Paging Ms Roland

[reprise]

What specific test should be ordered to confirm the presence or absence of Strep B in the birth canal. My daughter keeps showing traces of protein in her urine on antenatal visits (not particularly uncommon in pregnant women -which I found out today can be - but is certainly not necessarily - an indication of Strep B). Apparently 10% of Australian women carry Strep B in their vagina (kind of surprising that they still do VDRLs on pregnant women given just how uncommon syphillis is these days but they don't test for Strep B) but it only presents a risk under certain circumstances - most specifically premature rupture of membranes.

I know I'm being an overly concerned grandma to be here, but I'd at least like to ask at the next antenatal appointment why Strep B is not considered worthy of being a routine antenatal test here (the information I read today suggests that it's extremely simple and safe to treat it during pregnancy). From what I read today, it's also a significant causative factor in premature labours. If it can be detected from a swab, then a simple swab will put our collective minds at ease. If it can only be detected by highly invasive tests which pose their own risks of infection, then I can understand why it isn't a routine test.

Worried almost grandma now. :(

[Roland98]

What specific test should be ordered to confirm the presence or absence of Strep B in the birth canal. My daughter keeps showing traces of protein in her urine on antenatal visits (not particularly uncommon in pregnant women -which I found out today can be - but is certainly not necessarily - an indication of Strep B).

Generally a swab is the first test they do. They can then use that to either simply grow it on a plate, or there are some quick tests they can do to see if it's there without culturing it. Either one shouldn't take much more than a day.

Just a note--even if she's colonized now, it doesn't necessarily mean she will be when the baby is born. Here they test at around 35-37 weeks (and she's earlier than that, right?), as colonization can (and often is) fairly transient. That is to say, that (if present) she may no longer carry the bacterium when she goes into labor.

Apparently 10% of Australian women carry Strep B in their vagina (kind of surprising that they still do VDRLs on pregnant women given just how uncommon syphillis is these days but they don't test for Strep B) but it only presents a risk under certain circumstances - most specifically premature rupture of membranes.

Yeah. Here, if women are known to carry it, they get antibiotics once labor starts (any earlier, and they may be re-colonized). Like syphillis, it's passed on through the birth canal, so if you kill it during labor, it's not an immediate problem for the baby. (It can be transmitted as well via unwashed hands and things like that, however, so one must still be careful even after da baby has arrived).

I know I'm being an overly concerned grandma to be here, but I'd at least like to ask at the next antenatal appointment why Strep B is not considered worthy of being a routine antenatal test here (the information I read today suggests that it's extremely simple and safe to treat it during pregnancy). From what I read today, it's also a significant causative factor in premature labours. If it can be detected from a swab, then a simple swab will put our collective minds at ease. If it can only be detected by highly invasive tests which pose their own risks of infection, then I can understand why it isn't a routine test.

Nope, no invasive tests needed.

Here (http://www.cdc.gov/groupbstrep/gbs/hospitals_guidelines_summary.htm) is a link to a summary of the CDC guidelines on screening for GBS (which has a link to the full guidelines, which you can print off and discuss with your daughter's doc if so inclined).

This is a nice little graph that shows the decreasing incidence of early-onset GBS disease (within the first 7 days of life; this is the one transmitted from mother to baby during birth):

http://img.photobucket.com/albums/v164/roland98/GBS.gif

(ref for graph: N Engl J Med. 2000 Jan 6;342(1):15-20).

You can see the affect that each set of recommendations had on the decline in early-onset infections. Pretty dramatic, and a pretty simple thing for doctors to do.

As for your daughter, I wouldn't worry too much at this point. Protein in urine can be caused by a ton of things, and E. coli is much more likely if it's a urinary tract infection than GBS. But it can't hurt to discuss it with your daughter's physician.

[reprise]

What specific test should be ordered to confirm the presence or absence of Strep B in the birth canal. My daughter keeps showing traces of protein in her urine on antenatal visits (not particularly uncommon in pregnant women -which I found out today can be - but is certainly not necessarily - an indication of Strep B).

Generally a swab is the first test they do. They can then use that to either simply grow it on a plate, or there are some quick tests they can do to see if it's there without culturing it. Either one shouldn't take much more than a day.

Just a note--even if she's colonized now, it doesn't necessarily mean she will be when the baby is born. Here they test at around 35-37 weeks (and she's earlier than that, right?), as colonization can (and often is) fairly transient. That is to say, that (if present) she may no longer carry the bacterium when she goes into labor.

