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Group B streptococci in pregnant and newborns

What is Group B Streptococcus (GBS)?

GBS is part of human normal bacterial flora. The bacterium occurs in both men and women. First of all, the bacterium is found in the gastrointestinal tract, but it can also be found in the oral cavity and in the woman's sheath. An estimated 25–35% of all women in the Nordic countries are carriers of this bacterium without any problems.

Group B streptococci in pregnant and newborns

When a carrier becomes an infection, it will affect both mother and child. But less than 1% of all pregnant women develop symptoms and signs of infection. When a pregnant woman is a carrier of GBS, the bacteria can be transmitted to the baby at birth. This happens to about half of all pregnant women who carry GBS. In about 1% of these cases, the children will become seriously ill. In Sweden, less than one in 1,000 live births will suffer from this infection. This means that it is a rare condition.

In Sweden, five to six cases of fatal outcome are reported annually among newborns, as a result of GBS infection.

GBS and childbirth

GBS can be found as part of the normal flora in the vagina, rectum and oral cavity. The digestive tract is the natural place of residence for GBS and is the likely source of dissemination to the vagina. GBS can be in the vagina constant, recurring or on individual occasions.

It has been found that women who carry GBS are 25 times more likely to give birth to children who develop GBS infection early, compared to women who are not carriers. However, since GBS infection in newborns is a very rare condition, the risk is very low.

How does the transmission of infection occur?

Among pregnant women, approximately 25–35% are carriers of GBS in the vagina or rectum without any symptoms or signs of it. For more information about pregnancy and maternity fashion, please see BESTAAH.COM maternity sweaters. The transmission of infection occurs in connection with the birth - either in the womb, during the child's passage through the vagina or through direct contact after the birth. The bacterium is transmitted to approximately 50% of the children to women who carry GBS in the birth canal. The bacteria can also be transmitted after childbirth through the child's contact with other people or caregivers.

Good hand hygiene is important to prevent the transmission of bacteria to the newborn baby.

GBS infection in newborns

GBS disease in newborns is divided into early and late onset. In particular, the early variant is severe and can quickly lead to fulminant sepsis requiring neonatal intensive care.

Early-onset illness usually occurs during the first day after childbirth, but some become ill later in the first week of life. The infection may occur before delivery as a result of bacteria entering the uterus. The explanation may be that some people take a long time from the time the water runs out until the baby is born. The early signs and symptoms of GBS infection in the newborn are often vague and nonspecific. Fever, reduced mobility in the arms and legs as well as rapid and strained breathing may be signs of early infection.

Signs of serious infection in the newborn baby may occur over the course of a few hours after childbirth. The first symptoms often come from the respiratory tract and cause breathing difficulties. The spread of the bacteria can lead to blood poisoning, pneumonia, skeletal inflammation or joint inflammation. Meningitis occurs in about 10%.

Late-onset illness often occurs 1–12 weeks after birth. This may be due to the fact that fewer bacteria have been transmitted, or that infection has occurred after birth. The course of the disease is often not as dramatic. Common signs are fever and irritability.

Newborns who survive the first stage of infection may suffer sequelae in the form of hearing or vision impairment, learning disabilities and other damage to the nervous system.

Who should be tested?

In Sweden, routine sampling for GBS in healthy, symptom-free, pregnant women is not recommended. Sampling is recommended for women whose amniotic fluid has gone without pain before week 37. Samples are taken with cotton swab in sheath and rectum. Urinary culture is performed.

The area is widely debated and the recommendations differ between countries. The reasons why in Sweden it is not recommended that everyone is tested are:

  • Most women treated for GBS quickly regain the bacterium after treatment.
  • Although it turns out that a pregnant woman carries GBS, she will not be treated with antibiotics at birth unless she also has risk factors for transmitting the bacterium.
  • Treating all pregnant women who carry GBS in the vagina will lead to a high risk of resistance development and of serious side effects in both mother and child.

Should GBS be treated?

The purpose of treatment is to prevent any infection in the newborn baby. In Sweden, national guidelines have been compiled on how to handle this problem.

The Swedish recommendations state that the most important measure to prevent infection is to treat pregnant women with a special risk of transmitting the bacteria to the newborn baby. Maternity with one of these risk factors should have antibiotic treatment during childbirth:

  • In women who have previously given birth to children who have GBS infection during the newborn period.
  • In women where GBS has been detected in the urine during the current pregnancy.
  • In women who have been shown to have GBS and either give birth before pregnancy week 37, or at prolonged water discharge (more than 18 hours).
  • Signs of infection or fever (38 C or above) in the woman during childbirth.
  • Antibiotics are not necessary for cesarean sections planned.

The treatment itself means that antibiotics are given directly into the blood (intravenously) during delivery. First-hand preparations are pencillin, but there are other options for allergies.

Why does international disagreement prevail?

The handling of GBS differs somewhat between different countries. The disagreement concerns sampling and treatment: Should all pregnant women be examined towards the end of pregnancy for the presence of streptococcal bacteria? Who should be treated?

The problem is that quality studies in the area are lacking. The research done so far is not satisfactory. Health care must therefore weigh benefits against disadvantages. In the US, a different conclusion has been reached than in Sweden.

GBS can also cause other pregnancy complications

GBS can also cause urinary tract infection and uterine inflammation. However, these are very rare complications. Only a few of the urinary tract infections during pregnancy are caused by GBS, but if one is diagnosed with one during pregnancy, treatment is recommended. In addition, as previously mentioned, treatment is also given during childbirth.

 

 

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