Pregnancy and Group Strep B
Introduction
Pregnancy is one of the most complicated part of being a woman, whilst being pregnant the women tends to face more risks in terms of health conditions. There are many infection-related diseases that a woman can encounter and one of these is Strep B. Accordingly, Group B streptococcus, more commonly known as Group Strep B is a bacteria which causes life-threatening infections among newborn babies. In addition, it is also considered as the leading cause of serious diseases in pregnant women, adults, and elderly with other illnesses. Primarily, this case will further discussion the implications if pregnant women were tested positive with group strep B.
Pregnant Women with Group Strep B
Medical authorities have always been focused in finding the causes of different illnesses around the world. One of the controversial issues that have been found throughout the years is the topic attached in connecting or associating different bacteria to cause further healthcare issues among pregnant women and also their newborn babies.
In the early 1970s, the bacteria called Group B streptococcus has been determined to be the number one cause of life threatening infections among newborn babies. Such bacteria can be normally found of in the vagina or in the lower intestine of 15% to 40% of women, including the healthy ones.
Studies have shown that 10%-30% of all women are considered as asymptomatic carrier of this kind of bacteria in the genital tracts. During labor, the bacteria are being transmitted on approximately half of all newborn babies to these women. And there are 2 for every 1000 babies in the USA has developed invasive infections, causing meningitis, pneumonia as well as other serious illnesses, typically within the first three months of their lives and half of those babies who developed Group Strep B meningitis experience long-term neurologic problems which include mental retardation and seizure disorders and about 10% of those infected by bacteria die (national Institutes of Health, 1996).
It has been known that Group Strep B is the most common cause of blood infection (sepsis) as well as meningitis among newborns. Studies have shown that between 10% and 35% of women is a carrier of this kind of bacteria within their vagina as well as their lower intestine. However, the bacteria does not cause any symptoms among pregnant women, though it can cause uterine and bladder infection. In times of pregnancy, the woman who underwent standard medical and health care typically has multiple tests considered to make sure that she and her baby is healthy. Such tests include the genetic screening via amniocentesis or blood tests, blood pressure monitoring, glucose and protein monitoring and most especially the Group Strep B test.
This type of test referred to the testing of the person for the streptococcus bacteria and only examines the B classification. As part of their prenatal care, pregnant women should undergo this kind of test. Accordingly, the test is being done in the third trimester of the pregnant women which is usually at their 35 to 37 weeks. This test is being done since there is a large possibility that the bacterial will pass to the baby during labor, hence physicians are very attentive and prepared to take precautions if this happens. Although not all pregnant women have Group strep b and some may test positive for these bacteria whilst others were not, most healthcare providers automatically consider the presence of these bacteria in women who have been previously tested positive. Hence, the test is not administered more than once if the pregnant woman receives a positive result. This kind of test is being done due to the risks for infection not only the mother but also their child.
If tested positive, Group strep b can cause serious conditions among newborn leading to other problems like blindness and even death especially because of sepsis. Although these dilemmas occur in a small number of situation which is only 0.5% to 1% of newborn to mothers tested positive with Group Strep B, those infants may develop other symptoms of early onset group strep B disease. If the pregnant women has tested positive with Group Strep B, then the physician should prescribe an oral antibiotic. In times of labor, the pregnant women will be placed on an intravenous antibiotic which will control any bacteria in the genital part which were not killed by the oral antibiotic. Group strep B test is a simple vaginal culture which is taken with a swab during the examination. In addition, those women who have been tested with GROUP STREP B are being colonized. In the United States it has been estimated that there are 12,000 infants who have been infected with this bacteria annually. Group B strep also become the number cause of death among infants with over 2, 000 infants dying yearly, whilst leaving other infants physically or mentally handicapped (GROUP STREP B Association, 1998).
Once test positive with Group Strep B, the mother is considered as a carrier. It has been estimated that one of every 100 to 200 newborn babies whose mothers were tested positive with group Strep b develop symptoms and signs of Group Strep B disease. However, there are various symptoms which may indicate that a mother is delivering babies with the bacteria and this include fever during labor, labor or rupture of membrane before the 37th weeks, rupture of membrane 18 hours or more before giving birth, urinary tract infection due to the group strep B during pregnancy.