Apparently 10% of Australian women carry Strep B in their vagina (kind of surprising that they still do VDRLs on pregnant women given just how uncommon syphillis is these days but they don't test for Strep B) but it only presents a risk under certain circumstances - most specifically premature rupture of membranes.

Yeah. Here, if women are known to carry it, they get antibiotics once labor starts (any earlier, and they may be re-colonized). Like syphillis, it's passed on through the birth canal, so if you kill it during labor, it's not an immediate problem for the baby. (It can be transmitted as well via unwashed hands and things like that, however, so one must still be careful even after da baby has arrived).

I know I'm being an overly concerned grandma to be here, but I'd at least like to ask at the next antenatal appointment why Strep B is not considered worthy of being a routine antenatal test here (the information I read today suggests that it's extremely simple and safe to treat it during pregnancy). From what I read today, it's also a significant causative factor in premature labours. If it can be detected from a swab, then a simple swab will put our collective minds at ease. If it can only be detected by highly invasive tests which pose their own risks of infection, then I can understand why it isn't a routine test.

Nope, no invasive tests needed.

Here (http://www.cdc.gov/groupbstrep/gbs/hospitals_guidelines_summary.htm) is a link to a summary of the CDC guidelines on screening for GBS (which has a link to the full guidelines, which you can print off and discuss with your daughter's doc if so inclined).

This is a nice little graph that shows the decreasing incidence of early-onset GBS disease (within the first 7 days of life; this is the one transmitted from mother to baby during birth):

http://img.photobucket.com/albums/v164/roland98/GBS.gif

(ref for graph: N Engl J Med. 2000 Jan 6;342(1):15-20).

You can see the affect that each set of recommendations had on the decline in early-onset infections. Pretty dramatic, and a pretty simple thing for doctors to do.

As for your daughter, I wouldn't worry too much at this point. Protein in urine can be caused by a ton of things, and E. coli is much more likely if it's a urinary tract infection than GBS. But it can't hurt to discuss it with your daughter's physician.

She's 31 weeks and no-one is concerned about the protein in her urine (she's booked into a birth centre which rejects you at the slightest hint of possible complications). It was bothering me enough last night that I actually rang them and asked them and they told me all of the procedures which they have in place for dealing with the eventuality of GBS and it pretty much amounts to we give baby antibiotics at birth if mum is running a significant fever during labour. They also explained to me - and it was something I expected might me the case - that the management of L&D in the US is far more litigation driven than here and that the obstetric practise in the US is conducted with the possibility of future litigation in mind.

Thank you so much for answering my questions. I guess that they sounded quite hysterical, but from what you have said and from what my daughter's birth care providers have said, she's now at the stage of pregnancy where something else would have to be "terribly wrong" for GBS to be of immediate concern.

I don't recall ever being as concerned about my own pregnancies as I am about my daughter's. The antenatal clinic has no problem whatsoever with her low blood pressure, but when she had it checked at the local doctor's today they had quite a stress about it being "on the low side". It was 80/40 the other day at her antenatal visit. The doctor who took her BP today freaked out when it was 94/72 and suggested that it was "too low". As someone who throws spectacularly low blood pressures myself, I'm aware that pregnant plus hot weather equals needing to drink fluids by the clock in order to keep your blood volume up.

I suspect that an epidural will be out of the question for my daughter given her naturally low blood pressure and the tendency of epidurals to send people into hypotensive episodes, but it feel so good to be able to discuss this tuff openly.

[Roland98]

She's 31 weeks and no-one is concerned about the protein in her urine (she's booked into a birth centre which rejects you at the slightest hint of possible complications). It was bothering me enough last night that I actually rang them and asked them and they told me all of the procedures which they have in place for dealing with the eventuality of GBS and it pretty much amounts to we give baby antibiotics at birth if mum is running a significant fever during labour.

Right. But with GBS, it's usually carried asymptomatically, so no fever would be present. Therein lies the problem, and the reason the recommendations were put into place.

They also explained to me - and it was something I expected might me the case - that the management of L&D in the US is far more litigation driven than here and that the obstetric practise in the US is conducted with the possibility of future litigation in mind.

