Powys Teaching Local Health Board
Directorate: Women’s and Children’s
Author: Lewis, Owen, Revell / Title: Guidance on the management of Group B Streptococcus
Code: PLHB/MAT 033

GUIDANCE ON THE MANAGEMENT OF GROUP B STREPTOCOCCUS

Policy Code / Date / Version Number / Planned Review Date
PLHB/MAT 033 / Jan 2009
Jan 2012 / 1st Issue: Guideline for the care of women with Group B Streptococcus. Reviewed and updated, sequence and order re-arranged to assist logical flow
2nd Issue. Reviewed and updated / Jan2012
Jan 2015
Document Owner / Approved By / Date
Women and Children’s Directorate / Womens and Children’s Directorate
Clinical Effectiveness Committee / 29/03/2012
03/07/2012
Document Type / Guidelines

Bwrdd Iechyd Addysgu Powys yw enw gweithredol Bwrdd Iechyd Lleol Addysgu Powys

Powys Teaching Health Board id the operational name of Powys Teaching Local Health Board

Guideline for management of Group B streptococcus

Contents / Page
Validation Form / 3
Equality Assessment / 4
Relevant to / 6
Purpose / 6
Definitions / 6
Responsibilities / 6
Process / 6
References / 10
Appendices

For Reviewed / Updated Policies Only:

Relevant Changes – / Date
Minor updates only / 2012

VALIDATION & RATIFICATION

Title: Guideline for the care of women with Group B Streptococcus.
Authors: Marie Lewis Practice Development Midwife, Donna Owen – Lead Midwife North Powys, Denise Revell Integrated Midwife
Directorate: Women and Children’s
Approved for submission by: Cate Langley Date: 14/03/12
Evidence Base
Are there national guidelines, policies, legislation or standards relating to this subject area?
If yes, please include below:
NICE [2008] Antenatal care: routine care for low risk women. National Institute for clinical Excellence, London
Royal College of Obstetricians and Gynaecologists (2003): Prevention of early onset GBS disease-Green top guideline. RCOG, London.
Royal College of Obstetricians and Gynaecologists (2007): The prevention of early onset neonatal Group B Streptococcal disease in UK Obstetric Units – RCOG Summary Report. RCOG, London.
CONSULTATION
Please list the groups, specialists or individuals involved in the development & consultation process:
Name / Date
Powys Midwives / 14.3.2012
Supervisor of Midwives / 14.3.2012
Practice Development Midwife / 24.3.2012
Agreed by Women’s and Children’s Directorate / 24.3.2012
Agreed by Head of Midwifery / 24.3.2012
Please insert the name of the Directorate/ Departmental/Discipline Committee or Group that has approved this policy/procedure/guidelines/protocol
Name / Date
Women’s and Children’s Directorate / 29/03/12
Clinical Effectiveness
Implications
Please state any training implications as a result of implementing the policy / procedure.. None
Please state any resource implications associated with the implementation.
No Additional Resources required
Please state any other implications which may arise from the implementation of this policy/procedure. none
For Completion by Quality & Safety Unit
Checked by: / Date:
Submitted to CEC: / Date:

Equality Assessment Statement

Equality statement
No impact / Adverse / Differential / Positive / Comments
Age / X
Disability / X
Gender / X / Woman focused midwifery policy
Race / X
Religion/ Belief / x
Sexual Orientation / X
Welsh Language / X
Human Rights / X

Please complete the following table to state whether the following groups will be adversely, positively, differentially affected by the policy or that the policy will have no affect at all.

Risk Assessment

Are there any new or additional risks arising from the implementation of this policy?None
Do you believe that they are adequately controlled?N/A.

Relevant to:

Local guideline for all midwives working in Powys.

Purpose:

The overall aim must be to provide safe and effective care to a womandiagnosed with Group B Streptococcus, and allow her to make an informed choice regarding care and place of delivery.

Responsibilities:

All midwives working within Powys hold a recognised midwifery qualification. No additional qualifications are required to carry out this policy. Midwives will be required to attend yearly obstetric emergency drills as part of their midwifery updates.

Monitoring

This policy will be monitored through clinical midwifery supervision, issues raised through training days and the Datix reporting system.