Although having group Strep b is considered as uncontrollable, there are some recommendations made to help mothers to protect their babies from Group strep b. In a study by Centers for Disease Control and Prevention, if the mother is tested positive with group strep and are not in the high risk classification then the chance to deliver baby with this kind of bacteria is 1 in 200 babies if antibiotics were not provided and 1 in 4000 if antibiotics were provided. On the other hand, if you test positive with it and meet the high risk classification, then the physician should recommend giving antibiotics through IV during labor for preventing the baby from becoming ill. Having antibiotics are said to decrease the possibilities of the baby to become more ill. Since group strep B has been considered to be the leading cause of death among new born and also illnesses, authorities have been developing major step for having a vaccine that will prevent the infections with this kind of bacteria.
Studies have noted that babies that have Group Strep B diseases are born to mothers who lack antibodies to such kind of bacteria, hence authorities have attempted to find ways on providing such kind of antibodies that will reduce or eliminate Group strep B. Accordingly, and these antibodies protect the babies from infection after they are born. In order to help in solving the issue of group strep B, Kasper (NIH, 1996) and his colleagues have attempted to develop vaccines which would secure infants from this bacteria by stimulating the production of the antibodies among pregnant women. In the theoretical context, the maternal immunity established by such a vaccines will cross the placental members which will protect the newborn for the first few months of its life, especially those times when most Group strep B happens.
Treating Group Strep B
It has been noted that women are now being aware of the Group Strep B. The United States Centers for Disease Control and Prevention (CDC) along with the American College of Obstetricians and Gynecologists (ACOG) have suggested that all women who are pregnant should be screened and tested to determine if they are GROUP STREP B carries. In addition, authorities also advise all pregnant women who tested positive should be treated with intravenous antibiotics in times of labor and delivery. The concern about GROUP STREP B is being considered since healthcare authorities are aware that it can be passed from the mother to their babies during delivery which may bring risk and burden to the infant. Hence, most pregnant women who have been tested positive of the bacteria are recommended to follow the recommendations of CDC and ACOG and attempt to prevent the transmission of the bacteria with the newborn babies through the use of IV antibiotics during delivery. However, this kind of antibiotic is still unacceptable in some aspects. Group Strep B is considered a problem when it is present in the genital tract of the pregnant woman during delivery and labor. When this occurs, there is a greater possibility that this will be passed on the newborn babies causing more health problems. Different concerns have been arising in various areas about the use of antibiotic. One issue is that colonization of the vaginal tract by group strep b, is at best, considered a poor approach of predicting if the newborn baby will develop the infection because of the bacteria. It can be said that even without any intervention in times of labor, there are still 1% of newborn babies delivered with carrier mothers develop infections (Gilbert & Garland, 1983: Isaacs & Royle, 1999). Some researchers have noted that there is a reduction in the group strep B infection in babies born with mothers who accepted IV antibiotics during delivery, but did not see any reduction in the death incidence (Smaill, 2000; Terrone et al (1999). Still there ate studies which found that preventive utilization of antibiotics is not always efficient to fight Group strep B infections (Ascher et al, 1994). In a study conducted by Katz and his colleagues (1999) they have noted that they did not see any decrease in Group strep B infection or deaths among newborn babies whose mothers have taken IV antibiotics during delivery.
With these studies, it can be said that the greatest concerns among medical authorities and other healthcare authorities is the alarming increase of the antibiotic-resistant strains of these bacteria. This kind of bacteria can cause infections in the babies which are very difficult to cure. Different studies have also noted that not only Group strep b can restrain bacteria but also other bacteria which can affect and infect the baby during laboring and delivery (Terrone et al, 1999; Manning et al, 2003). Some strains of the group strep B has been noted to be resistant to cure by all the utilization of antibiotics. Though different researches have noted that providing antibiotics during labor to women tested positive for group strep B reduces the rate of the group strep B infection among new born babies. Studies are starting to present that this benefit is being outweighed by the development of other forms of infection. For instance, in one research which looked at the rates of infection of the blood among newborn babies over a period of 6 years, have noted that the utilization of antibiotics during delivery decrease the occurrence of GROUP STREP B infection but increases the incidence of some other type of blood infection. In this regard, the result show that the incidence of blood infection among new born remained unchanged (Levine et al, 1999).