Oh, it certainly is, but that really is neither here nor there when it comes to GBS. Basically, screening for GBS is simple and cheap, and for women who carry it, antibiotics prevent early onset disease in infants almost 100% of the time. It's just one of those "duh" areas, IMO. The litigation part comes in more for actual procedures during the birth--fetal monitoring, whether to use certain kinds of drugs, how long to let the labor progress before you speed it along, or do a C-section, how long to let the pregnancy go before it's induced, things like that.

Thank you so much for answering my questions. I guess that they sounded quite hysterical, but from what you have said and from what my daughter's birth care providers have said, she's now at the stage of pregnancy where something else would have to be "terribly wrong" for GBS to be of immediate concern.

Not hysterical at all. I'm a mom; I understand your worry. :)

I don't recall ever being as concerned about my own pregnancies as I am about my daughter's. The antenatal clinic has no problem whatsoever with her low blood pressure, but when she had it checked at the local doctor's today they had quite a stress about it being "on the low side". It was 80/40 the other day at her antenatal visit. The doctor who took her BP today freaked out when it was 94/72 and suggested that it was "too low". As someone who throws spectacularly low blood pressures myself, I'm aware that pregnant plus hot weather equals needing to drink fluids by the clock in order to keep your blood volume up.

That does seem a bit low to me, but I really am not sure about it. Fluids are always a good thing, though. :)

I suspect that an epidural will be out of the question for my daughter given her naturally low blood pressure and the tendency of epidurals to send people into hypotensive episodes, but it feel so good to be able to discuss this tuff openly.

Is she taking any kind of natural birthing classes in that case? (I never did, but I know many people swear by them).

[reprise]

She's 31 weeks and no-one is concerned about the protein in her urine (she's booked into a birth centre which rejects you at the slightest hint of possible complications). It was bothering me enough last night that I actually rang them and asked them and they told me all of the procedures which they have in place for dealing with the eventuality of GBS and it pretty much amounts to we give baby antibiotics at birth if mum is running a significant fever during labour.

Right. But with GBS, it's usually carried asymptomatically, so no fever would be present. Therein lies the problem, and the reason the recommendations were put into place.

They also explained to me - and it was something I expected might me the case - that the management of L&D in the US is far more litigation driven than here and that the obstetric practise in the US is conducted with the possibility of future litigation in mind.

Oh, it certainly is, but that really is neither here nor there when it comes to GBS. Basically, screening for GBS is simple and cheap, and for women who carry it, antibiotics prevent early onset disease in infants almost 100% of the time. It's just one of those "duh" areas, IMO. The litigation part comes in more for actual procedures during the birth--fetal monitoring, whether to use certain kinds of drugs, how long to let the labor progress before you speed it along, or do a C-section, how long to let the pregnancy go before it's induced, things like that.

Thank you so much for answering my questions. I guess that they sounded quite hysterical, but from what you have said and from what my daughter's birth care providers have said, she's now at the stage of pregnancy where something else would have to be "terribly wrong" for GBS to be of immediate concern.

Not hysterical at all. I'm a mom; I understand your worry. :)

I don't recall ever being as concerned about my own pregnancies as I am about my daughter's. The antenatal clinic has no problem whatsoever with her low blood pressure, but when she had it checked at the local doctor's today they had quite a stress about it being "on the low side". It was 80/40 the other day at her antenatal visit. The doctor who took her BP today freaked out when it was 94/72 and suggested that it was "too low". As someone who throws spectacularly low blood pressures myself, I'm aware that pregnant plus hot weather equals needing to drink fluids by the clock in order to keep your blood volume up.

That does seem a bit low to me, but I really am not sure about it. Fluids are always a good thing, though. :)

I suspect that an epidural will be out of the question for my daughter given her naturally low blood pressure and the tendency of epidurals to send people into hypotensive episodes, but it feel so good to be able to discuss this tuff openly.

Is she taking any kind of natural birthing classes in that case? (I never did, but I know many people swear by them).

Yep. I have spectacularly low blood pressure myself and even more spectacularly low in summer. Sounds very odd in a Western society but unless our diastolic reading goes under 40 it's much more likely to be related to dehydration than to internal bleeding. An extremely common side effect of edpidural anaethesia is hypotension - which in people who have "normal" blood pressure would not be an issue, but in people who have naturally low blood pressure can be an issue.

Thanks for talking me through this. During summer I have to drink by the clock and I'm not even pregnant. I'm worrying too much and they'll be fine.