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Group B Strep 2010 CDC GBS REVISION of 2002 guidelines What’s new 2010 CDC COPY & PASTE MMWR November 19, 2010 / 59(RR10);1-32
WHATS NEW FOR THE LAB ,[object Object],[object Object],[object Object]
GBS BACTERURIA LAB CRITERIA Identification of group B Streptococcus (GBS) Bacteriuria in pregnant women ,[object Object],[object Object]
NO CHANGE IN OB MANAGEMENT FOR GBS BACTERIURIA ,[object Object],[object Object]
GBS BACTERIURIA TREATED EARLIER WITH NEGATIVE F/U CULTURE ,[object Object],[object Object]
WHATS NEW FOR PEDIATRICS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
WHATS NEW FOR OB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
GBS IPA INDICATED ,[object Object],[object Object],[object Object]
GBS IPA INDICATED   Unknown GBS status at the onset of labor (culture not done, incomplete, or unknown)   ,[object Object],[object Object],[object Object]
WHAT DOES THE CDC CONSIDER HIGH RISK FOR ANAPHYLACTIC ALLERGY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ANAPHYLACTIC RISK ,[object Object],[object Object]
                                                                                               
HOW IMPORTANT IS IT TO USE  ANCEF vs CLINDA OR VANCO ,[object Object],[object Object]
WHAT IS  APPROPRIATE  SUSCEPITIBILITY TESTING ,[object Object],[object Object]
VANCOMYCIN ,[object Object],[object Object]
PEDS DILEMMAS GBS IPA PROPHYLAXIS IN UTERO DURATION OF < 4 HRS  & CLINDA / VANCO NOT CONSIDERED “ ADEQUATE “ ,[object Object],[object Object],[object Object],[object Object],Pediatrics 2000;106:256  Obstet Gynecol 2006;108:1254  Pediatrics 2000;106:244  Obstet Gynecol 2008;112:265 Pediatr Infect Dis J 2003;22:430  Obstet Gynecol 1998;91:112
KP DATA Escobar & Bromberger  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HOW TO CULTURE ,[object Object],[object Object]
? WHEN TO CULTURE ? @ 35-37 WEEKS ,[object Object],[object Object]
GBS culture 5 VS 6 WEEKS ,[object Object],[object Object],[object Object]
Dr Montgomery prefers GBS CULTURE @ 36 wks to ensure all deliveries occur within 5 weeks of the culture because ~ 10 % may not be delivered until  42 0/7 ,[object Object],[object Object]
EFFICAY FOR < 37 0/7 WEEKS ,[object Object]
PTL INTACT MEMBRANES < 37 0/7 WEEKS  ,[object Object],[object Object],[object Object],[object Object],[object Object]
                                                                      
PpROM / PROM GBS IPA PROPHYLAXIS ONLY IF NO culture within 5wk   ,[object Object],[object Object],[object Object],[object Object]
                                                                       
GBS CULTURES FOR R C/S PATIENTS ,[object Object],[object Object],[object Object]
AMNIOTOMY ,[object Object],[object Object]
Chorioamnionitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Obstet Gynecol 2010;116:387–92 Meta  Analysis JAMA 2000; 284:1417  JAMA 2003: 290:2677
CHORIOAMNIONITIS CDC & EPIDEMIOLOGICAL DATA ,[object Object],[object Object],[object Object]
Chorioamnionitis Dx with 100.4 “UpToDate” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Original GBS Risk Factor Identification Cohort  with > 30,000 patients ,[object Object],[object Object],[object Object],J Infect Dis. 1983 Nov;148(5):795-801
If a patient is going to manifest an elevated temperature from an epidural the literature has demonstrated it typically occurs within the first 4 hours after epidural Results closely resemble the findings of Camann who demonstrated a maternal temperature increase of  1.3ºF versus 1.1ºF   (0.33ºF/hr in the first 4 hours).   Br J Anaesth 1991;67:565–8. Obstet Gynecol 2007;109:687–90
PEDIATRIC IMPLICATIONS OF DIAGNOSING  CHORIOAMNIONITIS ,[object Object],[object Object]
REGIONAL GUIDANCE ,[object Object],[object Object],[object Object],[object Object]
WHAT DOES THE CDC CONSIDER HIGH RISK FOR ANAPHYLACTIC ALLERGY ,[object Object],[object Object],[object Object],[object Object],[object Object]
History for an Allergic Reaction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ANGIODEMA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
WHAT IS URTICARIA ,[object Object],[object Object]
Confirmation that the lesions are urticaria ,[object Object],[object Object]
 
 
 
 
 
Sx / Sx associated with ANAPHYLAXIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 

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Gbs 2010