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

I have signed your petition, when I had my first son 8 years ago I developed GSB (didn't know at the time) he was born after a 3 day very slow labour and had to be rushed straight to the NICU as he had difficulty breathing, we were both on antibiotics for the infection and I did not see him for 2 days, we both stayed I. Hospital for a week, what really made me angry though is the fact that I was not told what it was, I only found out I was a carrier 3 later when I bled early on in my 2nd pregnancy, I was tested and it came back positive, I had antibiotics during labour with my second son and it was by far a less traumatic experience.

'we require proof that routine screening has a benefit, because there are consequences to it.'

But your so called 'consequences' are absurd. A staph infection at a cannula site? Come on. A baby with GBS infection is going to need an IV -- would you think twice about that on the basis of staph risk? How about an IV to deliver pain medication after a CS? IVs are inserted millions of times every single day in British hospitals. Should this be stopped altogether because of the risk of staph or the risk of extravastion? Maybe we should just abandon hospitals altogether and go back to the days of the hacksaw and the leech.

Routine screening of pregnant women was instituted in the US after a thorough review of studies, and further studies have established that this is the way to go.

Yes I do understand that you are talking about routine screening, DropYourSword. I am providing evidence to support routine screening.

Which is more significant? -- a staph infection at a cannula site or meningitis in a newborn: '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)'

Your real concern is that women should never have to 'suffer' a so-called 'medicalised' birth. This is the only risk you seem to care about. Your position is not reasoned. It starts with the assumption that interventions in childbirth are always terribly wrong and continues with fingers firmly in the ears and blinkers fixed in place to the conclusion that routine testing should not be done because women might end up with an IV in their wrists during labour. Never mind the fact that babies die and suffer long term consequences from GBS infections, and clear evidence that the risk based approach/ no routine testing in the UK has not been effective while the culture based approach and routine testing in the US has.

Ok, your last post is so full of straw man fallacy that I think just going to respectfully bow out of this debate. There are many things I would like to address, because you are manipulating, twisting and outright misrepresenting what I, and other posters, are saying but I feel there really is little point.

My baby had late GBS meningitis, it would not have been prevented by antibiotics in labour. It was terrifying, the worst of times. While DD is perfectly healthy now, it is not something I would want any other family to go through. I absolutely agree that women should have better information about GBS, and about early signs of infection, that should be routine. But, unfortunately, I am not convinced that we have an accurate enough way of working out who would benefit from antibiotics. Does anyone know if there are any moves to develop a better test or algorithm or something?

If you look on evidencebasedbirth.com (excellent site) it says that up until recently it was thought that risk based management (UK method) was as good as the routine screening method. Recently, they have found that routine screening has a slight increase in success rate over risk based management.

The main issue with the routine screening is that GBS is not present all the time. Routine screening can still miss infections and can alert to infections which have passed by the time the woman is in labour. If there was a test which was fast enough to be done during labour, that would be the most accurate way of testing. At present, we don't (but we can use it to assess the accuracy of tests done before labour.)

However according to the EBB article, routine screening does look to be more accurate than screening only women at high risk.

(Is the screening not just a urine test?)

I am anti unnecessary interventions (not ANY interventions, clearly, that would be ludicrous. I don't think anybody else on this thread is arguing this at all.) but if they have a well proven benefit, which this does seem to according to fairly recent US trials, then I would be for it.

To reduce the impact of the medicalisation aspect (which is a problem, and as ElectraCute put it excellently earlier in the thread: "it does have implications beyond some arbitrary 'fear of medicalisation'... they have nothing to do with airy-fairy fantasies about natural birth.") a cannula can be used which can be detached from the IV when the antibiotics are not being directly given, which allows for freedom of movement, use of water pools, etc.

The issue with medicalisation for me is that women who labour in CLU's (which is where they may end up if they need antibiotic prophylaxis) appear to have higher rates of prolonged labour and instrumental delivery. These two things alone probably increase the risk of transmission of GBS, which antibiotics may or may not resolve.

