New RCOG Guidelines to combat GBS
The Royal College of Obstetricians and Gynaecologists (RCOG) last week (13 September 2017) published new guidelines to help prevent the transmission of Group B Streptococcal (GBS).
What is Group B Streptococcal (GBS)?
GBS is one of the many bacteria present in our bodies. It naturally occurs in the digestive system and lower vaginal tract of around 20-40% of women, usually without symptoms or side effects. Although GBS usually does no harm, it can occasionally cause serious infection, most commonly in new-born babies.
Group B Streptococcal in new-born babies
There are two types of GBS infection in new-borns: early and late onset.
Early-onset GBS infection– if a baby develops GBS less than 7 days after birth.
Late-onset GBS infection– occurs in babies aged 7 days to 3 months.
How is GBS spread?
In cases of early-onset GBS, the bacteria are commonly passed from mother to baby during labour and birth. In pregnancy the GBS organism can infect the amniotic fluid which can lead to neonatal sepsis, pneumonia or meningitis.
The guidelines have identified a number of factors which appear to place women at an increased risk of delivering a baby with GBS. These include:
- Preterm birth (i.e. birth before 37 weeks)
- Prolonged rupture of membranes (i.e. when more than 24 hours has passed between rupture and the onset of labour)
- A previous baby with GBS
The NEW Guidelines
The new guidelines focus on the prevention of early onset GBS and provide guidance on what information should be provided to women, their partners and families.
Whilst the new guidelines do not go as far as other countries (i.e. Italy, Germany, US, Canada etc.) who recommend routine screening for GBS, RCOG now recommends that all women who go into preterm labour, regardless of whether their waters have broken, receive intravenous antibiotics during labour to help prevent the onset of GBS.
Furthermore, all pregnant women should be provided with “appropriate information” about GBS colonisation and the risk of neonatal infection during delivery and after birth.
It is disappointing that the National Screening Committee has concluded that there is no clear evidence to show that routine GBS screening would do more harm than good. A significant number of developed countries routinely offer GBS testing to pregnant women, and studies in the US have shown that upon implementation of universal screening there was a decline in the number of babies being born with early onset GBS.
It is also disappointing that when an expectant mother specifically requests bacteriological screening, they will not necessarily be offered it. Whilst I appreciate that there are cost implications in offering routine screening, if expectant mothers are now going to be given more information about GBS, and the risks involved, will that information include details of the availability of private GBS screening and its cost? The RCOG information leaflet referred to in the guidelines does not appear to inform expectant mothers of that fact. At home GBS testing kits are available for £35-40 or patients can attend a private clinic and pay a similar amount. Provision of this information is arguably even more vital as the guidelines state that mothers who test positive for GBS, after undergoing the test at an accredited laboratory, should be offered IAP (intrapartum antibiotic prophylaxis).
If the NHS is not going to offer routine screening for mothers, on the basis of arguably questionable National Screening Committee evidence, then surely they have a legal duty to advise not only of the treatment options available/not available on the NHS, but those available elsewhere.