Evidence show that the increased use of antibiotics can often leads to increasing bacterial resistance occurrence. In this regard, when a woman has been given antibiotics during labor, to treat Group step B, the antibiotics cross the placenta and goes to the amniotic fluid. Whilst the antibiotics may have wanted an effect of killing the GROUP STREP B bacteria, some of this bacteria can really survive and become more complicated, if not impossible, to kill with conventionally prescribed and used antibiotics. Likewise, other infectious bacteria may also be present in the mother or even the baby who can also become resistant to antibiotics cure and other prescribed medicine. Such bacteria may not have presented a large infection risk for the newborn babies until it is exposed to antibiotics and become a "super-bugs."
In a study conducted with 3 new born whose mother has been tested positive with GROUP STREP B and they develop blood infection, it has been found that, when the mothers of these babies had been given antibiotics during labor, there are 88% to 91% that infants' infections are resistant to antibiotics. This finding is not considered as coincidence that the medicines used in which the bacteria showed resistance were the same medicines and antibiotics which had been administered during delivery (Towers & Briggs, 2002). For the new born babies who had developed blood infections without exposure to any kind of antibiotics during labor and delivery, only 18% to 20% of their infections were resistant to antibiotics. In this regard, it can be said that the issue of Group strep b nowadays are not constrained in the test but in the prevention as well as the treatment.
Conclusion
Based on the analysis, it can be said that majority of pregnant women can be affected by the Group Strep B which can carry diseases to their newborn babies. In this regard, authorities are trying to find ways on treating and curing women who have tested positive with Group strep B. If women were tested positive with GBS, the pregnant women should consider the advice of the physicians and authorities on whether to take the medicine or not or any other treatment positive to ensure that the baby will not have the infection during labor and delivery. Healthcare authorities should enable pregnant women to know the risk of having this kind of disease and how it should be treated or handled carefully so that the baby will be protected during delivery.
Reference
Ascher, DP et al (1994). D. P. Ascher et al., "Failure of Intrapartum Antibiotics to Prevent Culture-Proved Neonatal Group B Streptococcal Sepsis," Journal of Perinatology 13, no. 3 (1994): 212-216.
GROUP STREP B Association (1998). "Awareness of Group B Streptococcus Infection During Pregnancy". Online available http://www.childbirth.org/articles/GROUP STREP B.html. Retrieve October 5, 2009.
Gilbert, GL and Garland, SM (1983). Prenatal Group B Streptococcal Infections," Medical Journal of Australia 1 (1983): 566-571.
Isaacs, D and Royle, JA (1999). "Intrapartum Antibiotics and Early Onset Neonatal Sepsis Caused by Group B Streptococcus and by Other Organisms in Australia," Australian Study Group for Neonatal Infections, Pediatric Infectious Disease Journal 18 (1999): 524-528.
Katz, PF et al (1999). ., "Group B Streptococcus: To Culture or Not to Culture?," Journal of Perinatology 19, no. 5 (1999): 37-42.
Levine, EM et al (1999). "Intrapartum Antibiotic Prophylaxis Increases the Incidence of Gram Negative Neonatal Sepsis," Infectious Disease Obstetric Gynecology 7, no. 4 (1999): 210-213.
Manning, SD (2003). et al., "Correlates of Antibiotic-Resistant Group B Streptococcus Isolated from Pregnant Women," Obstetric Gynecology 101, no. 1 (2003): 74-79.
National Institutes of Health (1996). Group B Strep Vaccine Shows Promise in Clinical Studies. Online available at http://www.nih.gov/news/pr/nov96/niaid-20.html. Retrieve October 5, 2009.
Smaill, F (2000). "Intrapartum Antibiotics for Group B Streptococcal Colonization," Cochrane Database Syst Rev (2000): CD000115; www.ncbi.nlm.nih.gov/.
Terrone et al (1999)., "Neonatal Sepsis and Death Caused by Resistant Escherichia coli: Possible Consequences of Extended Maternal Ampicillin Administration," American Journal of Obstetric Gynecology 180, no. 6, pt. 1 (1999): 1345-1348.
Towers, CV and Briggs, GG (2002), "Antepartum Use of Antibiotics and Early-Onset Neonatal Sepsis: The Next Four Years," American Journal of Obstetric Gynecology 187, no. 2 (2002): 495-500.
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