Thursday, July 30, 2009

Group B Strep Positive = Antibiotics During Labor... Evidence Based?

This review finds that giving antibiotics is not supported by conclusive evidence. The review identified four trials involving 852 GBS positive women. Three trials, which were around 20 years old, compared ampicillin or penicillin to no treatment and found no clear differences in newborn deaths although the occurrence of early GBS infection in the newborn was reduced with antibiotics. "Intrapartum antibiotics for known maternal Group B streptococcal colonization"

Anyone that has been pregnant knows that at around 35-36 weeks gestation, your OB tests you to find out of you are "GBS+" or Group B Strep positive. This involves a swab of the vagina and usually the rectum and it is sent off for analysis and culture. If the results show that you are GBS+, antibiotics are required during labor to keep the baby from contracting the infection.... or will they?

A new study by the Cochrane Reviews shows that giving antibiotics made no clear difference in the instance of GBS infections.

So, yet again, ACOG and its members are practicing medicine that is not evidence based. At the very least, I would like to see OB's using antibiotics on a case by case basis.

There are symptoms that can indicate that you are at a higher risk of delivering a baby with GBS...

* Labor or rupture of membranes before 37 weeks
* Rupture of membranes 18 hours or more before delivery
* Fever during labor
* A urinary tract infection as a result of GBS during your pregnancy
* A previous baby with GBS disease

Shouldn't we be looking more at these risk factors and treating mindfully, rather then assuming that yet another one-size fits all way of practicing is best?

Looking for some alternative treatment options?


Anonymous said...

I totally agree that the use of antibiotics during labor for all GBS+ mothers isn't necessarily a useful practice. However, reading the report you cited, they did find that the incidence of GBS infection was reduced, it was the mortality rate from GBS infection that did not change.

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