The Prevention of Early-Onset Neonatal Group B Streptococcal Disease (Replaces #61 (June 1997))

Prevention Early-onset Group B Streptococcus infection in newborns

The Society of Obstetrician and Gynaecologists of Canada (SOGC) in October 2013 A revised guideline for the prevention of early-onset group B Streptococcus (GBS) infection in newborns has been published. This guideline… By retrospectively analyzing relevant evidence from the literature, we propose intrapartum management strategies to prevent early-onset GBS infection in newborns. The main updates of this revision include: Prophylactic use of antibiotics, antimicrobial susceptibility testing, and management of premature rupture of membranes. Guide The evidence was derived from relevant literature indexed in MEDLINE, CINAHL, and The Cochrane Library, spanning the period from January 1980 to July 2012. The methodology employed was… Controlled vocabulary and keywords are: group B Streptococcus, antibiotic therapy, infection. Prevention. Study types include systematic reviews, randomized controlled trials or clinical controlled trials, and observational studies. No restrictions on publication date. Time and language type. In addition, by querying the websites of medical technology assessment agencies and related institutions, clinical practice guidelines, and clinical trial registries. We consult the websites of international medical professional organizations to obtain unpublished literature. The search results are updated regularly and incorporated into this guideline. Maternal and neonatal outcome assessments include antenatal… and maternal complications associated with intrapartum antibiotic use, as well as the incidence of early-onset GBS infection in newborns.

The recommendations in this guideline are intended to help clinicians identify and manage pregnancy-related risk factors for GBS infection in newborns, with the aim of improving maternal and neonatal outcomes; however, No cost-benefit analysis was conducted. The recommended provision is as follows.

1.　 All pregnant women should be screened for GBS colonization in the vagina and rectum between 35 and 37 weeks of gestation (II-1A). Pregnant women scheduled for cesarean delivery who have premature rupture of membranes or… Given the risks associated with preterm delivery, screening is also recommended (II-2B).

2. 　Because GBS colonization is strongly associated with early-onset GBS infection in newborns, pregnant women who meet the following criteria should receive prophylactic treatment at the onset of labor or in the event of premature rupture of membranes. Intravenous antibiotics: GBS-positive vaginal or rectal swab culture at 35–37 weeks of gestation (II-2B); a history of GBS infection in a previous infant born to the same mother (II-3B); During this pregnancy, the patient was diagnosed with GBS bacteriuria (regardless of the colony-forming unit count) (II-2A).

3. 　All pregnant women who undergo labor induction or experience premature rupture of membranes before 37 weeks’ gestation should receive prophylactic intravenous antibiotics for at least 48 hours. However, vaginal or rectal swab cultures obtained within 5 weeks or… Excluding those with negative GBS results on rapid nucleic acid testing (II-3A).

4. 　Pregnant women with intrapartum fever and signs of chorioamnionitis should receive intravenous broad-spectrum antibiotics covering GBS, regardless of GBS colonization status or gestational age. Vitamin (II-2A).

5. 　Pregnant women with a positive urine GBS test and those with a positive GBS culture from a vaginal or rectal swab should undergo antimicrobial susceptibility testing if they are allergic to penicillin (II-1A).

6. 　Pregnant women who experience premature rupture of membranes at or after 37 weeks’ gestation, if their vaginal or rectal swab cultures are positive for Group B Streptococcus (GBS), or if they have GBS bacteriuria during this pregnancy, or if they have previously delivered an infant with… If the infant has a history of GBS infection, prophylactic intravenous antibiotics should be administered. It is recommended to promptly initiate obstetric management, such as induction of labor, to terminate the pregnancy (II-2B).

7. 　For pregnant women at or beyond 37 weeks of gestation who have experienced premature rupture of membranes for more than 18 hours, if the Group B Streptococcus (GBS) colonization status remains unclear and GBS screening has not been performed between 35 and 37 weeks of gestation, or if screening… The outcome is unknown; prophylactic intravenous antibiotics should be administered (II-2B).

8. 　Pregnant women with premature rupture of membranes before 37 weeks’ gestation, who are awaiting the onset of labor or whose pregnancy needs to be terminated based on obstetric indications, should, if the Group B Streptococcus (GBS) culture result is unknown or positive, Prophylactic intravenous administration of antibiotics for at least 48 hours (II-3B). (Money D, Allen VM, Society of Obstetrician and Gynaecologists of Canada. The prevention of early-onset neonatal group B streptococcal disease[J]. J Obstet Gynaecol Can, 2013, 35: 939-951.)