Hjbuenodemesquita.jouwweb.nl
Speech of a daughterHome » 7-2-2012 GBS : what [ not ? ] to do? For all pregnant women and doctors

7-2-2012 GBS : what [ not ? ] to do? For all pregnant women and doctors

 GBS : what [ not ? ] to do? For all pregnant women and doctors

Often I get calls from pregnant patients [or E-mails ] what to do with the advice form hospital doctors about antibiotic prophylaxis / treatment during birth/delivery because of a  positive test for:

GBS = maternal Group B streptococcal colonization.


This whole issue is a relative "new fashion" in my opinion but I "refuse" give advice as to what the mothers should decide,this simply because this "new fashion" seems to be obscured by legal considerations"shikulim", more then medical ones.[see end of article below]
What I do advise in these cases is to take Echinacea ,in the form of Echinaforce[from Bioforce/Vogel] 3x per day 30 drops for a few weeks and to continue for a short while after delivery.
[Buy Echinaforce [Bioforce/Vogel] and not Echinaforte which is from another company]
Often the culture then becomes negative but this seems to have no bearing on the decisions of the hospital doctors who-also when confronted with these new facts-still advise to give antibiotics [the logic escapes me!]
The article below speaks clear language ,as it seems to me.
So, please don't call me for this issue but decide yourself............Sorry for this.
We are dealing here more with "legal medicine" then with common sense or willingness to ask oneself while women with a negative culture should be treated.
Pay attention: the article below is even not considering the point that the women can became negative by treatment with a simple herb but is dealing with women who enter birth with a positive culture
I would appreciate the commentary from any doctor on the mailing list.

 

 

Cochrane Database Syst Rev. 2009 Jul 8;(3):CD007467.

Intrapartum antibiotics for known maternal Group B streptococcal colonization.

Source

Departments of Paediatrics, Obstetrics and Gynaecology and Health Policy, Management and Evaluation, University of Toronto, # 14324 County Rd 29, Toronto, Ontario, Canada, K0K 3K0.

Abstract

BACKGROUND:

Maternal colonization with group B streptococcus (GBS) during pregnancy increases the risk of neonatal infection by vertical transmission. Administration of intrapartum antibiotic prophylaxis (IAP) during labor has been associated with a reduction in early onset GBS disease (EOGBSD). However, treating all colonized women during labor exposes a large number of women and infants to possible adverse effects without benefit.

OBJECTIVES:

To assess the effect of IAP for maternal GBS colonization on neonatal: 1) all cause mortality and 2) morbidity from proven and probable EOGBSD, late onset GBS disease (LOD), maternal infectious outcomes and allergic reactions to antibiotics.

SEARCH STRATEGY:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2009).

SELECTION CRITERIA:

Randomized trials assessing the impact of maternal IAP on neonatal GBS infections were included.

DATA COLLECTION AND ANALYSIS:

We independently assessed eligibility and quality of the studies.

MAIN RESULTS:

Three trials (involving 852 women) evaluating the effects of IAP versus no treatment were included. The risk of bias was high. The use of IAP did not significantly reduce the incidence of all cause mortality, mortality from GBS infection or from infections caused by bacteria other than GBS. The incidence of early GBS infection was reduced with IAP compared to no treatment (risk ratio 0.17, 95% confidence interval (CI) 0.04 to 0.74, three trials, 488 infants; risk difference -0.04, 95% CI -0.07 to -0.01; number needed to treat to benefit 25, 95% CI 14 to 100, I(2) 0%). The incidence of LOD or sepsis from organisms other than GBS and puerperal infection was not significantly different between groups.One trial (involving 352 women) compared intrapartum ampicillin versus penicillin and reported no significant difference in neonatal or maternal outcomes.

AUTHORS' CONCLUSIONS:

Intrapartum antibiotic prophylaxis appeared to reduce EOGBSD, but this result may well be a result of bias as we found a high risk of bias for one or more key domains in the study methodology and execution. There is lack of evidence from well designed and conducted trials to recommend IAP to reduce neonatal EOGBSD.Ideally the effectiveness of IAP to reduce neonatal GBS infections should be studied in adequately sized double-blind controlled trials. The opportunity to conduct such trials has likely been lost, as practice guidelines (albeit without good evidence) have been introduced in many jurisdictions.

PMID:
 
 19588432
 
 [PubMed - indexed for MEDLINE]