GBS Medical Articles and Abstracts

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ALTERNATIVE TREATMENTS | ANTIBIOTIC FAILURE | ANTIBIOTIC SIDE EFFECTS | ANTIBIOTIC TREATMENTS | BACTERIAL PERSISTENCE | BREASTFEEDING | CHORIOAMNIONITIS | CLINICAL TRIALS | COLONIZATION | GBS TESTING | GBS IN URINE | INCIDENCE RATES | INTRAPARTUM INFECTION | INVASIVE PROCEDURES & INDUCTION | IN UTERO INFECTION | LATE-ONSET | OVERVIEW OF GBS | PLACENTA | PLACENTAL TRIAGE & PATHOLOGYPRENATAL-ONSET |PRETERM INFO | RECOMMENDATIONS | RECURRENT GBS | RESEARCH | SCREENING & TREATMENT | SEPSIS | SEROTYPES | SEX AND GBSSTILLBIRTH |  SUBSEQUENT PREGNANCIES | TESTING AND RESULTS | UNIVERSAL SCREENING | VAGINITIS | VACCINE

ALTERNATIVE TREATMENTS

Downloadable Guide as to Why Alternative Treatments for GBS are NOT effective

Alternative GBS Treatment Guide (English PDF) Downloadable guide as to why alternative treatments for GBS are not effective
Authored by Josh Jones, GBS dad.

ANTIBIOTIC FAILURE

Continued Early Onset Group B Streptococcal Infections in the Era of Intrapartum Prophylaxis.
L.S. Pulver et al.
J Perinatol. 2009;29(1):20-25.
(Please see paragraphs 7-9 regarding negative GBS screening cultures.)

Failure of intrapartum antibiotics to prevent culture-proved neonatal group B streptococcal sepsis. (Abstract)
Ascher DP et al.
J Perinatol. 1993 May-Jun;13(3):212-6.

ANTIBIOTIC SIDE EFFECTS

Effects of Intrapartum Penicillin Prophylaxis on Intestinal Bacterial Colonization in Infants.
Françoise Jauréguy et al.
J Clin Microbiol. Nov 2004; 42(11): 5184–5188.

ANTIBIOTIC TREATMENTS

Third Trimester Intramuscular Penicillin

Efficacy of intramuscular penicillin in the eradication of group B streptococcal colonization at delivery. (abstract)
Pinette MG, Thayer K, Wax JR, Blackstone J, Cartin A.
J Matern Fetal Neonatal Med. 2005 May; 17(5):333-5.

Late third-trimester treatment of rectovaginal group B streptococci with benzathine penicillin G. (abstract)
Bland ML, Vermillion ST, Soper DE.
Am J Obstet Gynecol. 2000 Aug;183(2):372-6.

Persistence of penicillin G benzathine in pregnant group B streptococcus carriers. (abstract)
Weeks JW, Myers SR, Lasher L, Goldsmith J, Watkins C, Gall SA.
Obstet Gynecol. 1997 Aug;90(2):240-3.

Treatment for GBS in Urine

Antibiotic Elimination of Group-B Streptococci in Urine in Prevention of Preterm Labour (abstract)
AC Thomsen, L Morup, KB Hansen
The Lancet, 1(8533):591-593, 1987.

Intrapartum Treatment for Penicillin Allergic Patients

Intrapartum group B streptococci prophylaxis in patients reporting a penicillin allergy. (abstract)
Matteson KA, Lievense SP, Catanzaro B, Phipps MG. Department of Obstetrics and Gynecology, Women and Infants Hospital, the Warren Alpert Medical School at Brown University, Providence, Rhode Island 02905, USA.
1: Obstet Gynecol. 2008 Feb;111(2 Pt 1):356-64.

PPROM

Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. (Abstract)
Mercer BM et al.
JAMA. 1997 Sep 24;278(12):989-95.
“We recommend that women with expectantly managed PPROM remote from term receive antibiotics to reduce infant morbidity.”

BACTERIAL PERSISTENCE

How long do nosocomial pathogens persist on inanimate surfaces? A systematic review Note: Not specific to group B strep (streptococcus agalactiae)
Axel Kramer, Ingeborg Schwebke, and Günter Kampf
BMC Infectious Diseases 2006, 6:130 doi:10.1186/1471-2334-6-130

Survival of enterococci and staphylococci on hospital fabrics and plastic. (abstract)
Neely AN, Maley MP
J Clin Microbiol.  2000 Feb;38(2):724-6.

BREASTFEEDING

Benefits

Breastfeeding and the Use of Human Milk
American Academy of Pediatrics Policy Statement
Pediatrics Vol. 129 No. 3 March 1, 2012, pp e827-e841 (doi: 10.1542/peds.2011-3552)

Mother’s Milk Still Best-and We Must Do Better. (abstract)
Sarasa, NL
MEDICC Rev. 2013 Jan;15(1):48.

Isotype composition of antibodies to streptococcus group B type III polysaccharide and to tetanus toxoid in maternal, cord blood sera and in breast milk (abstract)
Lagergard T, Thiringer K, Wassen L, Schneerson R, Trollfors B., Department of Medical Microbiology, University of Goteborg, Sweden.
Eur J Pediatr. 1992 Feb;151(2):98-102.

Immunoglobulin concentrations and bacterial antibody titres in breast milk from mothers of ‘preterm’ and ‘term’ infants (abstract)
Suzuki S, Lucas A, Lucas PJ, Coombs RR.
Acta Paediatr Scand. 1983 Sep;72(5):671-7.

GBS in Breastmilk

Neonatal group B streptococcal infection related to breast milk. (abstract)
Byrne PA, Miller C, Justus K, Department of Pediatrics and Neonatology, Saint Charles Mercy Hospital, Oregon, Ohio 43616, USA. Paul_Byrne@mhsnr.org <Byrne@mhsnr.org>
Breastfed Med, 2006 Winter;1(4):263-70.

