RolandRat, every time an IV is used, the risk/benefit is weighed with the balance coming down heavily on benefit. Thousands of IVs are inserted daily in the UK.
At the moment, the best identification method available leads to AB delivery during labour, with the enormous benefit of saving lives. The benefit outweighs the risk. GBS is the most common cause of life threatening infection in newborns.
Carol:
GBS has risen by approx 32% in the UK in the last ten years. Experts all over the world have found the evidence in support of culture based routine screening compelling. Currently routine screening is offered to all pregnant women in the US, Canada, Australia and many European countries including France (despite NICE; and yes NICE is about bean counting) - these countries have reported 80% drops in infection rates thanks to routine screening and routine administration of ABs to women experiencing preterm labour.
www.bmj.com/content/344/bmj.e2803/rr/581189
'On myths about GBS' --
"research looking at just this issue repeatedly finds universal screening would be more cost effective and more clinically effective in the UK than the risk based strategy11-13;19 and these papers do not include in their analysis the fact that the Royal College of Obstetricians & Gynaecologists’s 2003 guideline20 is inconsistently applied21. A recently published UK study has shown that 81% of mothers who should have been offered intrapartum antibiotic prophylaxis because of risk factors did not receive it, and the authors estimated that 48% of babies who suffered EOGBS infection could have had their disease prevented22. Perhaps part of the problem with the risk-based strategy is that it is too complex – to be effective any strategy needs to be both easy to understand and easy to implement.
Despite pointing out that the media often don’t mention the potential harms of screening, Dr McCartney omitted to mention one of its key benefits - the major falls seen in the incidence of early onset GBS disease in all western countries which have introduced screening14-17. We know of no country presenting before and after data that has not shown a substantial reduction in the incidence after screening was introduced. In contrast, in the UK the incidence of EOGBS infection has risen since the risk-based prevention guidelines were introduced by the Royal College of Obstetricians & Gynaecologists in 200320 and is continuing to do so. The Health Protection Agency has found that voluntarily reported cases in England, Wales and Northern Ireland have risen from 229 in 200323 to 302 in 201024. The incidence of EOGBS disease in England, Wales & Northern Ireland is now 0.41 per 1,000 live births, which is higher than the USA post-universal screening (0.34 per 1,000 live births in 200814)."
I actually perceive a growing tide of acceptance that the NHS is barking up the wrong tree. Yes there are holdouts who for reasons of their own recoil from the idea of intervention in labour, but their objections are demolished by the clear evidence of success elsewhere.
You can look up the footnotes yourself.
Philip Steer, consultant obstetrician at Chelsea & Westminster Hospital, editor in chief of the British Journal of Obstetrics and Gynaecology, emeritus professor at Imperial College, and chair of the GBSS medical advisory panel, said: “Group B Strep infection is the commonest infection complicating labour and the newborn period, and the evidence is that in the UK the problem is increasing, affecting up to as many as 1,000 babies and their families per year. For too many, the complication is fatal.”
He said there is “compelling evidence” that, in other countries where routine screening of mothers at 35 to 37 weeks gestation has been introduced there have been “reductions of four fifths or more in the rate of infections due to GBS”.
www.gbss.org.uk/filepool/GBSSReport_2013.pdf
Philip Steer addressing HoC reception wrt GBS.
Wrt the risk based approach -- 'in the UK, '70% of carriers had no risk factors'.