Does anyone know why...GBS procedures

[mrsberman]

I'm not sure if every GBS test is done the same way. When I had DD they inserted something into the vagina, then the anus. Why aren't the areas tested separately? I read somewhere that GBS can be in both areas, or one and not the other. It makes no sense to me to test them together. If GBS is in the rectum and not the vagina I wouldn't see the need to give/encourage antibiotics during labor. Does anyone know why?

[Marcy&Dono]

I'm thinking this is a "just in case" thing. When my midwife tested me she told me there was no need to swab my rectum, they only cared about my vagina.

[MegBoz]

I'm fairly certain the CDC recommendation is to swab the anus as well. I guess the fear is that if GBS is present in the rectum, you are still "colonized" with the bacteria and the baby could still be exposed to it.

Although one of my MWs (hospital-based CNMs) didn't do it the first time I was swabbed! I was surprised, but certainly didn't question her on it. ;)

The 2nd MW who re-swabbed at my request did, but didn't insert it into my rectum, just swabbed outside the anus.

[mrsberman]

Originally Posted by MegBoz 

I'm fairly certain the CDC recommendation is to swab the anus as well. I guess the fear is that if GBS is present in the rectum, you are still "colonized" with the bacteria and the baby could still be exposed to it.

Although one of my MWs (hospital-based CNMs) didn't do it the first time I was swabbed! I was surprised, but certainly didn't question her on it. ;)

The 2nd MW who re-swabbed at my request did, but didn't insert it into my rectum, just swabbed outside the anus.

I think I see the reasoning behind being colonized, but if the bacteria is just in the rectum and not the vagina, why treat for it? Would there really be that much growth to spread to other areas in a few short weeks? I guess I'm assuming most women wipe front to back so there shouldn't be contamination from back to front.

[MegBoz]

Originally Posted by mrsberman 

I think I see the reasoning behind being colonized, but if the bacteria is just in the rectum and not the vagina, why treat for it? Would there really be that much growth to spread to other areas in a few short weeks? I guess I'm assuming most women wipe front to back so there shouldn't be contamination from back to front.

True, but maybe the thought is that if the mama passes any fecal matter in the birth process, then there is the whole cross-contamination issue.

[Llyra]

Are they concerned about contamination during birth? That would be my guess. There's not any reasonable way to ensure that baby won't come into any contact with mama's anus and with mama's feces during birth.

[allisonrose]

My current midwife said that the procedure is to test the vagina and then "tickle" the anal opening. I believe the reasoning is that the bacteria can easily spread between the anal area and the vagina so they don't give the mama the benefit of the doubt regarding hygiene. I have heard of mamas asking a provider to do two separate swabs so that they are more informed about what is where.

You know, I really think that health care providers should cover this info (where they will be testing and why) before doing the swab. Seems like that would be informed consent...

[Christine4kiddos]

The newest CDC recommendations(as of November) are to swab the vagina and then the rectum.  I would like to see the studies that show that gut colonization (but no vaginal colonization)  results in the same infection rate in the newborn as vaginal colonization/urinary tract involvement. Is this practice CYA only?? I don't know.  At present, our clients receive vaginal swab only... but all women need to know that the current Standard of Care is to swab both the rectum and vagina.  We still need to discuss how to deal with the new recommendations.

[mrsberman]

Originally Posted by Christine4kiddos 

The newest CDC recommendations(as of November) are to swab the vagina and then the rectum.  I would like to see the studies that show that gut colonization (but no vaginal colonization)  results in the same infection rate in the newborn as vaginal colonization/urinary tract involvement. Is this practice CYA only?? I don't know.  At present, our clients receive vaginal swab only... but all women need to know that the current Standard of Care is to swab both the rectum and vagina.  We still need to discuss how to deal with the new recommendations.

So are you saying the swabs tested separately for each area? I agree, I would really like to see studies like that. To me it seems the likely hood of infection from the rectum is so low, I personally wouldn't worry about it happening.

[Sileree]

This is an interesting study.

"The group B streptococci detection rate from vaginal-perianal specimens is not significantly different from the detection rate from vaginal-rectal specimens. Therefore, pregnant women do not need to be subjected to the discomfort of collection of a rectal specimen."

[Pirogi]

Originally Posted by Sileree 

This is an interesting study.

"The group B streptococci detection rate from vaginal-perianal specimens is not significantly different from the detection rate from vaginal-rectal specimens. Therefore, pregnant women do not need to be subjected to the discomfort of collection of a rectal specimen."

I am thinking that "perianal" would be the "tickling" outside the anus referenced by a PP.  I think this study is saying that there is no need to insert the swab inside the rectum.

[mrsberman]

Originally Posted by Pirogi 

Originally Posted by Sileree 

This is an interesting study.

"The group B streptococci detection rate from vaginal-perianal specimens is not significantly different from the detection rate from vaginal-rectal specimens. Therefore, pregnant women do not need to be subjected to the discomfort of collection of a rectal specimen."

I am thinking that "perianal" would be the "tickling" outside the anus referenced by a PP.  I think this study is saying that there is no need to insert the swab inside the rectum.

I agree.

[Christine4kiddos]

No... same swab. I think it makes sense if it is vaginal only... I mean, if it isn't in the vagina by NOW.... how likely is it to be there in a couple of weeks??