Mothers May be Key Source of LOD Strep in Neonates
Pullen LC
Medscape Medical News, January 7, 2013 www.

Late-onset and recurrent neonatal Group B streptococcal disease associated with breast-milk transmission. (abstract)
Kotiw M, Zhang GW, Daggard G, Reiss-Levy E, Tapsall JW, Numa A,  Center for Biomedical Research, Department of Biological and Physical Sciences, Faculty of Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia 4350. kotiw@usq.edu.au
Pediatr Dev Pathol. 2003 May-Jun;6(3):251-6. Epub 2003 Apr 14.

Breast milk transmission of group B streptococcal infection. (abstract)
Dinger J, Müller D, Pargac N, Schwarze R., Clinic of Pediatrics, Medical Faculty, Technical University of Dresden, Germany. DINGER@ukd80.med.tu-dresden.de
Pediatr Infect Dis J. 2002 Jun;21(6):567-8.Source

Late-onset group B streptococcal disease by infected mother’s milk detected by polymerase chain reaction. (abstract)
Lanari M, Serra L, Cavrini F, Liguori G, Sambri V.,Department of Paediatrics, Santa Maria della Scaletta Hospital, Imola, Italy.
New Microbiol. 2007 Jul;30(3):253-4.

Breast milk and Group B streptococcal infection: vector of transmission or vehicle for protection? (abstract)
Le Doare K, Kampmann B.
“Vaccine.” 2014 May 30;32(26):3128-32. doi: 10.1016/j.vaccine.2014.04.020. Epub 2014 Apr 13.

Group B Streptococcus Late-Onset Disease: 2003–2010 (Full Article)
Alberto Berardi, MD,a Cecilia Rossi, MD,a Licia Lugli, MD,a Roberta Creti, PhD,b et. all, American Academy of Pediatrics Vol. 131 No. 2 February 1, 2013 pp. e361 -e368 (doi: 10.1542/peds.2012-1231)

CHORIOAMNIONITIS

Peripartum infection associated with vaginal group B streptococcal colonization.
Yancey MK, Duff P, Clark P, Kurtzer T, Frentzen BH, Kubilis P.
Obstet Gynecol. 1994 Nov;84(5):816-9.
“Intrapartum vaginal colonization with group B streptococci is an important independent risk factor for chorioamnionitis.”

CLINICAL TRIALS

Oral Probiotics Reduce Group B Streptococci Colonization in Pregnant Women.
Sponsored by China Medical University Hospital

Newly Posted - Membrane Sweeping in Group B Streptococcus (GBS) Positive Patients

Keller, J.M.,George Washington University. May 26, 2010.

COLONIZATION (Maternal and Neonatal)

Association of sexual activity with colonization and vaginal acquisition of group B Streptococcus in nonpregnant women. (Abstract)
Meyn LA, Moore DM, Hillier SL, Krohn MA.
Am J Epidemiol. 2002 May 15;155(10):949-57.

Determinants of co-colonization with group B streptococcus among heterosexual college couples.
Manning SD, Tallman P, Baker CJ, Gillespie B, Marrs CF, Foxman B.
Epidemiology. 2002 Sep;13(5):533-9.
“Among heterosexual college couples, sexual activity, particularly male-to-female oral sex, increases the risk of co-colonization with an identical group B strain. Future studies should evaluate the role of the pharynx and examine the effects of both bacterial characteristics and host response on transmission.”

Prevalence of maternal group B streptococcal colonization and related risk factors in a Brazilian population. (Abstract)
Zusman AS, Baltimore RS, Fonseca SN.
Braz J Infect Dis. 2006 Aug;10(4):242-6.

First-trimester group B Streptococcus colonization of the cervix: a risk factor for maternal colonization at term?
Daimaru-Enoki LC, Morgan M, Nichols WS, Silverman NS.
J Reprod Med. 2005 Jul;50(7):496-500.

Group B Streptococcus colonization by HIV status in pregnant women: prevalence and risk factors.
Shah M, Aziz N, Leva N, Cohan D.
J Womens Health (Larchmt). 2011 Nov;20(11):1737-41. doi: 10.1089/jwh.2011.2888. Epub 2011 Oct 19.

Group B Streptococcus colonization during pregnancy and maternal-fetal transmission in Zimbabwe.
Mavenyengwa RT, Afset JE, Schei B, Berg S, Caspersen T, Bergseng H, Moyo SR.
Acta Obstet Gynecol Scand. 2010;89(2):250-5. doi: 10.3109/00016340903398029.

Interaction of Streptococcus agalactiae and Cellular Innate Immunity in Colonization and Disease.
Sybille Landwehr-Kenzel and Philipp Henneke
Front Immunol. 2014; 5: 519.

Prevalence and significance of vaginal group B streptococcus colonization in pregnant women from Osijek, Croatia.
Müller-Vranjes A, Puntarić D, Curzik D, Sijanović S, Topolovec Z, Kasac Z, Miskulin M.
Coll Antropol. 2011 Mar;35(1):21-6.

Incidence of maternal GBS colonization and neonatal GBS disease among Very Low Birth Weight Polish neonates.
Monika Brzychczy-Wloch, Jadwiga Wojkowska-Mach,Ewa Helwich, and Piotr B. Heczko
Med Sci Monit. 2013; 19: 34–39.

Group B streptococcus and Escherichia coli colonization in pregnant women and neonates in Lithuania. (Abstract)
Barcaite E, Bartusevicius A, Tameliene R, Maleckiene L, Vitkauskiene A, Nadisauskiene R.
Int J Gynaecol Obstet. 2012 Apr;117(1):69-73. doi: 10.1016/j.ijgo.2011.11.016. Epub 2012 Jan 20.
“Maternal and neonatal GBS colonization rates, serotypes, and susceptibility to antibiotics were comparable to those reported in previous studies. Population-based data regarding early-onset neonatal infection rates will enable the formulation of a prevention program for early-onset GBS disease in Lithuania.”

