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Treating ? haemolytic strep in pregnancy

Q - Group B ? haemolytic streptococcus is often found on high vaginal swabs in pregnancy. What are the latest guidelines on when to treat?

A - Group B streptococcus (GBS) is recognised as a frequent cause of severe early onset infection in newborns. In the UK authorities have not recommended universal screening in pregnancy, unlike the US, Australia and Canada. Recent figures for the rate of GBS carriage rate in the UK are not known.

In the absence of UK-based studies indicating a benefit for routine GBS screening in pregnancy, it is not recommended. If GBS is detected incidentally antenatal treatment with penicillin is not recommended since antenatal prophylaxis does not reduce the likelihood of GBS colonisation at time of delivery. Intrapartum antibiotic prophylaxis (IAP) should be offered to all women with a previous baby who had neonatal GBS disease. It should also be offered to women with GBS bacteriuria in the current pregnancy after discussion. IAP should also be considered in the presence of known risk factors for GBS disease such as intrapartum pyrexia (>38°C) prolonged ruptured membranes in labour (>18 hours) at term, prematurity (<37 weeks).="" iap="" is="" not="" required="" after="" caesarean="" section="" in="" the="" absence="" of="" labour.="" clindamycin="" is="" the="" drug="" of="" choice="" in="" those="" allergic="" to="">

Martha Hickey is associate professor at the University of Western Australia School of Women's and Infants' Health, King Edward Memorial Hospital

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