to happen with second one.
Your reply is greatly appreciated.
simran
At Thu Jul 03, 06:17:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Simran: It is not clear to me from your comment - did you lose that other baby because of GBS and premature delivery? Regardless, if you have GBS in your urine, you SHOULD be treated for that. Women with GBS in their urine are at the greatest risk for complications related to premaure labor, premature rupture of membranes, and uterine, fetal, and neonatal infections. Once you have been treated, you should be retested for GBS in the urine even if you are having NO symptoms. GBS places you at risk for these complications even if yiou are not in labor, but the time of greatest risk is after rupture of membranes and during labor. Best of luck to you. dr t
At Thu Jul 03, 08:29:00 PM 2008,
Cindy Arbogast said…
July 3, 2008
Dear Doctor,
We are so heartbroken. My daughter in law had her GBS test at 34 weeks and delivered vaginally at 37 weeks, she tested negative. We celebrated a healthy baby girl but 2 hours later she was fighting for her life. She went into septic shock. She was taken off of life support about 8 hours after birth. How can you trust the culture, if it comes back wrong? Very little information talks about false negatives. Doesn't human error play a role? Her birth was May 17, 2008, a day that will always be marked in our minds. Please answer two more questions. How long has this GBS been recognized? How far back does it go or thought to be in our world? The autopsy showed she was fully developed and healthy, otherwise. What a heart break. Thank you for your answers. From a very lost grandmother.
At Sat Jul 12, 08:34:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Cindy: I am so sorry. I am curious why did she have the test done at 34 weeks? We usually recommend it be done closer to 36 weeks because a negative test result decreases in predictive value beyond 4 weeks after it is done - in other words, situations like yours become more common 4 weeks past a negative culture. Unfortunately, some people only have the GBS detectable later in pregnancy. And, some people who have it at 36 weeks, don't have it at term when they come in to deliver. And MOST women who have GBS, do not end up with babies affecettd by it. Because your daughter-in-law had a severely affected child, she may not have a normal immune response to GBS or ot might have been something that she just happened to catch late in the pregnancy. I am so sorry for your loss, but it does not sound like anyone did anything wrong.
Dr T
At Sat Jul 12, 09:05:00 PM 2008,
Cindy Arbogast said…
Dear Doctor, I left out some other information. The umbilical cord and placenta tested negative for GBS. What role does this play into? How did our sweet newborn granddaughter get GBS? Thanks again for your answers.
Cindy Arbogast
At Tue Jul 15, 10:19:00 AM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
Cindy: Most likely he was exposed at delivery while passing through the birth canal or coming in contact with the perineum or possibly shortly AFTER delivery - even by someone other than your daughter-in-law. The fact that there was no clearcut infection of the placenta or cord suggests that an ascending infection was less likely to blame. Dr T
At Fri Jul 18, 05:38:00 AM 2008,
Anonymous said…
hi, i lost my baby on the 28.07.08, i was full term plus 1 week, i went into hospital on the saturday after i thought my water broke, i was checked and sent home after being told this wasnt the case, i had labour pains on the tue and was admitted at only 1cm, i had a long difficult labour with a temp of 110oC and not dialating, they did some gas tests on my baby and he was boarder line, they got me ready for a c section, but after an hour they did the test again and he was ok, i delivered an hour later and he'd stopped breathing for 6 mins, they told me he was brain damaged and after tests we decided to turn off the ventaltor, he lived 46 hours hours then went to sleep. khian as i named him had liver damaged that showed it had deteriated over a couple of days, i am still awaiting post morton results. just before Khian died the doctors told me i had strep b, from a test they had done on the saturday,so i pressume this is why khian died. i am now wanting to try for another baby and im scared to death this will happen again, am i safe to try? what are the chances of it happening again? i was treated with IV anti's but how do i know its gone? i have not even been given a 6 wk chk, but im chasing it up.am i likely to have another brain damaged child, they said next time i can have a c section, im so worried cause last time everything seemed so perfect all the way through there were no problems at all. many thanks kelly
At Fri Jul 18, 06:23:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
Oh, Kelly, I am SO sorry. As you will find in your reading about GBS, many more people carry it than ever have problems, but there are those that do. Even being treated with the antibiotics, you may well NOT be cured - people who carry GBS, tend to continue to carry it. But your doctors will be prepared to protect your baby the next time knowing you had the problems you did this time. The chance of another brain-damaged baby under those circumstances is very low. Again, I am so sorry. We will be thinking about you.