Process:

Introduction:

First recognised as a major perinatal pathogen in the 1970s, Group B Streptococcus (GBS), Streptococcus agalactiae, is the leading cause of serious neonatalinfection in the UK. Although GBS can affect a pregnant woman or her fetus or both; it mayexist in the genital and gastrointestinal tract of pregnant women with no symptoms and may also

exist without causing harm (NICE 2008). In the United Kingdom, the prevalence of GBS is estimated at around 28%, with no association to maternal age or parity.

GBS is one of the leading causes of infection in the neonate (RCOG 2003). It can either be early onset (within first 6 days of life-usually within 12-24 hours following delivery), or late onset (develops within 6 days to 3 months).

Risk Factors Associated With Early Onset GBS Infection (RCOG 2007):

  • Previous baby with GBS infection
  • GBS bacteria found in urine during the current pregnancy
  • GBS found on vaginal or rectal swab in current pregnancy
  • Raised temperature ≥ 37.8°c in labour
  • Preterm labour or rupture of membranes (before 37 weeks)
  • Prolonged rupture of membranes

Typical Symptoms of Early Onset GBS:

  • Grunting
  • Poor feeding
  • Lethargy
  • Irritability
  • Abnormally high or low temperature
  • Abnormally high or low heart rate
  • Abnormally high or low respiratory rate
  • Low blood sugar
  • Low blood pressure

Typical Symptoms of Late Onset GBS:

  • Fever
  • Poor feeding and vomiting
  • Impaired consciousness
  • Any symptom of meningitis

At present NICE [2008] and RCOG [2007] do not recommend routine antenatal screening for GBS. There are also risks associated with prophylactic antibiotic cover including anaphylaxis, development of resistant organisms, and potential immune development and allergy in the neonate. However, women who have had a previous baby with GBS, or GBS is present in the current pregnancy, should be advised to deliver in a Consultant Unit at a District General Hospital (DGH), and offered intravenous antibiotic prophylaxis during labour.

Actions:

Booking:

  • Identify risk factors for GBS e.g. previous baby affected by GBS
  • Offer all women routine urine sampling (MSSU) in line with NICE Antenatal guidelines (2008)
  • Woman with significant risk factors e.g. previous baby with GBS should be advised to deliver in a consultant unit with intravenous antibiotic cover for labour
  • Women should be advised that routine screening for GBS is not recommended (NICE 2008)

Antenatal Period:

  • Incidental detection of GBS (e.g. from swabs) does not give indication of likelihood of colonisation at delivery. Oral penicillin is not appropriate in these cases.
  • Women identified as having GBS in current pregnancy or previous pregnancy should be offered referral to DGH for opinion.
  • Intrapartum antibiotic cover should be considered if these results prove positive. Women who then choose to remain in Powys for birth should have the risks discussed with them. A detailed management plan in accordance with advice from the DGH detailing risks and plan of care for labour and the postnatal period should be written in the client held notes
  • A ‘Clinical Alert’ should be completed following discussion with a Supervisor of Midwives

Labour:

  • Women who are current carriers of GBS, or who have had a previous baby with GBS disease should be advised to deliver in a DGH
  • Intravenous antibiotics (usually penicillin) should be offered in line with current DGH policy
  • Women booked for elective caesarean section do not require prophylactic antibiotic cover

Postnatal:

  • The neonate should be evaluated clinically soon after birth and ideally observed for at least 12 hours within the DGH.
  • Parents who have chosen to birth in Powys should be informed of the warning signs to look for when observing their baby, and also highlight the possible need for treatment at a DGH (ensure parents have emergency contact numbers)
  • Plan of care should be documented in Baby Postnatal Pathway (taking advice from paediatricians if needed) and Supervisor of Midwives informed
  • Continue to observe the infant for late onset infection (see symptoms above)
  • Ensure appropriate handover of care to Health Visitor

Also Refer To The Following Guidelines:

All Wales Birth Centre Guidelines

Antenatal Care Guidelines

References:

National Institute of Clinical Excellence (2008) Antenatal care: Routine

care for the healthy pregnant woman. NICE, London.

Royal College of Obstetricians and Gynaecologists (2003): Prevention of early onset GBS disease-Green top guideline. RCOG, London.

Royal College of Obstetricians and Gynaecologists (2007): The prevention of early onset neonatal Group B Streptococcal disease in UK Obstetric Units – RCOG Summary Report. RCOG, London.

Issue Date: 2009
Status: Final / Page 1 of 10 / Review Date: 2015
Approved by: Clinical Effectiveness committee 03/07/12

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