Factors associated with intrapartum transmission of group B Streptococcus.
Berardi A et al.
Pediatr Infect Dis J. 2014 Dec;33(12):1211-5. doi: 10.1097/INF.0000000000000439.
“Heavy maternal colonization, intrapartum fever, African ethnicity and lack of IAP exposure were associated with GBS transmission in neonates born to women who were tested positive on admission. Low rates of NC were found among IAP-exposed neonates irrespective of IAP duration.”

Recolonization of group B Streptococcus (GBS) in women with prior GBS genital colonization in pregnancy. (abstract)
Tam T, Bilinski E, Lombard E.
J Matern Fetal Neonatal Med. 2012 Oct;25(10):1987-9. doi: 10.3109/14767058.2012.670331. Epub 2012 Apr 2.
“…patients with a history of GBS are at a significantly higher risk of GBS recolonization in subsequent pregnancies.”

Is there a correlation between the vaginal colonization with group B streptococci and premature deliveries? (abstract)
Kovachev E, Markova V, Bozhkova K, Popova A, Tsvetkova S, Cherneva S.
Akush Ginekol (Sofiia). 2003;42 Suppl 2:3-5.

Group B streptococcal colonization and preterm labour. (Abstract)
McDonald H, Vigneswaran R, O’Loughlin JA.
Aust N Z J Obstet Gynaecol. 1989 Aug;29(3 Pt 2):291-3.

GBS IN URINE

ACOG Patient Education Pamphlet of Urinary Tract Infections

Antibiotic Elimination of Group-B Streptococci in Urine in Prevention of Preterm Labour (abstract)
AC Thomsen, L Morup, KB Hansen.
The Lancet, 1(8533):591-593, 1987.

Prevention of Group B Streptococcal Disease in the Newborn
BS Apgar, MD, MS; G Greenberg, MD, MA; and G YEN, MD.
American Family Physician, March 1 2005
“Compared with infants born to lightly colonized women, those born to heavily colonized women have 2.5 times the risk of infection. Neonates born to mothers who have GBS bacteriuria at any time during pregnancy are known to be more frequently and more heavily colonized with GBS and are more likely to develop sepsis. Infections that occur in the first two days of life usually are caused by exposure to maternal organisms. Risk factors for neonatal transmission and infection are listed in Table 1. Compared with term newborns, preterm and low-birth-weight infants have increased rates of GBS sepsis.”

Urinary Tract Infections During Pregnancy (abstract)
John E. Delzell Jr, MD, and Michael L. Lefevre, MD, MSPH.
Am Fam Physician, 2000 Feb 1;61(3):713-21. Erratum in Am Fam Physician 2000 Jun 15;61(12):3567.

Urinary tract infections during pregnancy. (Abstract)
Le J, Briggs GG, McKeown A, Bustillo G.
Ann Pharmacother. 2004 Oct;38(10):1692-701. Epub 2004 Aug 31.
“Therapeutic management of UTIs in pregnancy requires proper diagnostic workup and thorough understanding of antimicrobial agents to optimize maternal outcome, ensure safety to the fetus, and prevent complications that lead to significant morbidity and mortality in both the fetus and the mother.”

GBS TESTING

Rapid Tests

Nanologix
Rapid test solutions that detect active threat bacteria and other microorganisms 4x – 12x faster than traditional Petri culture technology

Your Guide to Group B Strep
A very informative set of articles on rapid testing solutions including parent interviews. Featured on USAToday.com for July 2012 International Group B Strep Awareness Month.

Molecular Testing

Understanding Group B Strep
This set of articles includes interviews by GBS moms who tested negative at 35-37 weeks gestation, but were positive when their membranes were stripped/babies were born resulting in devastating GBS infections.

INCIDENCE RATES

Group B streptococcal disease in UK and Irish infants younger than 90 days. (Abstract)
Heath PT et al.
Lancet. 2004 Jan 24;363(9405):292-4.

Evaluation of Universal Antenatal Screening for Group B Streptococcus
Van Dyke et al
The New England Journal of Medicine 2009; 360:2626-2636 June 18, 2009
This paper analyzes the implementation and impact of the universal screening recommendations on provider methods and the incidence of GBS disease. It highlights the positive impact of universal screening and also identifies areas that need continued improvement.

Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis (abstract)
Dr Karen M Edmond PhD, Christina Kortsalioudaki MBBS, Susana Scott PhD, Stephanie J Schrag DPhil, Prof Anita KM, Zaidi MBBS, Prof Simon Cousens DipMathStat, Prof Paul T Heath MBBS [Hons].
The Lancet, Volume 379, Issue 9815, Pages 547 -556, 11 February 2012, doi:10.1016/S0140-6736(11)61651-6.
“Despite widespread use of intrapartum antibiotic prophylaxis, group B streptococcus remains a leading cause of morbidity and mortality in infants in Europe, the Americas, and Australia. However, estimates of disease burden in many countries outside of these regions is not available. We aimed to examine the current global burden of invasive disease and the serotype distribution of group B streptococcus isolates.”

Perinatal Group B Streptococcal Disease After Universal Screening Recommendations; United States, 2003-2005
CDC MMWR Weekly, July 20, 2007.  “…Although incidence among white infants decreased steadily during 2003–2005, incidence increased 70% among black infants.”

