Design Group B Strep Protocol

---
name: design-group-b-strep-protocol
description: Use when managing Group B Streptococcus in pregnancy — e.g., "GBS positive pregnancy", "what happens if GBS positive", "IV antibiotics during labor", "GBS screening week 36"
source: ACOG Practice Bulletin 280 (2020); CDC Group B Strep Guidelines 2010 (reaffirmed 2020); Ohlsson & Shah Cochrane 2014 (intrapartum antibiotics)
tags: [pregnancy, gbs, group-b-strep, antibiotics, labor, neonatal-sepsis, health]
verified: true
---

# Design Group B Strep Protocol

Screen for GBS at 35–37 weeks and execute the intrapartum antibiotic prevention protocol.

## Why This Is Best Practice

**Adopted by:** ACOG, CDC, AAP — universal GBS screening and intrapartum antibiotic prophylaxis (IAP) is the standard of care in the US, UK, Canada, and Australia.
**Impact:** IAP reduced early-onset neonatal GBS disease by 80% from 1990 to 2020 (CDC surveillance data). Without IAP, GBS-positive mothers have a 1 in 200 chance of neonatal sepsis; with IAP, risk falls to <1 in 4,000 (ACOG 2020).
**Why best:** GBS colonization is transient and harmless to the mother but causes severe sepsis, meningitis, and death in neonates. Screening + IAP is the most effective intervention.

## Steps

1. **Screening (weeks 35–37):**
   - Vaginal-rectal swab (one swab, self-collected or provider-collected)
   - Culture takes 24–48 hours; document result in chart for labor
   - Screen even if GBS-negative in prior pregnancy — colonization status changes
2. **Automatic IAP (regardless of culture result):**
   - GBS bacteriuria (any amount) in current pregnancy → treat bacteriuria + IAP in labor
   - Prior infant with invasive GBS disease → IAP in labor regardless of culture
3. **Culture-positive → IAP in labor:**
   - Preferred: Penicillin G 5 million units IV loading dose, then 2.5–3 million units IV q4h until delivery
   - Penicillin allergy (low risk): ampicillin 2g IV then 1g IV q4h
   - Penicillin allergy (high risk/anaphylaxis): culture-based — clindamycin if susceptible; vancomycin if resistant
4. **Timing:** IAP must begin ≥4 hours before delivery to be fully protective — communicate GBS status clearly when going to labor and delivery.
5. **Culture unknown at delivery (no result/unscreened):**
   - Give IAP if: <37 weeks gestation, ROM ≥18 hours, or intrapartum fever ≥38°C
6. **Planned cesarean (no labor, intact membranes):** IAP not required even if GBS-positive — exposure risk is membrane/birth canal.

## Rules

- GBS-positive status on chart must be communicated to labor and delivery team — it is a care-critical flag.
- Do not treat GBS colonization with oral antibiotics in pregnancy (except bacteriuria) — it will recur and may affect IAP choice.
- If water breaks and labor hasn't started, go to hospital — IAP window depends on time to delivery.

## Examples

**GBS positive at 36 weeks:** Document result, give patient card to carry, tell patient to notify L&D of GBS+ status on arrival; receive Pen G on admission, before any other interventions.
**Unknown GBS status, water broke at 39 weeks:** Go directly to hospital; receive IAP because ROM ≥18 hours threshold may be crossed.

## Common Mistakes

- Not asking GBS result at L&D intake — if documented in chart, team must confirm and administer IAP.
- Confusing "GBS treated" (bacteriuria treatment) with "cleared" for IAP — bacteriuria treatment does not remove need for IAP in labor.
- Arriving at hospital without communicating GBS status — carry a written record; verbal communication in active labor is unreliable.

> **Health Disclaimer:** This protocol is educational information, not medical advice. GBS management requires coordination with your healthcare provider and the labor and delivery team. Patients should understand their GBS status before 37 weeks and communicate it on arrival to hospital.