GBS+ at 26 wks=abx at delivery

[pammysue]

So, sunday I had a little scare and went into L&D. It turned out to be nothing, but they took a urine culture of course. The dr called to tell me that I am GBS positive and call in a rx for me. She also told me that this automatically means abx at delivery. I asked "evven though its so far out?" She said yes if you test positive for GBS at anytime during the pregnancy you have to have abx at delivery.

Does this sound right?

Also any advice for right now amd while I am on the abx?

PS-I am delivering at the local baby factory and having prenatals at their clinic, not by choice.

[LilyTiger]

My understanding is that they don't test until 36 weeks precisely because your status can change.  I would demand a retest as your due date gets closer.  Remember, it's your body and your birth.

[onlyboys]

A positive urine test denotes a high level of colonization with GBS.  In this case, most practitioners will, indeed, automatically treat.  They will likely not test you again at 36 weeks.  This is standard of care where I am.  Hope this helps you.

[pammysue]

So, this may be a stupid question, but how long does it take to get the antibiotics through the IV? Is it just a shot through the IV or a drip-type bag? Also, if I deliver quickly after taking the antibiotics do they have time to work before the baby comes through the vagina? I'm confused.

[calapitters]

I've done a bunch of research on alternatives to antibiotics for GBS during labor. I would be happy to PM everything to you (it's long).  There ARE reliable alternatives to antibiotics, they are just not well known in the US.  The most successfully researched is a a vaginal area rinse with Hibiclens (chlorohexidine solution used to kill bacteria in a surgical setting).  

To answer your question about the IV, it's a drip type of bag, but you can usually get a hep lock, which will allow you to remove the bag when you don't need it.  One dose takes about 4 hours to deliver, I believe, but don't quote me on that.  GBS comes and goes in the body in waves.  It takes about six weeks for a colony to really establish itself, so you may test differently at different times of your pregnancy.  Ask to be retested between 35-37 weeks.  

[womenswisdom]

GBS in the urine is considered indicative of a heavier colonization and would typically be reason to do antibiotics during labor (for most hospital-based providers). The antibiotics take about 30 minutes to infuse and are given every 4 hours, assuming that you are not allergic to penicillin, which is the usual antibiotic given. They are given in combination with saline and the IV can be disconnected from the saline lock when you are not receiving the antibiotics. They will want you to have at least 2 doses, which are given 4 hours apart for you to be considered "covered" for purposes of GBS treatment.

[onlyboys]

Yes to the above.  It doesn't take anywhere near 4 hours to infuse.  Typically, it takes about 30 minutes.  During that time, we try to make the mother as comfortable as possible in terms of position.  We like her to stay as mobile as possible, if she desires that.  I've even carried the bag of infusing antibiotics around like a movable IV pole.  :)

[MichelleZB]

Pammysue, this sucks. I was GBS+ too, and then my water broke before going into labour, so I had to go to the hospital and they started antibiotics before I'd even started contractions. BLECH. I hated it, I did.

But I wanted to post some encouragement: it'll be fine! Although the antibiotics sucked, I was still okay, and I managed to have a fairly unmedicated vaginal delivery anyway (I did do some laughing gas during transition but that's all) and the baby was put on my chest and breastfed and all was well. You'll be fine!

[AmandaMamma]

I think the amount of time for the drugs is dependent on the hospital. The hospital I'll be delivering at just recently changed their policy to having the antibiotics within the hour of birth and they call it good.

[womenswisdom]

This document from the CDC details the reason for their recommendation of 2 doses of antibiotics (>4 hours of antibiotic treatment) here: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm?s_cid=rr5910a1_w.

Under Prevention of Early-Onset Group B Streptococcal Disease: "Although the exact duration of antibiotics needed to prevent vertical transmission of GBS has been debated (84,85), beta-lactam antibiotics for GBS prophylaxis administered for ≥4 hours before delivery have been found to be highly effective at preventing vertical transmission of GBS (86) and early-onset GBS disease (68). Shorter durations of appropriate antibiotics might provide some protection; in particular, colonization data suggest durations of ≥2 hours before delivery might confer some protection (86)."

The whole paper is fairly interesting actually. There is a section entitled "Identification of Candidates for Intrapartum Antibiotic Prophylaxis" with a subheading of "Bacteriuria", which is particularly of interest in the OP's case.

[Plummeting]

There has been a study showing that maximum antibiotic levels are reached in the fetus only ONE hour after they're given, and the levels fall every hour after that, so four hours really isn't necessary. You should be able to find the study if you look for it. I think I may have even linked to it before in some other thread, but I'm not sure. :)