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       Group B Strep-what is it?  What is it and Who Has it

Group B Streptococcus (GBS) is a bacteria found in the lower intestine and in the vaginal of healthy women. (It is also found in other healthy adults). It is a bacterium that causes illness in newborns, pregnant women, the elderly, and adults with other illnesses, such as diabetes or liver disease. GBS causes sepsis (blood infection), meningitis (infection of the fluid and lining surrounding the brain) and pneumonia in newborns. Approximately 8,000 babies get GBS each year, and about 300 of these die.

Who is at risk? What are some signs of possible risk to have this?

Someone who had a previous baby with GBS disease
Urinary tract infection due to GBS
GBS late in pregnancy
Fever during labor-above 38 °C = 100.4 °F (Fahrenheit temperature = (9/5 x Celsius temperature) + 32)
Rupture of membranes 18 hours or more before delivery
Labor or rupture of membranes before 37 weeks– Premature babies are more at risk.  Their immune system is not fully developed.  Mature babies, at term, have a more developed immune system.

What Group B-strep is not:

It is not the kind that causes strep throat, that is from group A-strep. It is also not a sexually transmitted disease.

IF I have it?

When you have Group B Strep, you are said to be colonized, and are not contagious. Group B Strep is a normal part of the commonly found bacteria in the human body, and usually does not cause a problem. You can carry it in your bowel, vagina, bladder or throat.

What About My Baby?

With newborn babies, GBS is a common cause of sepsis (infection of the blood) and meningitis (infection of the fluid and lining surrounding the brain) and can cause pneumonia. If a baby has this, and survives, he can have long-term medical, hearing or vision problems, and other physical and learning disabilities such as cerebral palsy. Your baby can become colonized with GBS if the mother is colonized with GBS in the rectum or vagina, and this occurs before or at the birth.

How does the baby get this?

A baby can come in contact with it before or during birth if the mother carries GBS. About 1-2% infants that are colonized with GBS develop signs and symptoms of GBS Disease. Some get early onset GBS which occurs in the first week of life, but most are apparent within a few hours after the birth. If the water is broken in a mother with GBS for longer than 18 hours the risk to the infant is greater. If the baby is premature the risk is greater. There is also evidence that the GBS may cross the membranes prior to delivery. GBS can cause pre-term delivery, still births, or miscarriages, but is not the only cause of these things.

How am I be checked for this?

GBS is tested by taking a swab from your vagina and rectum. This culture is then processed in a lab. This is done from 35-37 weeks of your pregnancy. (recommended by the Center for Disease Control, CDC) . If you are positive, it means that you have GBS, you are colonized, it does not mean that you and your baby will become sick. You are then given antibiotics during the labor. If you have a positive culture from your urine, then that is treated at the time of diagnosis, not waited until labor begins. It is stated that the antibiotics prevent the spread of GBS from the mother to the baby.

What is recommended to treat this ?

Penicillin is the choice treatment for GBS.

Why would I not take treatment in labor?

It is NOT recommended that colonized women take oral antibiotics prior to labor beginning. It is recommended that you have IV antibiotics when labor begins. If you are delivering at home or a birth center, and are unable to have IV antibiotics, then it is recommended that you have IM antibiotics.

There are those (including physicians, OB’s, and midwives) that think to be tested at 35-37 weeks does not prove that your test would be the same results during labor. They say that you may have a negative result now and a positive result later, or visa versa. Others disagree. Either way, you need to become an informed consumer to make the choice that is best for you.

A colonized woman with no conditions mentioned above has the following risks:

  • A 1 in 200 chance of delivering a baby with GBS Disease if no antibiotics are given

  • A 1 in 10 chance of experiencing a mild allergic reaction to antibiotics (such as a rash)

  • A 1 in 10.000 chance of developing a severe allergic reaction (anaphylaxis) to antibiotics

  • For a woman who has a negative culture for GBS at 35-37 weeks, there is a one in 2,000 risk of her newborn developing a GBS infection, and antibiotics are not recommended by the CDC. The CDC does recommend treating with antibiotics all women with risk factors (fever, PROM, premature labor) if they have not been tested to determine whether they are carriers of GBS.

 

 

Group B Strep-info

For those of you who are medical and require more information, or for those of you who do not want to use antibiotics, and need other information about alternative things to do:

The following is taken from,
Vaginal Chlorhexidine for GBS Prophylaxis-Abstracts
J Matern Fetal Neonatal Med 2002 Feb; 11(2):84-8

Chlorhexidine vaginal flushings versus systemic ampicillin in the prevention of vertical transmission of neonatal group B streptococcus, at term. Facchinetti F, Piccinini F, Mordini S, volpe A. Department of Gynecology, Obstetrics and Pediatric Sciences, University of Modwna and Reggio Emilia, Italy

Objective:

To investigate the efficacy of intrapartum vaginal flushings with chlorehexidine compared with ampicillin in preventing group B streptococcus transmission to neonates.

METHODS:

This was a randomized controlled study, including singleton pregnancies delivering vaginally. Rupture of membranes, when present, must not have occurred more than 6 hours previously. Women with any gestational complication, with a newborn previously affected by group B streptococcus sepsis or whose cervical dilation was greater than 5 cm were excluded. A total of 244 group B streptococcus-colonized mothers at term (screened at 36-38 weeks) were randomized to receive either 140 ml chlorhexidine 0.2% by vaginal flushings every 6 hours or ampicillin 2 g intravenously every 6 h until delivery. Neonatal swabs were taken at birth, at three different sites (nose, ear and gastric juice).

