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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Group B Streptococcal Disease in the Perinatal Period
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7. I.H.S. on-line resources
For additional resources please go to 8 Other Online Resources.
A.C.O.G
A.C.O.G./I.H.S. Postgraduate Reference Text
2003 A.C.O.G. / I.H.S. Reference Text Online: GBS in Pregnancy, pp 23-26 (pdf 979k)
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Group
B streptococcal infection in neonates, young infants and pregnant women
UpToDate software 13.1, 2005.
Group
B streptococcal infection in neonates and young infants
Group
B streptococcal infections in nonpregnant adults
Chemoprophylaxis
for the prevention of neonatal group B streptococcal disease
Microbiology
and epidemiology of group B streptococcal infection
Vaccines
for the prevention of group B streptococcal disease
Other
Management
of premature rupture of the fetal membranes at term
Preterm
premature rupture of membranes
Cochrane Library
*Intrapartum antibiotics for Group B streptococcal colonisation
(Cochrane Review).
Smaill F. In: The
Cochrane Library,
Issue 1, 2003. Oxford: Update Software.
Implications for practice
The available evidence suggests that sweeping the membranes promotes the onset
of labour. For women thought to require induction of labour, a reduction in the
use of more formal methods of induction could be expected. For women near the
term in an uncomplicated pregnancy there seems to be little justification for
performing routine sweeping of membranes. Sweeping of the membranes is probably
safe, provided that the intervention is avoided in pregnancies complicated by
placenta praevia or when contraindication for labour and/or vaginal delivery
are present. There is no evidence that sweeping the membranes increases the risk
of maternal and neonatal infection, or of premature rupture of the membranes.
However, women's discomfort during the procedure and other side effects must
be balanced with the expected benefits before submitting women to sweeping of
the membranes.
*Membrane sweeping for induction of labour. (Cochrane Review). Boulvain M, Stan C, Irion O. In: The
Cochrane Library,
Issue 1, 2003. Oxford: Update Software.
Implications for practice (NB: pre-revised 2002 CDC guidelines)
The results of this review suggest intrapartum antibiotic treatment of women
colonized with group B streptococcus will reduce infant colonization and neonatal
infection. The Centers for Disease Control and Prevention in 1996 include in
their guidelines the recommendation that any woman in preterm labour ( <37
weeks) and any woman who is known to be colonized with GBS receive intrapartum
antibiotics and that antibiotics also be given to any woman with intrapartum
fever or prolonged rupture of membranes if culture results are not available.
Other expert guidelines do not advocate the administration of intrapartum antibiotics
to all colonized women unless recognized risk factors are present. Good evidence
to support any one strategy is not available from controlled trials.
*Antibiotics for prelabour rupture of membranes at or near term (Cochrane
Review). Flenady V, King
J. In: The Cochrane
Library,
Issue 1, 2003. Oxford: Update Software.
Implications for practice
Until more reliable evidence is available indicating overall benefit from prelabour
prophylactic antibiotics for term PROM it would seem prudent that their routine
use be avoided.
*Antibiotics for preterm premature rupture of membranes (Cochrane Review). Kenyon S, Boulvain M,
Neilson J. In: The
Cochrane Library,
Issue 1, 2003. Oxford: Update Software.
Implications for practice
Antibiotic treatment following pPROM is associated with statistically significant
delay in delivery reductions in major markers of neonatal morbidity (although
not perinatal mortality). This delay in delivery would allow sufficient time
for prophylactic prenatal corticosteroids to take effect. These data support
the routine use of antibiotics in this clinical situation. There is, however,
the disquieting finding of increased necrotising enterocolitis with the use of
augmentin, which would strengthen the case for the use of a macrolide antibiotic
such as erythromycin.
*Prophylactic antibiotics for inhibiting preterm labour with intact membranes
(Cochrane Review).
King J, Flenady V. In: The
Cochrane Library,
Issue 1, 2003. Oxford: Update Software.
Implications for practice
Prophylactic antibiotics cannot be recommended in the routine management of women
in preterm labour with intact membranes.
*Antibiotic prophylaxis for cesarean section (Cochrane Review). Smaill F, Hofmeyr GJ. In: The
Cochrane Library,
Issue 1, 2003. Oxford: Update Software.
Implications for practice
Prophylactic antibiotics will reduce the incidence of endometritis following
both elective and non-elective cesarean section by two thirds to three quarters
and the incidence of wound infection by up to three quarters. Post-partum febrile
morbidity and the incidence of urinary tract infections are also decreased.
Fewer serious complications will occur. All units should have a policy that recommends
the administration of prophylactic antibiotics for women undergoing cesarean
section. Obstetrical units should collect information on infection rates following
cesarean section as an important quality indicator.
*Prophylactic antibiotic administration in pregnancy to prevent infectious
morbidity and mortality (Cochrane Review). Thinkhamrop J, Hofmeyr GJ, Adetoro O, Lumbiganon P. In: The
Cochrane Library,
Issue 1, 2003. Oxford: Update Software.
Implications for practice
High risk women should be considered for antibiotic prophylaxis during the second
or third trimester of pregnancy. We do not have enough data to recommend routine
use of antibiotics for pregnant women in general.
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