Group B streptococcus incidence rises significantly among newborns despite widespread adoption of prevention initiatives.
The Lancet. “Group B streptococcus incidence rises significantly among newborns despite widespread adoption of prevention initiatives.” ScienceDaily. ScienceDaily, 20 October 2014. <www.sciencedaily.com/releases/2014/10/141020090138.htm>.
“Group B streptococcus, a major cause of serious infectious diseases including sepsis, meningitis, and pneumonia, has increased by about 60% among infants younger than 3 months in the Netherlands over the past 25 years despite the widespread use of prevention strategies, new research has found.”

Before and After Implementation of Protocols

Ten-year study on the effect of intrapartum antibiotic prophylaxis on early onset group B streptococcal and Escherichia coli neonatal sepsis in Australasia. (Abstract)
Daley AJ, Isaacs D; Australasian Study Group for Neonatal Infections.
Pediatr Infect Dis J. 2004 Jul;23(7):630-4.

Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005.
Phares CR et al.
JAMA. 2008 May 7;299(17):2056-65. doi: 10.1001/jama.299.17.2056.

INTRAPARTUM INFECTION

Intrapartum evidence of early-onset group B streptococcus. (Abstract)
Tudela et al. Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9032, USA.
Obstet Gynecol. 2012 Mar;119(3):626-9. doi: 10.1097/AOG.0b013e31824532f6.

Factors Associated with Intrapartum Transmission of Group B Streptococcus. (Abstract)
Berardi et al.
Pediatr Infect Dis J. 2014 Jul 16.
“Heavy maternal colonization, intrapartum fever, African ethnicity and lack of IAP exposure were associated with GBS transmission in neonates born to women who tested positive on admission. Low rates of NC were found among IAP exposed neonates irrespective of IAP duration.”

INTUITION

The silent child–mothers’ experiences before, during, and after stillbirth. (abstract) Trulsson O, Rådestad. I,  Birth, 2004 31(3): p. 189-95

Women’s premonitions prior to the death of their baby in utero and how they deal with the feeling that their baby may be unwell. (abstract) Erlandsson K, et al.,  Acta Obstet Gynecol Scand 2012. 91(1):28-33.

Listening to Parents after stillbirth or the death of their baby after birth. Redshaw M, Rowe R, and Henderson J,  2014, National Perinatal Epidemiology Unit University of Oxford.

Using intuitive knowledge in the neonatal intensive care nursery. Schraeder BD, Fischer DK,  Hol Nurs Pract, 1987. 1(3): 45-51 (Link currently unavailable)

 Intuition: a critical review of the research and rhetoric. (abstract) King L, Appleton JV, JAN, 1997. 26: 194-202.

How expert nurses use intuition. (Link currently unavailable) Benner P., Tanner C.A.  AJN 1987 87(1), 23-31.

A is for aphorism: Do smart mothers make better diagnoses than poor doctors? (abstract) Cooke G,  Aust Fam Physician 2012. 41(9): p. 730.

Strengthening mindfetalness. (abstract) Rådestad I, Sex Reprod Health 2012. 3(2) 59-60.

Obstetric outcome in women complaining of reduced fetal movements. (Link currently unavailable) Sinha D et al.  J Obstet Gynaecol 2007 27 (1) 41-43.

Association between reduced stillbirth rates in England and regionaluptake of accreditation training in customised fetal growth assessment. Gardosi J, et al.,  BMJ, 2013. 3: p. e003942 doi:10.1136/bmjopen-2013-003942.

INVASIVE PROCEDURES & INDUCTION

Internal Monitoring

Previous intra-amniotic infection as a risk factor for subsequent peripartal uterine infections. (abstract)
Dinsmoor MJ, Gibbs RS.
Obstet Gynecol. 74(3 Pt 1):299-301. 1989.
“Those patients who did develop recurrent intra-amniotic infection had significantly longer labors, duration of ruptured membranes, and duration of internal monitoring, and an increased number of vaginal examinations.“

Risk factors for intraamniotic infection: a prospective epidemiologic study. (abstract)
Soper DE, Mayhall CG, Dalton HP.
Am J Obstet Gynecol. 161(3):562-6; discussion 566-8. 1989.
“The clinical diagnosis of intraamniotic infection was made in  (10.5%) patients. Patients with intraamniotic infection were younger, of lower gravidity and parity, more likely to require oxytocin augmentation, and more likely to be monitored internally than were patients who were not infected. They also had longer durations of labor, ruptured membranes, and hospitalization before delivery, had significantly more vaginal examinations, and were more likely to be delivered of infants by cesarean section, as compared with patients without infection. Logistic regression analysis identified four variables independently associated with intraamniotic infection: the number of vaginal examinations, duration of ruptured membranes, use of internal monitors, and duration of total labor.“

Logistic regression analysis of risk factors for intra-amniotic infection. (abstract)
Newton ER, Prihoda TJ, Gibbs RS.
Obstet Gynecol. 1989 Apr;73(4):571-5.
“…among patients meeting risk criteria, parity, duration of internal monitoring, and duration of membrane rupture were the significant risk factors for intra-amniotic infection.“

Is meconium passage a risk factor for maternal infection in term pregnancies? (abstract)
Jazayeri A, Jazayeri MK, Sahinler M, Sincich T.
Obstet Gynecol. 99(4):548-52. 2002.
“Meconium passage increases the risk of postpartum endometritis but not chorioamnionitis. Length of labor, internal monitoring, and number of vaginal exams are risk factors for chorioamnionitis.”

Induction

Maternal colonization with Group B Streptococcus and prelabor rupture of membranes at term: The role of induction in labor. (abstract)
Hannah, Mary E. MD,CM, et. al.
Am J Obstet Gynecol. 177:780-785. 1997.
“RESULTS: Group B streptococci were predictive of neonatal infection for the induction with vaginal prostaglandin E2 gel and expectant groups but not for the induction with oxytocin group. For women positive for group B streptococci the rates of neonatal infection were 2.5% for the induction with oxytocin group and > 8% for all other groups. CONCLUSIONS: Induction of labor with intravenous oxytocin may be preferable for group B streptococci-positive women with prelabor rupture of membranes at term.”

