2.14 Management of GBS Positive in Pregnancy

Management of Group B Streptococcus (GBS) positive in pregnancy
Antenatal care At booking:

 Universal antenatal screening for GBS is not recommended
 Detecting clinical risk factors for high-risk screening:
 GBS was detected in a previous pregnancy, and baby was affected
by GBS disease (onset: both early and late, GBS sepsis)
 Repeat testing is not necessary, as intrapartum antimicrobial
prophylaxis (IAP) will be needed.
 GBS was detected in a previous pregnancy and the baby was not
affected with GBS sepsis
 Bacteriological screening should preferably be done between 35-37
weeks of pregnancy, or 3-5 weeks before the expected delivery
date.
 If positive, offer IAP and if negative, IAP is not needed.
 The standard test is the HVS (high vaginal swab) C&S, especially for
symptomatic women (diagnostic).
 Swabs from the lower vagina (LV) and the anorectum should be taken
to check for GBS carrier status (asymptomatic). It is possible to use a
single swab (vagina then anorectum) or two separate swabs.
Antenatal care:
 Antenatal treatment for GBS cultured from a vaginal or rectal swab is
not recommended (if asymptomatic)
 GBS cultured from rectal or vaginal swabs (for symptomatic patient) –
treat and repeat swab two weeks following treatment. IAP would not
be required if it had been eradicated.
GBS Bacteriuria:
 Definition: Pregnant women with GBS urinary tract infections (growth
of more than 10⁵ cfu/ml)
 Marker for ‘heavy’ anogenital GBS colonization
 Should be given appropriate antibiotic at the time of diagnosis in
addition to later IAP.
Intrapartum care  Detect clinical risk factors that place pregnant women at increased risk
of having a baby with early-onset GBS (EOGBS) disease.
 Previous baby affected by GBS disease
 Detection of maternal GBS carriage current pregnancy - GBS
bacteriuria or GBS positive from PV discharge
 Preterm delivery
 Prolonged rupture of membrane
 Suspected chorioamnionitis and other maternal intrapartum
infections
 Pyrexia
 Intrapartum antibiotic prophylaxis (IAP): Benzylpenicillin should be
given to treat IAP. Once treatment has started, it should be continued
on a regular basis until delivery. IAP is needed for:
1. Women whose most recent rectal or vaginal swabs tested positive
for GBS (incidental swabs or intentional swabs e.g., 35-37 weeks
screening)
2. GBS was detected in a previous pregnancy, but no repeat swab was
performed- Inform the women that a 50% probability of maternal
GBS carriage during this pregnancy exists.
3. Previous baby affected by GBS disease/ sepsis
4. Current pregnancy with GBS bacteriuria
5. Preterm labour
6. Preterm prelabour rupture of membrane (PPROM): GBS positive in
the current or previous pregnancies
 > 34+0 weeks: IAP and expedite delivery
 < 34+0 weeks: Start antibiotic- The NICE guideline advocates
giving oral erythromycin 250 mg, four times a day for a
maximum of 10 days or until the woman is in established labour
(whichever is sooner). Deliver when indicated as risk of preterm
delivery are likely greater than the risk of perinatal infection.
7. Premature rupture of membrane:
 Known GBS carrier: Immediate IAP and induction of labour
 GBS carrier negative/ unknown: Commence IAP at 18 hours
after PROM and induce labour in accordance with protocol
(prior to 24 hours of PROM)
 Dose for IAP: IV Benzylpenicillin 5MU stat dose, then 2.5-3 MU 4 hourly
until delivery or IV Ampicillin 2 g stat, then 1 g 4 hourly until delivery
(NAG 2019). For penicillin allergy, can use cephalosporin group or
vancomycin.
 In women who are GBS carriers, membrane sweeping is not
contraindicated.
 A broad-spectrum antibiotic regimen that covers for GBS should be
administered to labouring women who are pyrexial (38°C or higher)
 IAP is not necessary for women undergoing a scheduled caesarean
section without labour and with intact membranes. The standard broad
spectrum antibiotic prophylaxis for surgery is required and sufficient.
Postnatal care  Refer baby to paediatric team
 Regardless of GBS status, breastfeeding needs to be encouraged
 Counsel the patient for her future pregnancy or delivery:
 For IAP if current baby affected with GBS disease
 Bacteriological screening for GBS at 35-37 weeks if the patient is
GBS carrier current/ previous pregnancy and the baby is not
affected
 Provide the comprehensive management plan in the antenatal book for
future reference
Contraception  Provide contraception as per WHO Medical Eligibility Criteria Guideline
References:
1. Hughes, RG, Brocklehurst, P, Steer, PJ, Heath, P, Stenson, BM on behalf of the Royal College
of Obstetricians and Gynaecologists. Prevention of early-onset neonatal group B
streptococcal disease. Green-top Guideline No. 36. BJOG 2017; 124: e280– e305.
2. Sabah Obstetric Shared Care Guidelines 2020
3. National Antimicrobial Guideline, Third Edition. Petaling Jaya: Ministry of Health, Malaysia;
2019
4. Perinatal Care Manual 4 th edition (released June 2022)- 5.7.6. Group B Streptococcus in
Pregnancy (Page 194)

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Management of Group B Streptococcus (GBS) positive in pregnancy

Antenatal care At booking:

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