Subject: Prevention of Perinatal Group B Streptococcal Disease

POLICY: Group B Streptococcal Protocol

GUIDELINES: 1. All pregnant women will be screened at 35-37 weeks gestation for vaginal and rectal GBS colonization. 

2. Women with GBS isolated from the urine in any concentration at any time during their present pregnancy should receive intrapartum chemoprophylaxis.

3. Women who have previously given birth to an infant with invasive GBS disease should receive intrapartum chemoprophylaxis.

4. If the GBS culture has not been done or the results are not known a the onset of labor they should receive intrapartum chemoprophylaxis if they have any of the following risk factors:

·         Gestation <37 weeks

·         Duration of membrane rupture >18 hours

·         Temperature of >100.4F (>38.0C)

5. Women with known negative GBS culture do not need intrapartum chemoprophylaxis even if they have any of the risk factors listed above.

 

PROCEDURE: 1.  All pregnant women will be screened at 35-37 weeks gestation for vaginal and rectal GBS colonization by:

·         Instruction given to patients on how to make the collection themselves at a prenatal visit

·         Collection is to be made on a transystem liquid amies polyester tipped swab transport system

·         The swab system will be sent to the lab for culture.

2. Women with a positive vaginal/rectal culture and women with a positive urine culture will be informed of the risks of GBS disease in infants and given the information and waiver sheet prior to labor.

3. If a woman chooses not to receive intrapartum chemoprophylaxis she must:

·         Verbalize understanding of the risks associated with GBS disease in infants

·         Must be willing to carefully observe and chart finding about their infant for the first 48 hours of life.

·         Must sign and initial all sites on the waiver form.

·         Must verbalize understanding of the need to reassess if any of the risk factors are present in their labor.

o   Gestation <37 weeks

o   Duration of membrane rupture >18 hours

o   Temperature of >100.4F (>38.0C)

3. If a woman chooses to receive intrapartum chemoprophylaxis she must:

·         Verbalize understanding of the desire to have at least two doses of antibiotics given, at least four hours of labor in center.

·         Be questioned about medication allergies and have noted in chart any allergies that are known.

·         Have treatment explained prior to receiving it in labor.

4. A GBS positive woman who chooses to undergo intrapartum chemoprophylaxis:

·         Will receive her first dose of antibiotics upon arrival at the birth center after assessment for safety and labor status.

·         Will continue to receive antibiotics as per protocol until delivery.

5.  Antibiotic treatment will consist of:

·         Five million units of penicillin G reconstituted in 100cc NS will be infused by IV catheter.

·         The IV site will be saline locked or a bag of 1000cc LR added as needed.

·         Every four hours after the initial dose was started an additional 2.5 million units of penicillin G will be reconstituted in 100cc NS and infused until delivery.

6. For penicillin allergic clients the following alternatives are adequate:

·         If not at high risk for anaphylaxis then Cefazolin 2gm loading dose then 1gm every 4 hours until delivery.

·         If at high risk for anaphylaxis then Clindamycin 900mg every 8 hours until delivery

·         If client is allergic and at high risk for anaphylaxis for all available medications then she will be referred to the hospital for delivery.

 

Recommended

Penicillin G, 5 million units IV initial dose, then
2.5 million units IV every 4 hours until delivery

Alternative

Ampicillin, 2 g IV initial dose, then 1 g IV every 4 hours until delivery

If penicillin-allergic

Patients not at high risk for anaphylaxis

Cefazolin 2 g IV initial dose, then
1 g every 8 hours until delivery

Patients at high risk for anaphylaxis
GBS susceptible to clindamycin and erythromycin

 

Clindamycin, 900 mg IV every 8 hrs until delivery

OR

Erythromycin, 500 mg IV every 6 hrs until delivery

These medications are not as effective as penicillin so use only when necessary

Patients at high risk for anaphylaxis
GBS resistant to clindamycin or erythromycin or susceptibility unknown

Vancomycin** 1 g IV every 12 hours until delivery

Vacomycin is not available at The Birth Center so client will be referred to hospital for treatment