Methods of induction of labour: a systematic review. (abstract)
Mozurkewich EL, Chilimigras JL, Berman DR, Perni UC, Romero VC, King VJ, Keeton KL.
BMC Pregnancy Childbirth. 2011 Oct 27;11:84. doi: 10.1186/1471-2393-11-84.

Membrane Stripping

Stripping the Membranes
Website article at Childbirth.org.
“Stripping the membranes is where a health care provider will separate your bag of water from the cervix, it is not intended to break your water, however, it may. It may also cause infection, and may be painful for some.”

Cervical Manipulations Linked to Perinatal Sepsis: Consider GBS-specific Chemoprophylaxis (Eight Case Reports)
Kathryn DeMott
OB/GYN News, Oct 15, 2001.
“Obstetricians may want to reconsider doing elective cervical manipulation, at least on patients who have cervical vaginal infection or colonization with potential perinatal pathogens. They may also want to consider providing GBS-specific chemoprophylaxis before membrane stripping.”

Maternal colonization with Group B Streptococcus and prelabor rupture of membranes at term: The role of induction in labor. (abstract)
Hannah, Mary E. MD,CM, et. al.
Am J Obstet Gynecol. 177:780-785. 1997.
“RESULTS: Group B streptococci were predictive of neonatal infection for the induction with vaginal prostaglandin E2 gel and expectant groups but not for the induction with oxytocin group. For women positive for group B streptococci the rates of neonatal infection were 2.5% for the induction with oxytocin group and > 8% for all other groups. CONCLUSIONS: Induction of labor with intravenous oxytocin may be preferable for group B streptococci-positive women with prelabor rupture of membranes at term.”

Group B Strep: A Patient/Provider Approach for Optimizing Care
James McGregor, MDCM
“Research has been done showing that both labor contractions and manual or digital examinations by care providers can actually move infectious vaginal fluid through the mouth of the womb.”

Group B Streptococci (abstract)
Anne Schuchat MD
The Lancet; 353: 51-6. 1999
“Birth practices differ substantially around the world, and home births and less invasive procedures during hospital births might limit the risk of GBS sepsis in the newborn.”

Vaginal/Cervical Exams

Cervical Manipulations Linked to Perinatal Sepsis: Consider GBS-specific Chemoprophylaxis (Eight Case Reports)
Kathryn DeMott
OB/GYN News, Oct 15, 2001.
“Obstetricians may want to reconsider doing elective cervical manipulation, at least on patients who have cervical vaginal infection or colonization with potential perinatal pathogens. They may also want to consider providing GBS-specific chemoprophylaxis before membrane stripping.”

The Myth of the Vaginal Exam
Website article at About.com by Robin Elise Weiss, LCCE.
“Vaginal exams can increase the risks of infection, even when done carefully and with sterile gloves, etc. It pushes the normal bacteria found in the vagina upwards towards the cervix. There is also increased risk of rupturing the membranes.”

Vaginal Exams in Late Pregnancy
Website article at Childbirth.org.
“Having a vaginal exam can cause your membranes to rupture prematurely (making an induction necessary in the eyes of most care providers, which is also more likely to end in a cesarean), you run the risk of getting an infection which can harm both you and the baby…”

The microbiologic effect of digital cervical examination. (abstract)

Imseis HM, Trout WC, Gabbe SG. Am J Obstet Gynecol. 180(3 Pt 1):578-80. 1999.

“An immediate effect of digital examination is the introduction of vaginal organisms into the cervical canal.“

Characterization and control of intraamniotic infection in an urban teaching hospital. (abstract)
Soper DE, Mayhall CG, Froggatt JW.
Am J Obstet Gynecol. 175(2):304-9; discussion 309-10. 1996.
“Risk factors (duration of ruptured membranes, use of internal monitoring, number of vaginal examinations) were similar in both term and preterm women with intraamniotic infection.”

International Multicentre Term Prelabor Rupture of Membranes Study: evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term. (abstract)
Seaward PG, Hannah ME, Myhr TL, Farine D, Ohlsson A, Wang EE, Haque K, Weston JA, Hewson SA, Ohel G, Hodnett ED.
Am J Obstet Gynecol. 177(5):1024-9. 1997.
“Increasing numbers of digital vaginal examinations, longer duration of active labor, and meconium staining of the amniotic fluid were the most important risk factors for the development of clinical chorioamnionitis in women with prelabor rupture of membranes at term.“

Is meconium passage a risk factor for maternal infection in term pregnancies? (abstract)
Jazayeri A, Jazayeri MK, Sahinler M, Sincich T.
Obstet Gynecol. 99(4):548-52. 2002.
“Meconium passage increases the risk of postpartum endometritis but not chorioamnionitis. Length of labor, internal monitoring, and number of vaginal exams are risk factors for chorioamnionitis.“

Pathophysiology, diagnosis, and management of intraamniotic infection. (abstract)
Riggs JW, Blanco JD.
Semin Perinatol. 22(4):251-9. 1998.
“There is no clearly established means for the prevention of IAI, but cervical examinations and cervical manipulation can increase the risk, so caution with their use is still warranted.”

LATE-ONSET

Ultra late onset group B streptococcal sepsis with acute renal failure in a child with urethral obstruction: a case report.
Daniela Freudenstein et al.
Journal of Medical Case Reports 2012, 6:68  doi:10.1186/1752-1947-6-68
“Group B streptococci serotype V, urogenitary tract malformations, previous hospitalization and medical interventions may be important risk factors for the development of ultra late onset Group B streptococci sepsis in non-neonates.”

