Group B Strep tests - how are they risky for mothers?

[EffieGadsby]

I'm a bit troubled by something Dr Gwyneth Lewis said in her web chat the other day - that, "the Royal College of Obstetricians and the National Screening Committee...do not support its routine introduction [screening] because of the potential risks to mothers."

I've been looking into having a private Group B Strep test later in my pregnancy, as they seem pretty cheap and straightforward, but I can't find anything that says what the "risks to mothers" from having the screening could be. Does anyone know what risks she might be referring to, or is it just guff and twaddle?

This is the webchat. Her Strep B comments are about two thirds of the way down.

bump...i caught this and wondered what she was referring to as I had a Group B strep test (in Canada is the norm) and it was just a swab of the cervix with a big cotton bud...not painful or intrusive at all.....

There's no risk to you in taking the test - it's just a swab. I suspect she's talking about the potential worry and stress that a positive NHS test could cause, and the risks associated with antibiotics in labour for you and the baby, and the fact that the NHS test is very unreliable having a massive false negative rate - meaning it won't pick up a full half of those women and babies who are at risk.

If you've been looking into having the private test then I assume you've seen the GBSS site - www.gbss.org.uk ?

the guidance is here:

rcog

Its because of the risk of fatal or severe anaphylaxis, and also the contribution that the extra antibiotic prescribing would make to treatment resistant infections.

I am so glad that you asked EffieGadsby.

I was wondering what in the world was meant by that comment but I lacked the courage to start a thread that might kick off.

Pepa I had my first two in Canada so I was very perplexed when the midwife suggested to me that it was not necessary with ds2.

I feel very passionate about this topic because ds2 was horrifically ill shortly after his birth and despite confirming that the infection was bacterial in nature, the consultants refused to acknowledge that it might be group B strep...

He was hospitalised for 10 days on IV antibiotics and went on to have another two go-rounds later for the same infection. It was dreadful. It is still unbearable to consider that it might have been avoidable with proper precautions.

What doesn't quite add up about the 'risks to mothers' argument for not screening women in late pregnancy, is that they do screen some women, who meet certain criteria. If necessary, they are given the antibiotics that will help prevent transmission to the baby; we know this practice currently exists in the NHS. So why are those women who are screened and treated not considered sufficiently 'at risk' of dying from anaphylaxis in labour?

If the risks are too high, no women should be given antibiotics in labour (although they estimate death rates will be 1 in 100,000 of women taking the antibiotics - that's not a terribly frightening figure).

It doesn't make sense. It looks like it's about money (although the tests aren't really that expensive). And the US, Canada, Spain and Australia all do it; are they wrong and our health services right?

sparkle, yes, I had a good look at that site. That and several other sources helped me come to an opinion on what I will do.

tigger thanks for the RCOG document; I didn't read the whole thing, but it was enough to leave me unconvinced that screening could be seen as a bad thing.

I think that it shifts the risk/balance benefit, so if you know that you have group B then the risk of anaphylaxis is the same, but your chance of your baby benefitting from the treatment is much higher.

Well, exactly. I mean, they aren't going to give antibiotics to women who aren't infected - that would be just nuts. But screening in itself cannot cause risks to the mother; only treatment can (and even then, only comparatively small ones). Therefore, they haven't got a great argument, saying that they won't test all women because it's "risky" to screen. It appears that it's not; it's the subsequent treatment that might be.

I believe it's because they estimate approx 60% of women carry Strep B at any one time and that giving anti-biotics to that many women would
a) lead to approx 15 deaths per year from reaction to the antibiotics
and
b) likely lead to more antibiotic resistant strains of various infections/etc.

In addition it's believed that routine treatment for Group B strep would only reduce the morbidity rate for babies (i.e. those that get ill from strep B) and not affect the mortality rate (studies have shown that antibiotics don't reduce the mortality rate)

The RCOG themselves, in their reasons for not screening, estimate that only two women per year would die from the antibiotics, rather than the more alarming sounding 15. Their estimated risk of dying because of anaphylaxis is 1 in 100,000. Sounds pretty good, especially compared with the maternal mortality rate in the UK of 1 in 25,000.

Anyway, we can argue the risks or benefits of the Strep B treatment until the cows come home! I guess the point of all this is that Dr Lewis could have phrased it a bit better, because what she said on the webchat was that screening had risks for the mother. There really don't seem to be any risks from having the screening procedure itself (unless, I suppose, you develop an allergy to the cotton buds used to take the swab). My troubles are eased.