Most pregnant women who carry group B streptococcus (GBS) bacteria have healthy babies. But there's a small risk that GBS can pass to the baby during childbirth. Sometimes GBS infection in newborn babies can cause serious complications that can be life threatening, but this is not common. Extremely rarely, GBS infection during pregnancy can also cause miscarriage, early (premature) labour or stillbirth. GBS is one of many bacteria that can be present in our bodies. It does not usually cause any harm. When this happens, it's called carrying GBS, or being colonised with GBS. It's estimated about 1 pregnant woman in 5 in the UK carries GBS in their digestive system or vagina. Around the time of labour and birth, many babies come into contact with GBS and are colonised by the bacteria. Most are unaffected, but a small number can become infected. If a baby develops GBS infection less than 7 days after birth, it's known as early-onset GBS infection. Most babies who become infected develop symptoms within 12 hours of birth. Symptoms include: • being floppy and unresponsive • not feeding well • grunting • a high or low temperature • fast or slow heart rates • fast or slow breathing rates irritability Late-onset GBS infection Late-onset GBS infection develops 7 or more days after a baby is born. This is not usually associated with pregnancy. The baby probably became infected after the birth. For example, they may have caught the infection from someone else. GBS infections after 3 months of age are extremely rare. Breastfeeding does not increase the risk of GBS infection and will protect your baby against other infections.

1. GROUP B STREPTOCOCCI
& PREGNANCY
DR ALKA MUKHERJEE
NAGPUR M.S. INDIA

2. • Group B streptococcus (GBS) is one of the many bacteria that live
in the body. It usually does not cause serious illness, and it is not
a sexually transmitted infection (STI).
• In women, GBS most often is found in the vagina and rectum. This
means that GBS can pass from a pregnant woman to
her fetus during labor. This is rare and happens to 1 or 2 babies
out of 100 when the mother does not receive treatment
with antibiotics during labor. The chance of a newborn getting sick
is much lower when the mother receives treatment.
• Even though it is rare for a baby to get GBS, it can be very serious
when it happens. Babies who get GBS may have early-onset or
late-onset disease.

4. Streptococcal Infection in Pregnancy
 Streptococcus Gram – positive, shape, and are typically arranged in chains or
pairs, Non- spore forming and catalase negative facultative anaerobes.
 Group B streptococcus grows in pairs as diplocci and from s a typical
appearance on sheep blood agar caused by destruction of erythrocytes.
 Leading cause of morbidity and mortality in neonates.
 Grops B streptococcus grows in pairs as diplococci and from a typical
appearance on sheep blood agar caused by destruction of erythrocytes.
 Leading cause of morbidity and mortality in neonates in addition to
 causing various infection in the mothers including(but not restricted to )
 Urinary tract infections(utis),
 Vulvo-vaginitis,
 Endometritis,
 Intra- amniotic fluid infections,
 Mastitis and
 Wound infections.

5. • Group B streptococcus froms a part of the normal vaginal and lower
gastrointestinal flora in 5%- 30 % of women.
• A major concern with group B streptococcus is its non- classic colonization and its
prevalence in about 25 % of pregnant women with no specific risk factors,
making it very difficult to account for its role in the development of an
asymptomatic or invasive infection.
• Identified risk factors include
 BLACK RACE,
 MASSIVE MATERNAL COLONIZATION,
 LOW LEVELS OF MATERNAL ANTIBODIES,
 MATERNAL AGE < 20 YEARS,
 MATERNAL DM,
 BACTEREMIA DURING PREGNANCY,
 PREMATURE RUPTURE OF MEMBRANCES FOR < 18 H,
 INTRAPARTUM FEVER, AND
 WITH A HISTORY OF A NEWBORN WITH EARLY ONEST NEONATAL SGB DISEASE.

13. GROUP B STREPTOCOCCI
& PREGNANCY
DR ALKA MUKHERJEE
NAGPUR M.S. INDIA

14. • Group B streptococcus (GBS) is one of the many bacteria that live
in the body. It usually does not cause serious illness, and it is not
a sexually transmitted infection (STI).
• In women, GBS most often is found in the vagina and rectum. This
means that GBS can pass from a pregnant woman to
her fetus during labor. This is rare and happens to 1 or 2 babies
out of 100 when the mother does not receive treatment
with antibiotics during labor. The chance of a newborn getting sick
is much lower when the mother receives treatment.
• Even though it is rare for a baby to get GBS, it can be very serious
when it happens. Babies who get GBS may have early-onset or
late-onset disease.

16. Streptococcal Infection in Pregnancy
 Streptococcus Gram – positive, shape, and are typically arranged in chains or
pairs, Non- spore forming and catalase negative facultative anaerobes.
 Group B streptococcus grows in pairs as diplocci and from s a typical
appearance on sheep blood agar caused by destruction of erythrocytes.
 Leading cause of morbidity and mortality in neonates.
 Grops B streptococcus grows in pairs as diplococci and from a typical
appearance on sheep blood agar caused by destruction of erythrocytes.
 Leading cause of morbidity and mortality in neonates in addition to
 causing various infection in the mothers including(but not restricted to )
 Urinary tract infections(utis),
 Vulvo-vaginitis,
 Endometritis,
 Intra- amniotic fluid infections,
 Mastitis and
 Wound infections.

