Variations in the investigation and management of group B streptococcus in Scotland

This article describes the practice of Scottish obstetricians in terms of their investigation and treatment of group B streptococcus (GBS). This was a postal questionnaire survey of all 125 consultant obstetricians in Scotland. We recorded indications for testing for GBS, categories of women to whom treatment is given empirically and following confirmed infection, type of antibiotic used, and timing and route of administration. No respondents screened all pregnant women but 97% screened some or all of those at highest risk. Three-quarters administered antibiotics empirically to women with intrapartum pyrexia. However, other high-risk groups were unlikely to receive treatment without confirmation of colonisation. Only one-third of respondents gave antibiotics to all women with confirmed GBS, and up to one-half withheld them from some colonised women in high-risk groups. Contrary to US guidelines, only 29% tested for GBS using low vaginal swabs and only 13% administered intrapartum antibiotics intravenously. There are wide variations in investigating and treating GBS throughout Scotland. It is likely that similar variations exist throughout the United Kingdom. UK guidelines are required to reduce variations and ensure appropriate and effective management.