Optional Testing During Pregnancy

Optional Testing During Pregnancy
Group Beta Streptococcus

By Valerie Jacques, RN, CPM, NHCM

This is the first in a series of articles exploring testing procedures available for you and your baby during pregnancy.

There are many decisions to be made when you become pregnant; one of the most important is the continued health of your baby. This article (and others to follow) will help explain the various testing procedures, when a particular test should be run (if at all), and what the benefits and drawbacks are.

Group Beta Streptococcus (GBS) is a common strain of bacteria found in about 4 out of 10 adults. Ordinarily, GBS does not cause a problem; in fact it is considered a normal organism. However, it does cause a potential problem for pregnant women. It is possible to pass the GBS organism from Mom to baby during birth, and it can be fatal in itself to your newborn (5%-15% fatality rate despite antibiotic treatment). Sepsis, serious infection throughout your baby’s body (also referred to as GBS disease) is the culprit. GBS can also be the cause of other potential life-threatening trauma such as pneumonia and meningitis. Permanent neurological damage to your newborn is also a possibility.

Babies who are most likely to develop GBS disease are born of mothers who are carriers of the GBS bacteria AND have one or more specific clinical risk factors. Those factors are: Previous baby with GBS disease, urinary tract infection during pregnancy (with GBS), onset of labor before 37 weeks, rupture of membranes before 37 weeks, rupture of membranes more than 18 hours before birth, and fever over 100.4 degrees Fahrenheit during labor. Other risks of GBS include: Urinary tract infection (Mom), and pre term labor.

GBS resides in the vaginal and/or rectal areas, and is tested for by a simple swab at or about 36 weeks of pregnancy. This is the best time in the pregnancy to get the most accurate prediction of whether or not Mom is a carrier of GBS. However, GBS can be erratic, appearing and disappearing without treatment. If the test is positive, relatively simple protocols of herbs, oral antibiotics, or intravenous antibiotics administered during labor are available.

But not all interested parties agree on who should be tested or if antibiotics should be administered. Some (the Group B Strep Association, for example) advocate universal testing for all pregnant women and antibiotic treatment for those who test positive for GBS. Others (The Centers for Disease Control and others) recommend one of two strategies: (1) universal testing followed by antibiotics for those testing positive, or (2) no universal testing but antibiotics for those with clinical risk factors (paragraph 3).

So why not test all Moms to be, and administer antibiotics to those who test positive, and be done with it? Because, of those Moms testing positive for GBS, about 95% of their babies would not get GBS even if not treated….and there are risks to administering antibiotics. Risks include: allergic reactions (from mild to possibly fatal…1 in 10,000 for penicillin, even for those with no prior known allergy to penicillin) and the fact that wide spread use of antibiotics can increase the chance that drug resistant strains of an organism will develop. Furthermore, even if Mom’s allergic reaction is not severe, dangerous complications sometimes resulting in permanent disability can occur in the baby.

So, here are your current choices (1) GBS culture and antibiotics during labor if positive for GBS (2) No GBS culture and antibiotics during labor if you have clinical risk factors (3) GBS culture and antibiotics during labor if positive AND you have clinical risk factors (4) No GBS culture and alternative or no treatment.
If you birth your baby at home or in a birth center, your midwives will review signs of infection that you should watch for in your baby. If any signs begin to occur, you or your midwife will need to contact your pre-arranged physician. Regardless of whether you had a GBS culture, or what the results were, if your baby shows signs of infection, the baby’s doctor will probably recommend lab studies and antibiotic treatment for your baby in the hospital.

If your baby is delivered in a hospital, treatment depends on whether you had a previous GBS culture, what the results were, and if you have any clinical risk factors. If your baby shows any signs of infection (as above), lab studies and treatment will likely follow.

If you had a positive GBS culture and received antibiotics for at least 4 hours during labor… with no signs of infection (in your baby) and no clinical risk factors, standard protocol in many hospitals is to perform a blood culture on your baby and observe for signs of infection for 48 hours (in hospital). Antibiotics will not usually be given to your baby unless symptoms occur.

If you had a positive GBS culture and received antibiotics for less than 4 hours during labor (or no antibiotics at all)… protocol in many hospitals is to perform a blood culture on your baby, and begin antibiotics immediately. If the culture comes back negative, the antibiotics are stopped and your baby is discharged.

If you had a negative GBS culture… there will be no prolonged observation, and your baby will usually be discharged when you are.

Knowledge is power. The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional.

Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at www.coastalfamilybirthretreat.com.