To think Strep B tests should be offered to all pregnant women?

[plinkyplonks]

Hadn't even heard of Strep B if it hadn't been for Bumpfest.

My midwife says Strep B tests are not offered as standard on NHS!

Please, please, please consider signing this petition if you think this is a test that should be offered to all pregnant women:

epetitions.direct.gov.uk/petitions/60515

Again, Minifingers puts the ideal of a 'natural' un-'medicalised' birth ahead of a test that would identify the 1 out of 3 pregnant women who would be offered (not forced to take) ABs during labour so that their babies would not be exposed to GBS and run the risk of meningitis, sepsis or pneumonia.

Estimated early-onset group B streptococcal neonatal disease

Suzanne Luck MRCPCH a, Michael Torny MRCPCH a, Katrina d'Agapeyeff MRCPCH a, Alison Pitt MRCPCH a, Paul Heath FRCPCH a, Aoadhan Breathnach MRCPath a, Dr Alison Bedford Russell FRCPCH a Corresponding AuthorEmail Address

Summary
Estimates of incidence of early-onset group B streptococcal (EOGBS) infection are based on blood or cerebrospinal fluid culture-proven cases, which can be falsely negative and hence underestimate the true burden of disease. Probable EOGBS infection can be defined as colonisation by group B streptococci accompanied by features of clinical sepsis. Data collected prospectively in the UK over 1 year for neonates who required a septic screen in the first 72 h of life indicated a combined rate of definite and probable EOGBS infection of 3·6 per 1000 livebirths. This estimate indicates a much greater disease burden in the UK than that suggested by figures of culture-proven sepsis, and lends support to the need for prevention strategies.

plinky and math

the false reassurance comes from the 10% of women who are negative at 36 weeks, but positive at birth.

more importantly, the US and UK have the same level of babies with GBS, so universal screening and AB do not have any effect - please read that - it does not make a difference.

also, IV AB in labour do not prevent late onset GBS, ie that occuring more than 1 week after birth.

I am fully supportive of screening that benefits the average person, but not when it is useless.

Screening itself is not without risk.

• Risks of allergic reaction to the antibiotics
• risks relating to cannulation to give these drugs: failed attempts, pain, infection around the site.
• risks relating to taking the swab: infection.
• risks related to the environment, increased maternal anxiety, increased interventions.

And screening doesn't change the outcome

Hospitals already consider which babies are going to be high risk, both before AND after birth. We give antibiotics to high risk women in labour and when baby checks are done actively LOOK for risk factors for sepsis then too. Multiple risks factors = antibiotics.

But how many women or babies is it 'acceptable' to harm when statistically it will not change the morbidity or mortality from GBS?

www.cdc.gov/mmwr/pdf/rr/rr5910.pdf

A large population-based study conducted during 1998–1999 demonstrated the superiority of culture-based screening over the risk-based approach to prevention of early-onset GBS disease (*). The study found that culture-based screening resulted in the identification of a greater proportion of women at risk for transmitting GBS to their newborns. Furthermore, women with a positive antenatal GBS culture were more likely to receive intrapartum antibiotic prophylaxis than those women with a risk-based indication for chemoprophylaxis. In 2002, CDC’s guidelines for GBS prevention were updated to recommend universal culture-based screening to determine which women should receive intrapartum GBS chemoprophylaxis (15). CDC recommended that women with unknown GBS colonization status at the time of delivery be managed according to the presence of intrapartum risk factors.

• Schrag SJ, Zell ER, Lynfield R, et al. A population-based comparison of strategies to prevent early-onset group B streptococcal disease in neonates. N Engl J Med 2002;347:233–9.

Identification of a greater proportion of women at risk seems to be considered a good thing in the US where perhaps the idea of saving babies' lives makes more sense for whatever reason but appears to elicit a horrified response in the UK. This is because the UK is fixated on 'natural' birth without 'interventions'.

It is completely possible to manage the care of women who are allergic to penicillin. Most will have discovered this allergy before they arrive in a labour ward. Erythromycin and clindamycin are alternatives.

'risks relating to cannulation to give these drugs: failed attempts, pain, infection around the site.'
Really?

'risks relating to taking the swab: infection.'
Are you serious?

'risks related to the environment, increased maternal anxiety, increased interventions.'
Ridiculous.