Late and ultra late onset Streptococcus B meningitis: clinical and bacteriological data over 6 years in France. (Abstract)
Guilbert J et al.
Acta Paediatr. 2010 Jan;99(1):47-51. doi: 10.1111/j.1651-2227.2009.01510.x.
“These data suggest that LOD and ULOD would be the same clinical and bacteriological entity, except for prematurity, which seems significantly associated with ULOD.”

Group B Streptococcus Late-Onset Disease: 2003–2010 (Full Article)
Alberto Berardi, MD,a Cecilia Rossi, MD,a Licia Lugli, MD,a Roberta Creti, PhD,b et. all, American Academy of Pediatrics Vol. 131 No. 2 February 1, 2013 pp. e361 -e368 (doi: 10.1542/peds.2012-1231)

IN UTERO INFECTION

A hemolytic pigment of Group B Streptococcus allows bacterial penetration of human placenta. (Abstract)
Whidbey C et al.
J Exp Med. 2013 Jun 3;210(6):1265-81. doi: 10.1084/jem.20122753. Epub 2013 May 27.

OVERVIEW of GBS

Specific Bacterial Infections: Group B Streptococcus.
David A. Eschenbach, MD
The Global Library of Women’s Medicine

PLACENTA

A hemolytic pigment of Group B Streptococcus allows bacterial penetration of human placenta. (Abstract)
Whidbey C et al.
J Exp Med. 2013 Jun 3;210(6):1265-81. doi: 10.1084/jem.20122753. Epub 2013 May 27.

The role of the placenta in feto-neonatal infections. (Abstract)
Spinillo A, Iacobone AD, Calvino IG, Alberi I, Gardella B.
Early Hum Dev. 2014 Mar;90 Suppl 1:S7-9. doi: 10.1016/S0378-3782(14)70003-9.

The Placenta Harbors a Unique Microbiome. (Abstract)
Kjersti Aagaard et al.
Sci Transl Med. 21 May 2014:  Vol. 6, Issue 237, p. 237ra65 Sci. Transl. Med. DOI: 10.1126/scitranslmed.3008599″>10.1126/scitranslmed.3008599

Study Sees Bigger Role for Placenta in Newborns’ Health
Denise Grady
New York Times, May 21, 2014
“A study led by Dr. Kjersti Aagaard found that the placenta has its own microbiome that may help shape the health of an infant.”

PLACENTAL TRIAGE & PATHOLOGY

Placental Triage 101 (website)
“Placental triage is the standardized, thorough gross examination of the placenta in the delivery room, to identify abnormal placentas to send to surgical pathology for complete gross and microscopic examination and to save the normal placentas for 7 days, refrigerated, until the condition of the infant and mother are stabilized, with documentation in the medical record of the examination findings. Despite the long description, once well practiced, placental triage only takes a couple of minutes.”

Abnormal Placentas May Signal Autism Risk
Deborah Brauser
Medscape News Infectious Diseaes, Apr 30, 2013

The role of the placenta in feto-neonatal infections. (Abstract)
Spinillo A, Iacobone AD, Calvino IG, Alberi I, Gardella B.
Early Hum Dev. 2014 Mar;90 Suppl 1:S7-9. doi: 10.1016/S0378-3782(14)70003-9.
“…certain placental reaction patterns may identify and estimate the risk for specific perinatal complications in infants.”

PRENATAL-ONSET GBS (POGBS) DISEASE

Intrapartum evidence of early-onset group B streptococcus.
Tudela CM, Stewart RD, Roberts SW, Wendel GD Jr, Stafford IA, McIntire DD, Sheffield JS.
Obstet Gynecol. 2012 Mar;119(3):626-9. doi: 10.1097/AOG.0b013e31824532f6.
“We believe that these findings are compelling evidence that fetuses with early-onset GBS may have signs of sepsis peripartum. We hypothesize that these data support the concept that early-onset GBS represents a spectrum of infection that often precedes birth.”

PRETERM INFO

Antibiotic Elimination of Group-B Streptococci in Urine in Prevention of Preterm Labour (abstract)
AC Thomsen, L Morup, KB Hansen
The Lancet, 1(8533):591-593, 1987.

Prevention of Group B Streptococcal Disease in the Newborn
BS Apgar, MD, MS; G Greenberg, MD, MA; and G YEN, MD
American Family Physician, March 1 2005
“Compared with infants born to lightly colonized women, those born to heavily colonized women have 2.5 times the risk of infection. Neonates born to mothers who have GBS bacteriuria at any time during pregnancy are known to be more frequently and more heavily colonized with GBS and are more likely to develop sepsis. Infections that occur in the first two days of life usually are caused by exposure to maternal organisms. Risk factors for neonatal transmission and infection are listed in Table 1. Compared with term newborns, preterm and low-birth-weight infants have increased rates of GBS sepsis.”

Premature labor with intact membranes: microbiology of the amniotic fluid and lower genital tract and its relation with maternal and neonatal outcome. (abstract)
Rev Med Chil. 2000 Sep;128(9):985-95.
Ovalle A, Martinez MA, Gomez R, Saez J, Menares I, Aspillaga C, Schwarze JE.
“In preterm labor with intact membranes, intraamniotic infection is the most frequent cause of prematurity and is associated with a higher prevalence of maternal and neonatal problems.“

Genetic risk factor for premature birth found.
University of California, San Diego Health Sciences. ScienceDaily. ScienceDaily, 6 May 2014.
“Researchers have discovered a genetic risk factor for premature birth. The risk factor is related to a gene that codes for a protein that the scientists have found helps the body’s immune cells recognize and fight Group B Streptococcus (GBS) bacteria. These bacteria are found in the vagina or lower gastrointestinal tract of approximately 15 to 20 percent of healthy women, but may cause life-threatening infections, such as sepsis or meningitis in newborns, especially those born prematurely.”

