7th May 2013 21:44Antenatal testing for HIV and other serious diseases such as Hepatitis B are routine in Ireland. Most likely you signed a consent form for a blood test to be done at your booking appointment and that was the last you heard of it. If you were positive for these diseases the hospital would notify you and discuss a plan of care for you in pregnancy and labour. These diseases can pass to your baby – however they are rare. Group B strep colonization is not a sexually transmitted disease (STD). Approximately 25% (1 in 4) of pregnant women carry group B strep bacteria in their vagina or rectum. For most women there are no symptoms of carrying group B strep bacteria. The bacteria can pass to your baby during labour. It is the most common cause of life-threatening infections (sepsis, meningitis, pneumonia) in newborn babies. 90% of early onset GBS infection is preventable by treating mum with IV antibiotics in labour – and yet most Irish women are not routinely tested and in some cases Mums are put at additional risks by routinely breaking the waters in labour without knowing Mum’s GBS status. Most Irish/UK hospitals only treat mums who have specific risk factors; however 40% of babies that develop GBS have no risk factors. • You carry Group B Strep in your body • You’ve had a previous baby infected with GBS, • Your waters have released for more than 18 hours • Your labour starts before 37 weeks • You have a temperature in labour, • Multiple pregnancy, • Your baby’s heart rate is high throughout labour [b:3qo1w43t]How Accurate is the Test?[/b:3qo1w43t] If you’ve been diagnosed with GBS in a previous pregnancy you’re 38% more likely to have it in a subsequent pregnancy. Maybe you’ve been tested and found to be negative but another big problem is the reliability of the tests for GBS. The process called ‘Direct Plating’ is the most commonly used test and involves a swab taken from high inside your vagina (HVS). However this test only detects around 50% of infections. The gold standard and more accurate test is the ‘Enriched Culture Medium’ (ECM) but not widely used. A swab is taken from low in the vagina and the rectum around 35 – 37 weeks and is predictive for about 5 weeks. There’s no way of knowing if you’re carrying GBS without a test. These tests all involve incubating the bacteria for around 48 hours to see if the GBS bacteria shows up. There is also a rapid test PCR that can be done bedside and the result is available in less than 2 hours and no lab is required – however this is expensive. Pharmaceutical companies are currently developing a GBS vaccine – Novartis recently trialed a vaccine in South Africa but it’ll be several years before these are widely available. Keep in mind that no screening test is entirely accurate. A negative swab doesn’t guarantee that you’re not a carrier and even with antibiotics in labour no treatment is guaranteed to work all the time for everyone. These days most people are trying to reduce their antibiotic use as bacteria become more resistant however according to UK figures 1 in 300 babies will develop early onset GBS without having antibiotics in labour whereas only 1 in 6000 babies will develop GBS after Mum has received antibiotics in labour. Speak to your midwife/consultant at your next appointment about testing for GBS. If testing is not available you can purchase a private test (ECM) you can do at home from sonichealthcare.ie – before purchasing the test please discuss with your caregiver your labour care plan if you are positive (in other words will the hospital accept the privately done test as evidence of being GBS positive?). Some women under the private care of a consultant do get tested however the test is processed in the hospital’s public lab so all mothers should have access to this test. [b:3qo1w43t]Signs to look out for after your baby is born.[/b:3qo1w43t] If your baby is unwell due to early onset GBS it is likely to show up in the first 12 – 24 hours. Ongoing grunting of your baby. Not feeding well Seems lethargic Irritable High or low temperature High or low heart rate If you have any worries about your baby’s wellbeing speak to a midwife on the postnatal ward. For more information visit - http://www.gbss.org.uk/ I’ll post more about late onset GBS this week.