The effects of screening in the US:
From evidencebasedbirth.com/groupbstrep/

'In 1993-1994, the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics recommended screening all pregnant women for GBS and treating GBS-positive women with intravenous (IV) antibiotics during labor. Since that time, we have seen a remarkable drop in early GBS infection rates in the U.S.—from 1.7 cases per 1,000 births in the early 1990’s, to 0.25 cases per 1,000 births today (CDC 2012).'

'If a mother who carries GBS is not treated with antibiotics during labor, the baby’s risk of becoming colonized with GBS is approximately 50% and the risk of developing a serious, life-threatening GBS infection is 1 to 2% (Boyer & Gotoff 1985; CDC 2010; Feigin, Cherry et al. 2009). As I noted earlier, being colonized is not the same thing as having an early GBS infection– most colonized babies stay healthy.

'On the other hand, if a woman with GBS is treated with antibiotics during labor, the risk of her infant developing an early GBS infection drops by 80%. So for example, her risk could drop from 1% down to to 0.2%. (Ohlsson 2013)

'Researchers have estimated that the death rate from early GBS infection is 2 to 3% for full-term infants. This means of 100 babies who have an actual early GBS infection, 2-3 will die. Death rates from GBS are much higher (20-30%) in infants who are born at less than 33 weeks gestation (CDC 2010).

'Although the death rate of GBS is relatively low, infants with early GBS infections can have long, expensive stays in the intensive care unit. Researchers have also found that up to 44% of infants who survive GBS with meningitis end up with long-term health problems, including developmental disabilities, paralysis, seizure disorder, hearing loss, vision loss, and small brains. Very little is known about the long-term health risks of infants who have GBS without meningitis, but some may have long-term developmental problems (Feigin, Cherry et al. 2009; Libster et al. 2012)'

They are all risks mathanxiety. I struggle to find things you say credible when so clearly dismiss anything you don't think is important to your opinion. It makes me assume there it's a lot of confirmation bias affecting you.

Are you suggesting that penicillin routinely kills patients, RolandRat?

Wrong poster identified there, DropYourSword.

What are you referring to when you speak of confirmation bias?

If you want to ignore the CDC findings and dispute their recommendations you will need to provide evidence that they are wrong, misguided, etc. and that the culture based approach doesn't work. Otherwise I am going to have to ask myself what major objection you may have to intervention during labour.

I'm saying that there is no evidence that routine screening provides any benefit or has any affect on outcomes. If there were evidence, of course I'd be happy to support it.

I had never heard of this but signed a petition earlier in the week after I read about a couple in the news who lost their dd to this. Heartbreaking. It should definitely be looked into and I think it seems a good idea to offer the screening to all - admittedly Im no doctor but if this can be detected and the risks minimised with just some antibiotics then that's what should be done. I can't imagine how those parents feel when their baby could have been saved if a simple test had been done.

math Again I repeat, the UK does not have a higher infection rate or detah rate than the US. The US used to have a much higher rate of death, and have reduced that, but they are not lower than the UK.
There is no evidence that universal screening will save any lives in the UK.

the UK rate of infection is 0.5%, compared to 1.7 in the US prior to universal screening

This talk of avoiding medicalised birth is taking the discussion off on an irrelevant tangent because, although some posters here have given it as a reason for not signing the petition, it actually has nothing to do with the current decision not to implement universal screening. That is solely to do with absence of benefit.

It's been looked at several times and I don't doubt will be reviewed every time further data is published. Picking out individual studies here isn't scientifically valid, all the evidence has to be looked at as a whole.

And just to add, there would be nothing really stupid or insignificant about acquiring a Staph aureus bacteraemia as the result of an unnecessary cannulation.

DropYourSword -- I have provided links and quoted a few articles. If you don't want to read them or don't accept them, then I can only guess it is because some bias is preventing you.

CarolDecker:
Not only is the UK risk-based approach not working to reduce rates of infection in the UK, rates are actually rising. Contrast that with the falling rates in the US. I find your complacency about the rate of infection very puzzling in the face of such strong evidence from the US that culture-based risk assessment can be so much more efficient than the risk-based approach. Effectively what you are saying is you are prepared to live with the rising UK rate of infection. What benefit justifies the risk of even one baby dying from an easily preventable infection?