RESULTS:

A total of 108 women were treated with ampicillin and 109 with chlorhexidine. Their ages and gestational weeks at delivery were similar in the two groups. Nulliparous women were equally distributed between the two groups (ampicillin, 87%; chlorhexidine, 89%). Clinical data such as birth weight (ampicillin 3,365 +/- 390 g; chlorhexidine, 3440 +/- 0.6; chlorhexidine, 9.6 +/- 1.1) were similar for the two groups, as was the rate of neonatal group B streptococcus colonization (chlorhexidine, 15.6%; ampicillin, 12%). Escherichia coli, on the other hand, was significantly more prevalent in the ampicillin (7.4%) than in the chlorhexidine group (1.8%, p < 0.05). Six neonates were transferred to the neonatal intensive care unit, including tow cases of early-onset sepsis (one in each group).

CONCLUSIONS:

In this carefully screened target population, intrapartum vaginal flushings with chlorhexidine in colonized mothers display the same efficacy as ampicillin in preventing vertical transmission of group B streptococcus. Moreover, the rate of neonatal E. coli colonization was reduced by chlorhexidine.

BMJ 1997 Jul 26;3 15(7102):216-9; discussion 220 comment in : BMJ Jul 26; 315(7102):199-200. Effect of cleansing the birth canal with antiseptic solution on maternal and newborn morbidity and morality in Malawi: clinical trial. Taha TE, Biggar RJ, Broadhead RL, Mtimavalye LA, Justesen AB, Liomba GN, Chiphangwi JD, Miotti PG. Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore MD 21205, USA.

Treatment of Group B strep

A colonized woman with no conditions mentioned above has the following risks:

  • A 1 in 200 chance of delivering a baby with GBS Disease if no antibiotics are given

  • A 1 in 10 chance of experiencing a mild allergic reaction to antibiotics (such as a rash)

  • A 1 in 10.000 chance of developing a severe allergic reaction (anaphylaxis) to antibiotics

  • For a woman who has a negative culture for GBS at 35-37 weeks, there is a one in 2,000 risk of her newborn developing a GBS infection, and antibiotics are not recommended by the CDC. The CDC does recommend treating with antibiotics all women with risk factors (fever, PROM, premature labor) if they have not been tested to determine whether they are carriers of GBS.

Remember that hibiclens is the only item on this list that has research behind it.  But it’s use can irritate sensitive skin.

WHAT CAN I DO TO HELP PREVENT THIS?

If you are GBS negative, you do not need to have any treatment (this is the medical community advice) I still suggest that you do a few things, because I believe that GBS can then be positive later, if you are having any problems with your immune system. Again, not everyone believes this.

If you are GBS positive, and are not comfortable with a out of hospital birth, then you may transfer care to a physician and deliver in the hospital. IV antibiotics will be given. It only takes 2 doses during labor for you to then be considered’safe’ to deliver vaginally.

The following are things that are an alternative to IV antibiotics.

Work on your immune system.

~Vitamin C with bioflainoids- up to 2000 mg daily. Do not take this all at once. I suggest you get chewable tablets, and quarter them. (example 500 mg) then take one quarter of a tablet (at the most a half of a tablet) every 3-4 hours.

~Zinc: (you should be taking this anyway) but you can increase the amount you take.

~Garlic: first use it to cook with, even roast the cloves and put on your toast. Take at least 1-2 capsules a day

~ Echinacea take up to 2 capsules at least 2 times a day, but up to 4 times.

~Acidophilus-best to take the kind you need to keep in the frig-the cultures are live and work better.  You can also make your own yogurt and eat some daily or up to 3 times a day.

OPTIONAL things to do before you go into labor from week 36-to delivery:

~Tea tree tampon -soak a tampon in a solution of 2-3% of tea tree to 97-98% olive oil. So example: 98 drops of olive oil to 2 drops of tea tree oil. Soak the tampon in the solution, and insert tampon vaginally. Leave in up to 4 hours. Do this once a day for 7 days.

~Hibiclens rinse– 2 T of Hibiclens (chlorhexidine) in a peri bottle, then fill the rest of the peri bottle with warm water and squirt over your vulva. Do this 2- 3 times a week, from 37 weeks until you deliver. During labor, do this every 4-6 hours until transition.

~Vaginal wash:

1.) Boil 1 quart of water, add once ounce of Echinacea and one ounce of Lavender. allow to steep for 6-8 hours. Strain out the herbs, and you can use this for a vaginal wash.  Keep unused amount in frig to keep fresh.

2.) ~hydrogen peroxide can also be used as a rinse.

3.) ~Mix: one ounce of Echinacea root to 1 pint of boiling water-boil for 10 minutes then shut off and allow to steep for 6 hours or up to 10 hours. strain herbs, add essential oil as follows: 10 drops of tea tree, 10 drops of lavender, 6 drops of thyme, 6 drops of calendula, 6 drops of rosemary and 4 drops of yarrow. Add 2 table spoons of sea salt and mix well. Wash with this daily for 7 days.

4.) ~one whole garlic clove, peeled, (do not nick it with the knife or it will burn)-although some care providers do suggest making slits in the clove and do believe that it works better that way. Then you insert this at night just before bed, and remove it in the morning.

THINGS TO DO once you begin labor or your water breaks:

1. Any one of the above herbal washes. Rinse every 3 hours.

2. Hibiclens: (chlorhexidine) 4 tablespoons (15ml) in 2-1/4 cup water. Fill your peri bottle half way with this mixture then fill the rest of the way with warm water and rinse over your vulva area well. DO this every 4 hours in labor.