Dr T
At Sat Aug 09, 04:36:00 PM 2008,
laila said…
Hi there. I just saw my Dr. yesterday, and she informed me that I tested positive for group B strep,
she didn't seem too worried about it, but I'm freaking out right now, I'm scheduled for a C-Section next week for another reason (I delivered with C-Section
6 1/2 years ago, they think i might have a Scar tissue
that might not stech during a natural vaginal birth)
anyhow, my Dr. said that i don't need antibioticssince i'm having the C-Section, but i can't help it i'm too worried about this specially after reading some stories. please help i'm going crazy.
i also would like to know if my C-Section incision or better say my scar tissue would be infected?
and is the baby going to be exposed to the GBS?
thank you in advance for any input.
At Wed Aug 13, 05:06:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Laila: Currently GBS prophylaxis is NOT widely used for elective c/sections in patients who have not labored or had the membranes rupture. You will probably do just fine. Your doctor will probably use some prohylactic antibiotics just before starting the surgery or after the umbilical cord is clamped. Good luck! Dr T
At Wed Sep 10, 04:07:00 PM 2008,
Anonymous said…
dr. t,
i am 7 weeks pregnant and just found out i have tested positive for gbs. this is my first prenancy. i also have hyperthyroid disease and a weakened immune system. i am VERY concerned as to how the thyroid, my weakend immune system, and the gbs will affect baby.
also, last week i had to go to the ER because i had a "bleed" and when they did an internal ultrasound they found that i had a hemorrhage. we did hear a strong heartbeat and otherwise they said as far as they could tell the baby was healthy. this was before they found the gbs.
concerned,
Amy
At Mon Sep 22, 12:36:00 PM 2008,
Anonymous said…
hi my name is kelly, i last wrote to you on the 18 of july this year after losing my baby when he was 46 hours old. I had a perfect pregnancy and at 41 weeks i went to hospital telling them my waters broke, they told me they hadnt and that it was my bladder. I was sent home untill the tuesday when i had labour pains,i had a long difficult birth and when my son Khian came out he wasnt breathing, i had to make a desion to take him off the venterlator, the doctor said some tests came back and that i had GBS and Khian had brain damage and liver damage of a which he felt had detrioted over a few days, the doctors said this co-insided with my waters breaking therefore passing the GBS infection to him, my son died and since the post mortom confirmed all of this, and i am still waiting for the outcome of thier investigation.
I am now 7 weeks pregnant, and so scared this will happen again, in england they dont test for GBS,only in your first appt when they ask you to do a mid stream sample. what advice do you have for me? should i buy these tests privatly and when should i start doing them, straight away or in the last trimester? when you talk of coming into contact with GBS in 'your enviroment'and re infecting yourself, do you mean partners ? also i am allergic to penecillin and my understanding is that the other drugs are not as effective, can they test me to see if i actually am allergic as this is was my mum who said i came out in a rash once. Also in hospital i was on a antibiotic drip for nearly 2 days and had 2 other courses of tablets for about anther 2 or 3 weeks because they didnt think it was going, although they never checked.
when can i pass GBS to my unborn child? is it only if my waters break? sorry to ask so many questions but i really dont feel i am getting any support anywhere, no one really seems to know much about it, although i have been booked in for a scan next week and i believe i will have consultant care,and can have a selective c section, i would still really appriciate your opinion thank you, i look forward to hearing from you. kelly
At Tue Sep 23, 12:29:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Amy: GBS generally is not associated so much with early pregnancy complications as it is with later ones. Why were you tested for GBS or was this found in a urine culture? Urinary tract infections wih GBS are a cause for concern during pregnancy because of the increased risk for premature labor and early rupture of membranes. What kind of thyroid disorder do you have and how ar you being treated? Why do you think you have a weakened immune system? Best wishes! Dr T
At Mon Sep 29, 08:28:00 PM 2008,
Anonymous said…
Hi!