Some UK figures and persepctive
'Rates of early-onset disease rose between 1991 and 1997 before dropping to reach a low in 2000 of 0.28 per 1000 live births. Subsequent to this, a clearer pattern of increased early-onset disease incidence emerged reaching 0.41 per 1000 births in 2010. Across the 2 decades, a slight increase averaging at 1% per year could be seen in cases of early-onset disease (RR = 1.01, 95% CI, 1.00 – 1.01), whereas rates increased by 5% per annum between 2005 and 2010 (RR = 1.05, 95% CI, 1.02 – 1.08).'...

...'Our observed rates of late-onset disease were similar to those reported in Finland, the Netherlands, Norway, and the United States [4, 17, 21, 22]. Rates of early onset disease vary considerably across developed countries, in part a reflection of different prevention strategies [19]. UK guidelines for prevention of early-onset GBS disease, based on identfication of obstetric risk factors, were introduced in November 2003 [23]. Rates of early-onset disease fell slightly between 2003 and 2005, from 0.35 to 0.31 per 1000 live births, but subsequently increased back to the same rate by 2006.'

Heynowbill, the CDC issued its recommendation for culture based screening on the basis of solid scientific evidence. The reason this evidence didn't fall on deaf ears was that 'natural birth' is not an article of religious belief among the American medical community the way it is in the UK.

It remains a ridiculous, silly objection.

Would anyone in their right mind worry more about the risk of a staph infection at a cannula site than they would about the risk of a newborn contracting meningitis?

Would anyone in their right mind worry more about the risk of a staph infection at a cannula site than they would about the risk of a newborn contracting meningitis?

Probably not. That's not what we are saying. You are conveniently ignoring our rounded argument to our objections to routine screening. We are patiently explaining, without creating straw man arguments or misquoting previous posters, why we require proof that routine screening has a benefit, because there are consequences to it. For any intervention the benefits must outweigh the risks. You just aren't understanding that so far, we are saying there has been no proven benefit, but there are risks, however ridiculous you believe them to be. If you'd ever suffered with extravasation during IV Abx administration for example, I'm pretty sure you wouldn't be half as quick to dismiss it as insignificant. You may not agree with our position, that's your prerogative. But don't try to turn our reasoned position into fetishm for natural birth when actually we just promote evidence based practice.

DropYourSword -- I have provided links and quoted a few articles. If you don't want to read them or don't accept them, then I can only guess it is because some bias is preventing you.

1. I have only skim read some of the quotes you provided because you don't seem to understand that my debate is regarding routine screening. I will go back and read more thoroughly, but it seems that you are providing evidence to support treatment, not screening

2. I think the bias preventing me may be NICE guidelines. I tend to hold great stock in them.

Prophylactic abs for newborns are a BIG deal. We are only beginning to understand the havoc they play with gut flora and the development of atopic (allergic) illness, as well as the immune system and all sorts of other issues. A friend of mine is an immunologist and says it is a growing concern re routine ab use in babies. Obviously they have their place, and are sometimes lifesaving, but routine screening has significant implications in terms of large numbers of newborns given abs unnecessarily.

I think they should introduce bedside testing in labour (this is possible the culture take 1-2 hours). That way you know while in labour if you have GBS. If you test negative at 35 weeks you can still have it.

Oh and I declined the routine test I was offered in Australia. There wouldn't have been enough time to give me a drip if I'd had it anyway.

I feel so passionately about this.
Due to a bleed earlier in my pregnancy, I knew I was a GBS carrier and thank my lucky stars every day that I did. I laboured fairly quickly but had enough time for the IV antibiotics but my daughter still caught it. She spent a week in the neonatal unit as it wasn't picked up straight away but I and the doctors believe that it would have been a situation with much worse consequences if she hadn't had the antibiotics so early. We had to let our baby have a lumbar puncture and endless tests and it broke my heart.
On the other hand my son was meant to be born by c-section though I went into labour naturally. We were begging for the antibiotics just in case he came before I could get to theatre (which he did!) but the midwives were in no hurry and I didn't get them. Thank goodness he was fine but I couldn't relax at all when he was born as I was convinced he was going to show symptoms later on.
This test is standard procedure in other "civilised" countries such as the US and Australia so definitely should be over here.