Compliance with screening for and recommended management of maternal group B streptococcus carriage in pregnancy

Abstract

Background: Universal screening of pregnant women at 35-37 weeks gestation is recommended for detection of anogenital group B streptococcus carriage.Intrapartum chemoprophylaxis is prescribed to carriers to prevent transmission to babies, reducing early-onset neonatal group B streptococcal sepsis. Aims: To review compliance with, and the effects of education on group B streptococcus screening and intrapartum chemoprophylaxis practices at The Royal Women's Hospital, Melbourne, Australia. Materials and Methods: A retrospective audit of women delivering in February 2016 and February-March 2017 was conducted. In February 2017, updated earlyonset group B streptococcal disease prevention guidelines were released and promoted with targeted education of clinical staff. Compliance was considered appropriate if practices followed up-to-date local protocols.Results: Screening rate for group B streptococcus was 84.4% (599/710) and carriage rate 19.5% (109/558), while intrapartum antibiotic prophylaxis was optimal in 83% of those labouring greater than four hours (39/47). There was no significant difference in compliance between 2016 and 2017. Of 113 women with unknown group B streptococcal status at delivery, only five of 33 (15%) with clinical risk factors for early-onset neonatal disease received intrapartum prophylaxis. Conclusions:Compliance remained stable, with no change during or after implementation of new protocols. Compliance with protocols was low for cases with unknown group B streptococcal status at delivery but with the presence of one or more clinical risk factors for early-onset group B streptococcal sepsis. K E Y W O R D Scompliance, group B streptococcus, pregnancy, prophylaxis, screening

Preventing Early‐Onset Group B Streptococcus neonatal infection and reducing antibiotic exposure using a rapid PCR test in term prelabour rupture of membranes

“…Of these six, only one (16.7%) received IAP for >4 h, while two received no IAP and three received IAP for <4 h. The failure to give adequate IAP in these cases was due to rapid labour/urgent CS with no EOGBS cases due to IAP compliance failure. However, others have reported issues with compliance in the risk‐factor model 4,10,13 …”

“…Group B streptococcus (GBS) is a common genital tract commensal in pregnant women and a leading cause of early‐onset neonatal infections 1 . In the pregnant population, 15–25% are colonised by GBS at any time during pregnancy 2‐4 . Among women colonised with GBS in labour who do not receive GBS intrapartum antibiotic prophylaxis (IAP), at least 1% of the newborns develop early‐onset GBS infection (EOGBS) 5 …”

Adherencia a las recomendaciones de prevención de la sepsis neonatal temprana asociada a la colonización por Streptococcus agalactiae en una institución de referencia en Bogotá, Colombia, 2019

“…La adherencia a la recomendación de tamización para EGB es superior a la informada por Ceballos et al en Medellín, Colombia 11 , quienes reportaron tamización en 7,0 % de las gestantes en 2010, antes de la publicación de la guía. En otros países se han reportado adherencias a la tamización que varían del 22,7 % en la cohorte de gestantes alemanas analizada por Kunze et al 17 hasta mayor al 80 % en Estados Unidos y Australia 18 , 19 . La baja tasa de cribado para EGB en la cohorte de Kunze 17 ) fue explicada porque el costo de las pruebas estuvo a cargo de las pacientes, mientras que en Colombia la prueba está cubierta por el sistema de salud y no sería esta la causa de una baja frecuencia de tamización encontrada en el presente estudio, más importante en las pacientes del régimen subsidiado.…”

“…McLaughlin et al 18 , en la clínica Mayo en Rochester, Estados Unidos, reportaron una adherencia del 96,8 % en la adherencia al cribado de EGB mediante sesiones académicas y recordatorios al personal de salud. Moorhead et al, en Melbourne, Australia, describieron adherencia a la tamización del 84,4 % involucrando a las mujeres mediante auto-toma de cultivo para EGB en 710 gestantes 19 .…”

Adherence to screening and management guidelines of maternal Group B Streptococcus colonization in pregnancy

“…Various models of maternity care are available for Western Australian women, including public hospital care, care from a general practitioner, private midwife or private obstetrician, shared care and midwife led care (WA Department of Health, 2019). While there has been international research regarding adherence to antenatal GBS screening guidelines (Dalmartello et al, 2019; De Luca et al, 2016; Gopal Rao, Nartey, et al, 2017; HogenEsch et al, 2020; Kunze et al, 2015; Yamaguchi & Ohashi, 2018), as well as two Australian studies (Braye et al, 2019; Moorhead et al, 2019), only one has been identified with a focus on adherence to GBS screening guidelines specifically within the midwifery led model of care (MMC) (Yamaguchi & Ohashi, 2018). Knowledge is limited regarding the comparison of adherence to GBS screening between pregnant women cared for in different care models, particularly under the MMC, and those cared for under the non‐midwifery led model of care (NMMC).…”