17. • Group B streptococcus froms a part of the normal vaginal and lower
gastrointestinal flora in 5%- 30 % of women.
• A major concern with group B streptococcus is its non- classic colonization and its
prevalence in about 25 % of pregnant women with no specific risk factors,
making it very difficult to account for its role in the development of an
asymptomatic or invasive infection.
• Identified risk factors include
 BLACK RACE,
 MASSIVE MATERNAL COLONIZATION,
 LOW LEVELS OF MATERNAL ANTIBODIES,
 MATERNAL AGE < 20 YEARS,
 MATERNAL DM,
 BACTEREMIA DURING PREGNANCY,
 PREMATURE RUPTURE OF MEMBRANCES FOR < 18 H,
 INTRAPARTUM FEVER, AND
 WITH A HISTORY OF A NEWBORN WITH EARLY ONEST NEONATAL SGB DISEASE.

29. • What is early-onset disease?
• With early-onset disease, a baby typically gets sick within 12
to 48 hours after birth or up to the first 7 days.
• Early-onset disease can cause severe problems, such as
• inflammation of the covering of the brain or spinal cord
(meningitis)
• infection of the lungs (pneumonia)
• infection in the blood (sepsis)
• A small number of babies with early-onset disease die even
with immediate treatment.

30. • What is late-onset disease?
• With late-onset disease, a baby gets sick between a week to a few
months after birth.
• The disease is usually caused by contact with the mother after
delivery if she is infected.
• But it can come from other sources too, such as contact with
other people who have GBS.
• Late-onset disease also is serious and can cause meningitis.
• In newborns, the signs and symptoms of meningitis can be hard to
spot. Contact Doctor if baby have any s/s
• Lack of energy
• Irritability
• Poor feeding
• High fever

31. • Pregnant women are screened for GBS as part of routine prenatal care. A
swab is used to take a sample from the vagina and rectum and sent for
culture done between 36 and 38 weeks of pregnancy.
• Gbs is present, iv antibiotics – at the oncet of labor –helps to protect
the fetus from being infected.
• Penicillin is the antibiotic of choice
• Can help prevent early-onset gbs disease in a baby, this treatment does
not prevent late-onset disease.

32. Effect of Colonization by Group Streptococcus
during Pregnancy
• Infection that threaten to disrupt maternal and fetal wellbeing.
• Urinary Tract Infections
• UTIs are the most common infections during pregnancy. The common
causative organisms range from Escherichia coli to klebsiella, but a small
percentage is caused by group B streptococcus symptoms are virtually
indistinguishable to these caused by other bacteria, but it complicates up to
seven percentage of pregnancies. crucially, about 70% is asymptomatic. In
Exceptional cases, it may even cause serious complications like acute
pyelonephritis to the mother leading to adverse fetal outcome.
• A comprehensive study conducted by Nicolle et al. concluded that it is
necessary to treat even asymptomatic bacteriuria to prevent any
unforeseen complications during pregnancy. Frist line of treatment should
be the oral administration of penicillin 250 mg PO6 hourly for 4-7 days
followed by a urine culture to spell out the next step of management

33. Vaginitis
• Group B streptococcus is also notorious for its association
with vaginitis during pregnancy and is found more in women
with excessive and/or purulent vaginal discharge Jensen and
Andersen found an association between colonization of
group B streptococcus and vaginitis, whereas Honing et al.
and shaw et al. found no association rather than a causal
association. Even though treating asymptomatic vaginitis
does not reduce the change of preterm birth but does
reduce the risk of premature rupture of membrance and low
birth weight. Preterm premature rupture of Membranes and
preterm Labor This may be attributed to its ascending route
of colonization.

34. Effect of Colonization of Group B streptococcus
during Delivery
• Intra- amniotic infection a clinical diagnosis made based on symptoms
including maternal body temperture > 38 C, fetal tachycardia (>160
beats/min), uterine tenderness, and foul-smelling discharge is commonly
caused by the commensals that colonize the vagina .One of the most
common causative organisms is group B streptococcus, The incidence of
intra- amniotic infection (by virute of a clinical diagnosis) is more during
preterm delivery rather than term. Moreover, majority of cases in a
setting of PROM do not produce classical clinical signs thereby increasing
the associated risk. This may lead to sepsis, prolonged duration of labor,
increased incidence are advised for patients with PROM to prevent the
same.

