Streptococci b screening in pregnancy

One in five pregnant women carries streptococci b during pregnancy. Approximately 1 in 1000 babies become infected before or during birth. An infection can usually be treated, but in rare cases the infection becomes fatal. In order to ensure that as few babies as possible are infected with the bacterium, all pregnant women in Belgium are given the opportunity to receive one streptococcal b screening to undergo before giving birth.

This possibility is not available in the Netherlands. Pregnant women only receive a streptococcal b screening if there is an increased risk of infection. Is that sufficient? Or should Dutch women always have the opportunity to test themselves, even without increased risk? Read more about streptococci b screening and infection here.

What are streptococci b?

Streptococci b or actually group B streptococcus is a bacterium. This bacterium is in the vagina of many pregnant women. In most cases, this bacterium can not hurt. But in some cases the baby can become seriously ill if the baby is infected with it. Gcall B STreptococci is also called GBS.

Streptococci b how do you get it?

This bacterium is often found in the normal vaginal flora or intestinal flora of women. This is the case with 1 in 5 women. The women who carry GBS with them usually have no complaints. In some cases, complaints can arise when the GBS causes a bladder infection during pregnancy.

There is no concrete cause that explains why some women carry the bacterium (they are also called 'carriers') and others do not. In your vagina and intestines is a whole range of bacteria, both good bacteria and bad bacteria and streptococci b can be part of this.
In most cases the women do not suffer from this. But when women carry GBS, there is a chance that they infect their baby during birth.

About 50% of the women who carry GBS carry the baby. This means that about 10% of all babies born are infected with GBS!

An infection does not always have to lead to illness, sometimes the bacteria can only sit on the skin or mucous membranes of the baby. Your baby will not get sick of this. Approximately 1 in 1000 babies will get sick from GBS. This happens when the bacterium invades the small body.

An infection can cause deafness, blindness, neurological problems, pneumonia and in the worst case even death of the newborn baby. In the Netherlands, a streptococcal b screening is not carried out with every pregnant woman in order to prevent infection of the baby.

When can your baby be infected with GBS?

Your baby can become infected with GBS in 3 ways if the mother carries the bacteria.

  1. In the womb

    Your baby can already be infected with streptococci in the uterus b. This usually happens when the membranes are broken. The bacterium then has 'free access' to the baby because the baby is no longer protected by the membranes.

  2. During the delivery

    If the bacterium is present in the vagina during birth, about half of the babies are infected during the delivery.

  3. After birth

    Only 1/3 of the infected babies are ill after birth. This is called a late-onset infection. It is possible that these babies were already infected during birth, but the disease developed only later because it was only on the skin first and later penetrated the body.

    Babies can still get sick of a GBS infection in the first 3 months. A baby can also become infected with streptococcal b after birth because the bacterium, for example, sits on the hands of adults.

Streptococci b symptoms

If the baby is already infected with GBS in the womb, the symptoms are temperature increase in the mother and faster heartbeat of the baby. When this is detected during controls, a streptococcal b screening will take place. If the baby is infected during birth, your baby will become ill the first day in 9 out of 10 cases.
Pay close attention to the following symptoms:

  • Fast breathing.
  • Superficial breathing.
  • Breathing sometimes stops.
  • The skin has no pink but a gray color. Sometimes the skin is blue or pale.
  • Your baby feels limp and drowsy.
  • In some cases, the baby is over-irritable and your child may have convulsions.
  • When you exhale, you hear a soft moaning sound (important symptom).
  • Spitting or not wanting to drink.
  • Fever or under temperature.

Group B streptococcal treatment

If your baby has a GBS infection, your baby will get antibiotics. In some cases babies become seriously ill. There is usually talk of inflammation such as a blood infection, pneumonia or meningitis.
The symptoms can develop very quickly sometimes even within a few hours. Therefore, medical assistance may be too late or the antibiotic treatment can no longer help.

In severe cases, it is possible that the disease develops very quickly so that treatment is too late. Sometimes the result can be fatal. In other cases, the infection does not cause inflammation, but your baby is 'just' ill.
In that case a streptococcal b screening will take place and your baby will get antibiotics. However, this is when the infection is detected in the baby after birth.

Women who are at increased risk of carrying GBS may already receive a streptococcal b screening during pregnancy. When the bacterium is present the pregnant preventive antibiotics to prevent infection during birth.

GBS pregnancy protocol

In Belgium, every pregnant woman may undergo a streptococcal b screening if she is between 35 and 37 weeks pregnant. During the streptococcal b screening, a wiper is removed from the vagina and the anus using a cotton swab. In the Netherlands, pregnant women are only tested when there is an increased risk.
Women have an increased risk when:

  • There is a premature birth for the 37th week of pregnancy.
  • The membranes are broken for a long time, longer than 18 to 24 hours.
  • The mother has a temperature increase of 37.8 to 38 degrees Celsius during the delivery.
  • If the mother has a bladder infection during pregnancy that is caused by GBS.
  • The mother has previously had a child with GBS disease.

NVOG guideline: Prevention of perinatal group b streptococcal disease

In the Netherlands, unlike Belgium and a number of other countries, not every pregnant woman receives a streptococcal b screening. One reason for this is that GBS is found in only 1 in 5 women and it also rarely affects the baby.

Only when there is an increased risk as mentioned earlier, pregnant women receive a streptococcal b screening. When the bacterium is detected during the streptococcal b screening, antibiotics can be given during the delivery to prevent the baby from getting an infection.

Sometimes the baby also receives antibiotics after birth, for example when there is a fever during delivery. In other cases, doctors advise to keep a close eye on the baby for the first 48 hours and to pay attention to any symptoms of one GBS infection. For the first 24 hours the baby will remain in the hospital for observation. When symptoms are detected, the baby receives antibiotics.

Why not always have a streptococcal b screening in the Netherlands?

In many cases the mother has GBS, but the baby is not infected or not sick. But in some cases it can be fatal. Why is not a streptococcal b screening performed in the Netherlands so that a possible death of the baby can be prevented?

What I have been able to find so far is that the risk of contamination and fatal outcome is so small that it is not deemed necessary. In addition, administering antibiotics too often is not desirable because it creates an antibiotic residence (you become immune to it).
On the other hand, in Belgium there is always a streptococcal b screening performed and this is the number of babies with GBS infection significantly reduced. Do you have an opinion or experience with this? We really love it!

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