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Group B Beta Strep (streptococcus) causes more infections in newborns than any other bacteria, and remains a leading infectious cause of neonatal morbidity and mortality in the U.S.
Sadly, many babies with Group B Strep needlessly die or suffer from serious complications that could be prevented if their mothers were given beta strep testing during pregnancy.
Beta-Strep is bacteria that exists normally in the vagina of many women and usually creates no symptoms and no problems. It becomes a problem during pregnancy because it can cause premature delivery, premature rupture of membranes (commonly called “when the water breaks”), and chorio-amnionitis. Chorio-amnionitis is an infection of the amniotic fluid and membranes in the uterus that can spread to the baby.
About half of all babies of symptomatic mothers become infected right after they are born, resulting in serious consequences, including brain damage and death. Other effects include severe developmental delay, spastic quadriparesis, and permanent neurological injuries, sometimes requiring lifelong dependent care.
This tragedy is unnecessary because a simple test can determine if the infection is present, and can prevent problems either pre-delivery or immediately post-delivery. Delivering the baby quickly as soon as a problem develops, a ggressive monitoring during delivery as well as during and after delivery administration of antibiotics can avert the tragic consequences of Group B Strep infections in the fetus and newborn.
Group B Strep Testing, also known as Beta Strep Testing or GBS for short is a very simple test. A sterile cotton swab takes a fluid sample from the cervix (the entrance to the uterus) and the swab is sent to a laboratory to be tested for the presence of the beta strep virus. Tests are usually done at the beginning of the pregnancy and then again a couple of weeks before delivery.
The challenge with Beta-strep testing is that although is it is a simple and easy test, since the test returns a high degree of false positives, the infection has a high recurrence rate, and the culture is not cost-effective, Beta-strep testing is not routine for pregnant women. Thus, it is up to the doctor to determine from history, examination, symptoms, and risk factors if Beta-strep testing is called for.
An example of the consequences and seriousness of Beta Strep is this story of a 36-year-old mother whose pregnancy and delivery were normal until the mother developed a high fever 8 hours into her labor, indicating chorio-amnionitis. The infant was born with no heart rate, blue, floppy, and apneic. Although resuscitated, within a few days, she exhibited general seizures with tremors in the lower and upper extremities. An MRI revealed that the infant had severe hypoxic ischemic encephalopathy. The child will remain fully dependent throughout her life and is not expected to develop beyond the level of a one month old infant. This is a dramatic example of the dangers of Strep B and chorio-amnionitis.
There is some disagreement in the medical world about how best to treat Beta-Strep. The Centers for Disease Control recommends that for every carrier of Beta Strep, there should be a prophylactic (preventative) dose of antibiotics. Many medical professional groups disagree with this because treatment is given to a patient who may or MAY NOT have the condition. Also, antibiotics can upset the balance of other bacteria that are beneficial to the baby and important for its survival.
If the beta-strep infection is found (a positive Beta-strep test) then antibiotics should be started as soon as possible after the rupture of membranes to prevent infection passing to the baby. Prolonged rupture of membranes can cause chorio-amnionitis. Once membranes are ruptured (in other words, once the mother’s water breaks), labor and delivery should proceed as quickly as possible because the longer membranes are ruptured in a mother with Beta-strep, the higher the probability that the baby will become infected through Chorio-amnionitis. In cases of heavy growth of the Beta-strep virus in the mother with ruptured membranes and no preventative treatment, there is a 95% probability of the baby becoming infected.
One indication of chorio-amnionitis is that the mother herself develops a fever. If this happens right before delivery, sometimes it is best to wait until the baby is born before administering antibiotics, and the baby itself can also be directly cultured for infection. Sometimes a culture will not show the infection in the baby because the mother was treated with antibiotics, but the baby should still be tested, treated and medicated if appropriate. If the membranes are ruptured for more than 24 hours, and the mother develops a fever and is treated with antibiotics, protocol calls for a pediatrician to be present for the delivery because an infected baby (also called a septic baby) may be born with respiratory distress (problems breathing), as well as other problems and early treatment by trained personnel can affect the baby’s outcome.
In 1996, the American College of Obstetrics & Gynecology and the Centers for Disease Control published recommendations for the prevention of perinatal group B Strep (GBS) disease. These guidelines included:
Revised guidelines for Perinatal Group B Strep Testing were published in 2002 (MMWR 2002; 51 No. RR-11), which included these changes:
The major issue is that Group B Strep damage to the infant is entirely preventable with properly managed testing and monitoring, administration of antibiotics, and appropriate protocols during and just after the birth. Issues arrive if testing was not done when it should have been and/or protocols were not properly followed.
If there was any indication of Beta-Strep risk and no test was administered, or if there was any failure to administer treatment to the mother or the child in a timely manner, then there is a good chance that damage and infection could have been prevented and that medical malpractice or negligence was a factor. In any case of death or disability of a child from a Group B Strep infection whose mother was not given the Group-B- Strep test and proper treatment, a malpractice evaluation might be worthwhile.
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