I suspect a lot of the problems with high death rates from GBS (despite routine testing and antibiotic treatment) in the USA comes from the way many women's labours are managed there - lots of women being induced and labouring for many many hours with ruptured membranes and internal monitoring. Really not a good thing if you're trying to reduce transmission.

Signed without hesitation here. To my way of thinking the benefits of Strep B testing and giving antibiotics outweigh the risks.

Can I just point out that I said Stapn aureus bacteraemia as a result of unnecessary cannulation (ie the cannula site being the portal of entry) NOT Staph infection at a cannula site. That's not the same thing at all and the complete opposite of insignificant.

I am also bowing out due to the twisting and mid-representing. It's all become rather hysterical and I hate the way the science is being mid-used here.

It worries me that anyone thinks health policies should be decided by people who (largely) haven't read the research or who don't undersland it rather than by epidemiologists, doctors and other researchers in the field.

math In terms of consequences, your article linked earlier states:

However, worrying reports from the Far East and United States describing the emergence of clinical GBS isolates with reduced susceptibility to penicillin have been made [24–27]. Resistance to clindamycin, an alternative firstline agent for penicillin-allergic patients, [23] and erythromycin increased substantially during our study period, reaching 9% and 15%, respectively, in 2010, although remaining below levels reported in the United States [28].

So, the US system does not provide better results and creates AB resistence, basically meaning that in the future many more children will die.

Where I live (not uk) all pregnant women are tested at 36/37 weeks. I tested positive with DS1 and was given intravenous antibiotics. He didn't have any treatment and was fine. I tested negative with DC2 and 3 but was given the antibiotics anyway, as it can come and go.

No problems with long labours or dc being resistant to antibiotics in my case.

I'm still trying to decide on this one and would really love to see studies on the lack of evidence/benefit for the test that some have been referencing?

Comments seem to be either 'there is no evidence' (my question: has anyone looked for it?) or 'evidence is there is no benefit' (much stronger and much more convincing).

Can anyone share the evidence? Google shows up a vast amount.

Actually, reading the consultation responses from the last proposals to introduce universal screening are quite illuminating.

Jassy

The RCOG leaflet is here and the reasoning behind no universal testing and evidence there is no benefit is here

Carol - I'm seeking scientific studies, not PR or patient info leaflets? RCOG don't actually cite any of the scientific evidence for their position in their leaflet (which is in itself an issue - too much 'trust me, I'm a doctor').

As I say - the group and individual consultation responses are extremely interesting and provide plenty of evidence about why certain groups take their current positions - including the relative weighting of medical evidence and economics, as well how much professional bodies reflect the views of their members. It certainly isn't clear cut, and the recent review seems to have been in and of itself problematic.

The HPA response is particularly illuminating, but there are plenty of responses that provide links to the current evidence base on this, which is by no means as clean cut as anyone on this thread has been presenting.

I apologise - I note RCOG have provided a link to the evidence base they use in their brochure. You've got to really dig through their website to get to their sources, though, and it is interesting to read their guidance note ( a strong theme RCT or nothing!) alongside other evidence reviews which take greater account of clinical evidence and note the problems of conducting RCTs.

I get that it's difficult - making policy where there is a lack of evidence that clears certain hurdles, versus clear evidence to point to one path or another. But given the different positions of different parts of the medical and scientific community, presenting it as a clear-cut decision is misleading.

As a parent who nearly lost a child to other economic rationalism in the health system (late ultrasound screening), I'll be doing everything in my power next time around to minimise the risks to my child, and bugger the costs.

Jassy If you read the second link, there are 46 references to scientific papers

This is well referenced: evidencebasedbirth.com/groupbstrep/

Carol, I apologised. I can rend my clothes if that helps?

Thanks Bertie.

Jassy cross-posts, no clothes rending required .

Cheers. Quite like this top.

Still unconvinced by RCOG - but as I say, I don't think there is a single convincing position on this, from what I've read so far (still reading), but some quite significant problems in how current policy has been arrived at (plenty of criticism of the review document).

It is an option in the UK - but only for wealthy women.

If you show that you're gbs positive, you'll be offered iv abs so clearly it's thought to be important enough to treat.

You just have to be rich enough to afford the test.