I had GBS present in my urine at 12 weeks with my last pregnancy. I was on three rounds of antibiotics until it was out of my urine. A few weeks after the negative urine test, (30 weeks gestation) I delivered my baby boy. I tested positive again for GBS and fortunately I had medication at delivery to prevent him from getting it. I did have a UTI after birth that they believe the GBS caused. The doctor said they can only say clinically that they are 90% sure the GBS was the cause of the pre-term birth. I had a perfect pregnancy other than the GBS (which I was originally told was not a big deal).
We are looking to conceive again and want to know the risks involved for this next pregnancy. What are the risks of another pre-term delivery? What are the risks of GBS being a problem again? What precautionary steps can we take? How often should I be tested for GBS?
I really appreciate your website. I have looked for answers to these questions but can't find anything since he did not actually contract GBS.
Thanks!
At Tue Sep 30, 01:02:00 PM 2008,
Anonymous said…
dr. t,
i had a urine culture done, so that is how they found the group b strep. im on synthroid for my overactive thyroid and they told me my immune system was more than likely weaker than usual because when i had my thyroid tested recently, some of my levels were off. i dont remember specifically which ones though. also i just found out i have a urinary tract infection. i keep reading that testing for group b strep before 35 weeks is not accurate because it comes and goes, so why did my doctor put me on 250mg of amoxicillan to take three times a day?(this was before i found out about my UTI.) Is it really safe for the baby for me to be taking so much antibiotics?
confused.
Amy
At Sun Oct 05, 05:10:00 AM 2008,
danie ga said…
Dear Doctor
First off, had come across the page by chance whilst surfing for more info on GBS. I feel you are really sincere in your advice and are very kind in your words.
Have read most of your replies on GBS and as I have been planning for a water birth with a midwife, currently at 36wks, have a few choices I need to make which I am hoping for some advice.
1) My midwife and doc are hoping to prescribe me a duration of oral antibiotics for my GBS which I am to take all the way till labor. From what I've read, am not sure if it works as well as IV antibiotics given 4h prior to labor
2) If I am not high risk and do get an IV drip prior to labor, what are the risks I am exposing my baby to? I have read that antibiotics during labor could do something which may potentially reduce the immunity system of my baby. If so, I am wondering if I should reject antibiotics at all.
3) Do you know if having a water birth after being treated (via IV) with antibiotics still possible?
Thanks for reading and looking forward to your kind response
At Sun Oct 05, 06:05:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Kelly: I am afraid Khian had a classic case of GBS sepsis and I am so sorry. In the UK, there are specialist in Maternal-Fetal Medicine and becuase of your tragic loss, a referral to one should be available to you. I would NOT recommend self-testing for GBS even if you could get the test kits. That is something your providers should do for you. With this pregnancy, you shoul;d be treated with antibiotics in labor even if you test negative for GBS during the pregnancy. Penicillin is the most effective treatment because it readily gets across to the baby. Ask your providers if you can be "desensitized" to penicillin - this is something that is frequently done when patients report penicillin allergies and they have syphilis as well where that is the best antibiotic to use. If you only had a rash as a child, there is a good chance you can take the peniciilin. Good luck to yyou and thanks for the great questions. Again, I am so sorry for the loss of Khian. Kind regards, Dr T
At Tue Oct 07, 05:38:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To danie ga: The standard of care is to administer the antibiotics throughout your entire labor and the ideal way to do that is intravenously so that the baby will recieve good levels of protective antibiotics as well. Anything less than that you do at your own risk. It is true that many (most) women who are colonized with GBS will not have a poor outcome for their babies, but do you REALLY want to take that chance? Think about it. Regards, Dr T