35. Effect of Colonization of Group B streptococcus
After Delivery
• During postpartum period, Group B streptococcus is knows to cause
comparatively benign infection like mastitis, wound infection to dreaded
complications such as meningitis, endometritis, and bacterial sepsis
• Effect of Colonization of Group B streptococcus on Neonates
SGB disease in neonates can occur as early onset disease which occurs up
to 7th day of the life and accounts for 85% of the neonatal infections,
late onest disease which occurs from 8th day until the 3rd month of life
and very late onset disease occurring after 1 month of life. The
streptococcus B is known to cause vertical transmission in fetus due to
its ascending route and with aspiration of the contaminated amniotic
fluid where the whole scenario is accelerated with PROM and premature
delivery of fetus.

36. • Had a previous child who had GBS disease
• Have GBS bacteria in her urine at any point during the
pregnancy
• GBS status is not known when she goes into labor and have
a fever
• GBS status is not known and pt go into labor before 37
weeks
• GBS status is not known and it has been 18 hours or more
since water broke
• GBS status for this pregnancy is not known but pt tested
positive for GBS in a past pregnancy
Inclusion Criteria for Intrapartum Antibiotic prophylaxis
for Early Onset Group B Streptococcal Infection

37. • Centre of Disease control and prevention recommends a few
strategies to identify the colonization of group B
streptococcus in mothers during pregnancy and to identify
the important maternal risk factors to curtail early onset
infection
• The routine screening at 35-37 weeks is strongly
recommended by the American College of Obstetricians and
Gynecologist(ACOG) followed by the appropriate
management.

38. Specimen Collection for Culture
• 1] Site :- Vaginal introitus, trcyum (through the anal
sphincter).This may be taken using the same swab
or using two different swabs. It can be done either
in an outpatient setting or by the patient herself.
• 2] Transport Medium :- Non – nutritive transport
medium like stuart’s medium with or without
charcoal. Even though group B streptococcus can
survive in the culture medium for several days at
room temperature, it is recommended to refrigerate
the sample immediately after collection.

39. Algorithms for Screening for Group B Streptococcus and the
use of Intrapartum Antibiotic Prophylaxis have been Made by
ACOG. Algorithm 1: Screening of GBS with premature PROM.
Obtain Vaginal – rectal swab for GBS culture and start
antibiotic for latency or GBS prophylaxis
Patient entering labor ?
Continue
antibiotics until
delivery
Continue antibiotics
per standard of care if
receiving for latency or
continue antibiotics for
48 hours if receiving
for GBS prophylaxis

40. Obtain GBS culture result
Positive
Not available prior
to labor onset
Negative
No GBS prophylaxis at
onset of true labor;
repeat vaginal- rectal
culture if patient
reaches 35-37 weeks’
gestation and has not
delivered
GBS prophylaxis at onset
of true labor

41. Algorithm 2: Screening of GBS colonization and use of
intrapartum prophylaxis for women with preterm labor
Pateint admitted with signs and symptoms of preterm
labor
Obtain Vaginal – rectal swab for GBS culture and start GBS
prophylaxis
Patients entering true labor ?
Continue GBS
prophylaxis
Discontinue GBS
prophylaxis
Obtain GBS culture results

42. Positive
Not available prior to labor
onset and patient still preterm
Negative
No GBS prophylaxis at
onset of true labor; repeat
vagnial rectal culture if
patient reaches 35-37
weeks’ gestation and has
not yet delivered
GBS prophylaxis at onset
of true labor

43. Algorithm 3 : Screening of GBS colonization and use of
intrapartum prophylaxis for prevention of early onest
group B streptococcal infections
No Yes
Patients entering true labor ?
Penicillin G,5 Million units IV
intial dose then 2.5 – 3.0
million units every 4 hrs until
delivery
or
Ampicillin,2 g IV initial dose,
then 1 gIV every 4 hrs Until
delivery
Patient with a history of
any of the following after
receiving penicillin or a
cephalosporin ?
• Anaphylaxis
• Angioedema
• Respiratory distress
• Urticaria

44. No Yes
No Yes
Cefazolin ,2g IV intiital
dose, then 1g IV every 8
hrs Until delivery
Isolate Susceptible to
Clindamycin and
erythromycin ?
Vancomycin,1g IV every
12 hrs until delivery
Clindamycin, 900 mg
IV every 8 hrs until
delivery

45. Conclusion
• It becomes reflective to adopt rectovaginal culture
for Group B streptococcus as part of our routine
obstetric care, which would be proportional in
detecting the early neonatal infection.
• It would further reduce the risk and rate of both
maternal and neonatal morbidity.
• Further the judicious use of intrapartum antibiotic
with a proper preventive strategy and surveillance
would cut down on the rates and incidence of the
same.

46. • Women who have a cesarean birth do not
need to be given antibiotics for GBS during
delivery if their labor has not started and
the amniotic sac has not ruptured (their
water has not broken). But these women
should still be tested for GBS because labor
may happen before a cesarean birth. If the
test result is positive, the baby may need to
be monitored for GBS disease after birth