| name | design-group-b-strep-protocol |
| description | Use when managing Group B Streptococcus in pregnancy — e.g., "GBS positive pregnancy", "what happens if GBS positive", "IV antibiotics during labor", "GBS screening week 36" |
| source | ACOG Practice Bulletin 280 (2020); CDC Group B Strep Guidelines 2010 (reaffirmed 2020); Ohlsson & Shah Cochrane 2014 (intrapartum antibiotics) |
| tags | ["pregnancy","GBS","group-b-strep","antibiotics","labor","neonatal-sepsis","health"] |
| verified | true |
Design Group B Strep Protocol
Screen for GBS at 35–37 weeks and execute the intrapartum antibiotic prevention protocol.
Why This Is Best Practice
Adopted by: ACOG, CDC, AAP — universal GBS screening and intrapartum antibiotic prophylaxis (IAP) is the standard of care in the US, UK, Canada, and Australia.
Impact: IAP reduced early-onset neonatal GBS disease by 80% from 1990 to 2020 (CDC surveillance data). Without IAP, GBS-positive mothers have a 1 in 200 chance of neonatal sepsis; with IAP, risk falls to <1 in 4,000 (ACOG 2020).
Why best: GBS colonization is transient and harmless to the mother but causes severe sepsis, meningitis, and death in neonates. Screening + IAP is the most effective intervention.
Steps
- Screening (weeks 35–37):
- Vaginal-rectal swab (one swab, self-collected or provider-collected)
- Culture takes 24–48 hours; document result in chart for labor
- Screen even if GBS-negative in prior pregnancy — colonization status changes
- Automatic IAP (regardless of culture result):
- GBS bacteriuria (any amount) in current pregnancy → treat bacteriuria + IAP in labor
- Prior infant with invasive GBS disease → IAP in labor regardless of culture
- Culture-positive → IAP in labor:
- Preferred: Penicillin G 5 million units IV loading dose, then 2.5–3 million units IV q4h until delivery
- Penicillin allergy (low risk): ampicillin 2g IV then 1g IV q4h
- Penicillin allergy (high risk/anaphylaxis): culture-based — clindamycin if susceptible; vancomycin if resistant
- Timing: IAP must begin ≥4 hours before delivery to be fully protective — communicate GBS status clearly when going to labor and delivery.
- Culture unknown at delivery (no result/unscreened):
- Give IAP if: <37 weeks gestation, ROM ≥18 hours, or intrapartum fever ≥38°C
- Planned cesarean (no labor, intact membranes): IAP not required even if GBS-positive — exposure risk is membrane/birth canal.
Rules
- GBS-positive status on chart must be communicated to labor and delivery team — it is a care-critical flag.
- Do not treat GBS colonization with oral antibiotics in pregnancy (except bacteriuria) — it will recur and may affect IAP choice.
- If water breaks and labor hasn't started, go to hospital — IAP window depends on time to delivery.
Examples
GBS positive at 36 weeks: Document result, give patient card to carry, tell patient to notify L&D of GBS+ status on arrival; receive Pen G on admission, before any other interventions.
Unknown GBS status, water broke at 39 weeks: Go directly to hospital; receive IAP because ROM ≥18 hours threshold may be crossed.
Common Mistakes
- Not asking GBS result at L&D intake — if documented in chart, team must confirm and administer IAP.
- Confusing "GBS treated" (bacteriuria treatment) with "cleared" for IAP — bacteriuria treatment does not remove need for IAP in labor.
- Arriving at hospital without communicating GBS status — carry a written record; verbal communication in active labor is unreliable.
Health Disclaimer: GBS management requires coordination between prenatal care provider and labor and delivery team. Patients should understand their GBS status before 37 weeks and communicate it on arrival to hospital.
