NeoNotes Journal Club
Andrew B. Kairalla MD, Editor
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Summary of New
Obstetric Management
1.
Universal prenatal screening for
vaginal and rectal GBS colonization of all pregnant women at 35-37 weeks
gestation.
Ø
Designates change or
addition to 1996 CDC guidelines.
ü
Designates reiteration
of 1996 CDC guidelines.
Ø
The strategy of routinely offering IAP based on intrapartum risk
factors (prolonged ROM, intrapartum fever, preterm labor) is no
longer recommended.
ü
All women with positive GBS screening cultures should
be given IAP when they present in labor.
ü
Women with negative screening cultures do not
need IAP regardless of intrapartum risk factors.
ü
Women with unknown GBS status at delivery will continue to be
managed with the risk-based approach.
Ø
GBS-colonized women undergoing planned cesarean deliveries without
labor or rupture of membranes do not need IAP.
ü
GBS colonization during a previous
pregnancy is not an indication for IAP in subsequent deliveries.
ü
Women with GBS bacteriuria during the current pregnancy or who
have had a previous infant with invasive GBS disease do not
need screening cultures and should
receive IAP.
ü
Treatment to eradicate recto-vaginal GBS colonization prior to the
intra-partum period is not indicated.
ü
GBS screening cultures should be collected by swabbing the lower
vagina and rectum, and cultured on selective medium for GBS.
Suggested Discussion Point:
Should ACOG endorse the
CDC recommendations and encourage obstetricians to abandon the risk-based
strategy in favor of universal screening?
Comment:
ACOG has been a strong
proponent of the risk-based approach for IAP to prevent early-onset GBS disease,
and I’m not sure if they have formally endorsed the new CDC guidelines.
In any case, formal CDC practice guidelines tend to quickly become the
standard of care, and obstetricians are encouraged to incorporate these
recommendations into their current practice.
There are several challenges in implementing an effective screening
program for GBS colonization. First,
we need to be sure that the specimens are collected and handled appropriately,
and that the laboratories are using selective media for isolation of GBS.
Next, we need to have a system in place to ensure the availability of GBS
screening results at the time of labor. Finally,
we need to educate medical and nursing staff on these changes. ABK.
Additional Comments: You
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