Is there a correlation between the vaginal colonization with group B streptococci and premature deliveries? (Abstract)
Kovachev E, Markova V, Bozhkova K, Popova A, Tsvetkova S, Cherneva S.
Akush Ginekol (Sofiia). 2003;42 Suppl 2:3-5.

Group B streptococcal colonization and preterm labour. (Abstract)
McDonald H, Vigneswaran R, O’Loughlin JA.
Aust N Z J Obstet Gynaecol. 1989 Aug;29(3 Pt 2):291-3.

RECOMMENDATIONS

United States

Prevention of Perinatal Group B Streptococcal Disease. Revised Guidelines from CDC, 2010.
Morbidity and Mortality Weekly Report. November 19, 2010 / 59(RR10);1-32.

Prevention of Early-Onset Group B Streptococcal Disease in Newborns.
Committee Opinion No. 485. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;117:XX–XX.

Canada

The Prevention of Early-Onset Neonatal Group B Streptococcal Disease (replaces #149, Sept. 2004)
Victoria M. Allen, Deborah Money
The Society of Obstetricians and Gynecologists of Canada. 298 – Published October 2013

Management of Group B Streptococcal Bacteriuria in Pregnancy.
Victoria M. Allen, Mark H. Yudin
The Society of Obstetricians and Gynecologists of Canada. 276 – Published May 2012

Antibiotic Therapy in Preterm Premature Rupture of the Membranes
Nancy Van Eyk, Mark H. Yudin, Julie van Schalkwyk
The Society of Obstetricians and Gynecologists of Canada. 233 – Published September 2009

RECURRENT GBS

Recurrent group B streptococcal infections in infants: clinical and microbiologic aspects. (abstract)
Green PA, Singh KV, Murray BE, Baker CJ.
J Pediatr. 1994 Dec;125(6 Pt 1):931-8.

Late-onset and recurrent neonatal Group B streptococcal disease associated with breast-milk transmission. (abstract)
Kotiw M, Zhang GW, Daggard G, Reiss-Levy E, Tapsall JW, Numa A,  Center for Biomedical Research, Department of Biological and Physical Sciences, Faculty of Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia 4350. kotiw@usq.edu.au
Pediatr Dev Pathol. 2003 May-Jun;6(3):251-6. Epub 2003 Apr 14.

RESEARCH

Choriodecidual group B streptococcal inoculation induces fetal lung injury without intra-amniotic infection and preterm labor in Macaca nemestrina.
Adams Waldorf KM et al.
PLoS One.2011;6(12):e28972. doi: 10.1371/journal.pone.0028972. Epub 2011 Dec 21.
“A transient choriodecidual infection can induce cytokine production, which is associated with fetal lung injury without overt infection of amniotic fluid, chorioamnionitis or preterm labor. Fetal lung injury may, thus, occur silently without symptoms and before the onset of the fetal systemic inflammatory response syndrome.”

Group B Streptococcus β-hemolysin/Cytolysin Breaches Maternal-Fetal Barriers to Cause Preterm Birth and Intrauterine Fetal Demise in Vivo. (Abstract)
Tara M. Randis et al.
“Preterm birth and fetal demise are likely the direct result of toxin-induced damage and inflammation rather than differences in efficiency of ascension into the upper genital tract. These data demonstrate a distinct contribution of βH/C to GBS chorioamnionitis and subsequent fetal infection in vivo and showcase a model for this most proximal step in GBS pathogenesis.”

SCREENING AND TREATMENT

Assessment of Intrapartum Antibiotic Prophylaxis for the Prevention of Early-onset Group B Streptococcal Disease
FENG-YING C. LIN et al.
Pediatr Infect Dis J. Sep 2011; 30(9): 759–763.

Maternal screening and treatment for group B streptococcus. (abstract)
James DC.
J Obstet Gynecol Neonatal Nurs. 2001 Nov-Dec;30(6):659-66.

SEPSIS

New Approaches to Preventing, Diagnosing, and Treating Neonatal Sepsis.
Edmond K, Zaidi A (2010) New Approaches to Preventing, Diagnosing, and Treating Neonatal Sepsis. PLoS Med 7(3): e1000213. doi:10.1371/journal.pmed.1000213

SEROTYPES

Analysis of group B streptococcal isolates from infants and pregnant women in Portugal revealing two lineages with enhanced invasiveness.
Martins ER, Pessanha MA, Ramirez M, Melo-Cristino J; Portuguese Group for the Study of Streptococcal Infections.
J Clin Microbiol. 2007 Oct;45(10):3224-9. Epub 2007 Aug 15.

Serotype IV and Invasive Group B Streptococcus Disease in Neonates, Minnesota, USA, 2000–2010
Patricia Ferrieri, Ruth Lynfield, Roberta Creti, and Aurea E. Flores
CDC Emerging Infectious Diseases, Volume 19, Number 4–April 2013

SEX and GBS

Association of sexual activity with colonization and vaginal acquisition of group B Streptococcus in nonpregnant women. (Abstract)
Meyn LA, Moore DM, Hillier SL, Krohn MA.
Am J Epidemiol. 2002 May 15;155(10):949-57.

Determinants of co-colonization with group B streptococcus among heterosexual college couples.
Manning SD, Tallman P, Baker CJ, Gillespie B, Marrs CF, Foxman B.
Epidemiology. 2002 Sep;13(5):533-9.
“Among heterosexual college couples, sexual activity, particularly male-to-female oral sex, increases the risk of co-colonization with an identical group B strain. Future studies should evaluate the role of the pharynx and examine the effects of both bacterial characteristics and host response on transmission.”

Group B Streptococcus Colonization in Male and Nonpregnant Female University Students: A Cross-Sectional Prevalence Study.
Sandra J. Bliss et al.
Clin Infect Dis. (2002) 34 (2):184-190.doi: 10.1086/338258

Prevalence of group B streptococcus colonization and potential for transmission by casual contact in healthy young men and women. (abstract)
Manning SD, Neighbors K, Tallman PA, Gillespie B, Marrs CF, Borchardt SM, Baker CJ, Pearlman MD, Foxman B.
Clin Infect Dis. 2004 Aug 1;39(3):380-8. Epub 2004 Jul 16.