At Tue Oct 07, 08:24:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Amy: If you had a GBS UTI, that should be treated ANY time it is diagnosed during pregnancy to reduce the risk of preterm labor, kidney infections and chorioamnionitis. Women who get GBS UTIs are at greater risk for all those things and are also at greater risk for having a baby who develops GBS disease after birth. Once you have a GBS positive UTI, you are always considered to be GBS positive for that pregnancy and should get prophylactic antibiotics in labor. Good luck and thanks for reading. Dr T
At Tue Oct 07, 08:29:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous Sept 29: Women who develop GBS UTIs are at greater risk for GBS complications themselves and at greater risk for their babies to get GBS disease. It may have something to do with an immune response that is suboptimal for the GBS. Regardless, you should have urine cultures periodically in a subsequent pregnancy even if you have no symptoms of a UTI - perhaps as often as every 4-6 weeks. Treatment of these and prophylaxis at delivery should reduce the risk to you and the baby. Thanks for writing. Dr T
At Wed Oct 15, 07:41:00 AM 2008,
Anonymous said…
HI =) I'm a healthy 29 year old and pregnant with our first baby, 37 weeks. I just found out I am positive for GBS. I am also one of those allergic to penicillin. To make matter more complicated, my particular case is proving resistant to the cephalosporin options and the third option (can't remember the name but possibly starts with a 'C') is only intermittently effective. So Vancomycin has become my option.
A couple questions: I already have poor hearing in one ear, and intermittent ringing. I currently have extra fluid in my ears from the pregnancy. Am I a candidate for the ototoxicity?
Also, I plan to breast-feed immediately after birth. FDA reports no 'real' side effects for a baby in gestation however, it does caution against breast-feeding. Will taking vacomycin prevent me from breast-feeding immediate and have the baby miss the colostrum which is so high in antibodies and such. If so, how long before I can breast-feed my baby?
KLF
At Sun Oct 19, 07:49:00 AM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To KLF: Fortunately, you will need only a short course of the vancomycin (and clindamycin is still an option as well), during labor and, hopefully, none once you have delivered. That should not be enough to raise much concern about breast feeding. But, ask your pediatrician if they think you should simply "pump" your breasts following delivery for a few days. I really don't think that will be necessary, but they will be in the best position to advise you. Dr T
At Thu Oct 23, 08:04:00 AM 2008,
Anonymous said…
Thanks so much Dr. T.
Now should I request a PICC line for the vanc because I've read about the phlebitis (sp?)?
I haven't found anything about if a PICC line is even worth it since I'll only get a small dose . . .
is worth me even asking about it? Hope you don't mind my questions!
KLF
At Thu Oct 23, 12:14:00 PM 2008,
Anonymous said…
at 33 weeks i was tested for GBS and was found to be negative. at 34 weeks my boys were born by c-section due to pre-eclamplsia and low amniotic fluid.
my water was broken for twin A at 7am and i delivered at 7pm. i was on antibiotics when my water was broken and through labor despite the negative gbs test. at 10 days old twin A was rushed to the ER twice (the second time he quit breathing and had to be intubated) he was diagnosed with sepsis from group b strep.
at 14 days old twin B started showing symptoms also and was immediately put on antibiotics in PICU. blood test results showed he was positive as well for GBS.
what are the chances that it came from me? they both spent 8 days in NICU and were only home less than 48 hours when Twin A got sick and had to be re-admitted.
At Wed Oct 29, 06:03:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To KLF: PICC lines carry there own risks. I would not recommend that unless it is absoluetely necessary. Good luck! Dr T
At Wed Oct 29, 06:08:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous Oct 23: I don't
think I can give you the answer. Did you go into spontaneous labor or were you induced for the preeclampsia? What antibiotics did you receive? There is a possibility that you are infected and the GBS did not happen to grow in the culture; there is also the possibility that someone else in the family or in the nursery who touched the babies was GBS-positive and heavily colonized. You might bring this up with the director of the nursery in case it is an 'infectious control' problem. Sorry things got rough there for awhile but I hope everything is okay now. Best wishes. Dr T
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