Major Bactericidal Activity of Human Seminal Plasma Is Zinc-Dependent and Derived from Fragmentation of the Semenogelins
Anneli M. L. Edström et al
J Immunol. 2008 September 1; 181(5): 3413–3421.

STILLBIRTH

Proceedings of the Stillbirth Summit 2011
GBSI attended this eye-opening conference on the many causes of stillbirth. Dr. James A. McGregor’s presentation on “Infection and Inflammation” is included as well as presentations by top stillbirth researchers around the world.

Prediction and prevention of recurrent stillbirth (abstract)
UM Reddy
Obstet Gynecol. 110(5):1151-64, November 2007.

Newly Posted- The Challenge of Fetal Mortality (article)
MacDorman M, Kirmeyer S. The challenge of fetal mortality. NCHS data brief, no 16. Hyattsville, MD: National Center for Health Statistics. 2009.

SUBSEQUENT PREGNANCIES

Advice for Moms who have had a Previous GBS Infected Baby
By Lisa Porter, GBS mom

Recurrence of Group B Strep High in Subsequent Pregnancies, Say Obstetricians
Science Daily, August 5, 2008.

TESTING and RESULTS

Effect of specimen storage, antibiotics, and feminine hygiene products on the detection of group B Streptococcus by culture and the STREP B OIA test. (Abstract)
Ostroff RM, Steaffens JW.
Diagn Microbiol Infect Dis. 1995 Jul;22(3):253-9.

Third trimester group B streptococcus test doesn’t accurately predict presence during labor
Society for Maternal-Fetal Medicine. “Third trimester group B streptococcus test doesn’t accurately predict presence during labor.” ScienceDaily. ScienceDaily, 11 February 2011.
“Many women are having different test results for Group B streptococcus between their routine third trimester screening and a rapid test performed at the time of labor.”

UNIVERSAL SCREENING

A Population-Based Comparison of Strategies to Prevent Early-Onset Group B Streptococcal Disease in Neonates
SJ Schrag et al.
New England Journal of Medicine, 2002.

VAGINITIS

Bacterial Vaginosis

What is the best approach for managing recurrent bacterial vaginosis?
Grace A. Alfonsi, MD; Judith C. Shlay, MD, MSPH
Denver Health and Hospital Authority, University of Colorado Health Sciences Ctr. Sandi Parker, MLS: Denison Memorial Library, University of Colorado Health Sciences Center, Denver.
Journal of Family Practice, Vol. 53, No. 8. August 2004.

Should we screen for bacterial vaginosis in those at risk for preterm labor?
Beth Potter, MD and Laura Jhorden, MD, Department of Family Medicine, University of Wisconsin–Madison;
Marlene Porter, MLS, Medical College of Ohio, Toledo.
Journal of Family Practice, Vol. 53(10)  October 2004.

GBS Vaginitis

Streptococcus agalactiae: a vaginal pathogen?  (abstract) Note: Streptococcus agalactiae is the scientific name for Group B Strep.
Maniatis AN, Palermos J, Kantzanou M, Maniatis NA, Christodoulou C, Legakis NJ. Department of Microbiology, Medical School, University of Athens, Greece.
J Med Microbiol.
;44(3):199-202, March 1996.

Can group B streptococci cause symptomatic vaginitis? (abstract)
Honig E, Mouton JW , van der Meijden WI.
Department of Dermatology and Venereology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Infect Dis Obstet Gynecol. 1999;7(4):206-9.

Newly Posted- GROUP B STREPTOCOCCUS: PREVALENCE IN A NON-OBSTETRIC POPULATION (article)
Leclair, C. M., Hart, A. E., Goetsch, M. F., Carpentier, H., Jensen, J. T. (2010) Journal of Lower Genital Tract Disease,14(3), 162–166. doi:10.1097/LGT.0b013e3181d3d40f

Vaginal pH Testing

Lactobacilli in the female genital tract in relation to other genital microbes and vaginal pH. (abstract)
Rönnqvist PD, Forsgren-Brusk UB, Grahn-Håkansson EE.
Department of Clinical Bacteriology, Umeå University, Sweden. daniel.ronnqvist@essum.se
Acta Obstet Gynecol Scand. 2006;85(6):726-35

VACCINE

The projected health benefits of maternal group B streptococcal vaccination in the era of chemoprophylaxis. (abstract)
Sinha A, Lieu TA, Paoletti LC, Weinstein MC, Platt R.
Vaccine. 2005 May 2;23(24):3187-95.

Newly Posted- Maternal immunization.
Chu, H.Y., Englund, J.A. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.

Newly Posted- Early-onset group B streptococcal disease in the United States: potential for further reduction.
Verani JR, Spina NL, Lynfield R, Schaffner W, Harrison LH, Holst A, Thomas S, Garcia JM, Scherzinger K, Aragon D, Petit S, Thompson J, Pasutti L, Carey R,McGee L, Weston E, Schrag SJ. Obstet Gynecol. 2014 Apr;123(4):828-37. doi: 10.1097/AOG.0000000000000163.

Newly Posted- Considerations for a phase-III trial to evaluate a group B Streptococcus polysaccharide-protein conjugate vaccine in pregnant women for the prevention of early- and late-onset invasive disease in young-infants.
Madhi SA, Dangor Z, Heath PT, Schrag S, Izu A, Sobanjo-Ter Meulen A, Dull PM. Vaccine. 2013 Aug 28;31 Suppl 4:D52-7. doi: 10.1016/j.vaccine.2013.02.029.

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