A complete audit cycle of intrapartum group B streptococcus prophylaxis

Group B Streptococcus (GBS) colonises the intestines of approximately one third of women and can result in intermittent colonisation of the vagina. The principal route of neonatal infection is from the vagina during delivery which can cause morbidity and mortality in the neonate. We recently introduced a protocol of intrapartum prophylaxis based on recognised risk factors.

To complete an audit cycle to determine the adequacy of intrapartum antibiotic prophylaxis for women with recognised risk factors for neonatal GBS infection, to make changes to the indications for prophylaxis and to highlight and rectify any deficiencies in practice.

Women identified with risk factors for neonatal GBS were treated with a regimen of intravenous benzylpenicillin or clindamycin. Adequate prophylaxis was achieved if the women received antibiotics more than four hours prior to delivery. The case notes of all deliveries over a four-week period were reviewed in both the initial audit and the re-audit.

Three hundred and fifty nine deliveries occurred during the initial study period. Thirty seven (10.3%) women were identified with risk factors but adequate prophylaxis was provided to only 32%. Difficulty in providing adequate prophylaxis to women with intrapartum maternal pyrexia due to time constraints and an unanticipated increase in the number of neonates of 35 to 37 weeks gestation receiving postnatal intravenous antibiotics necessitated changes to the indications for prophylaxis. During the re-audit there were 378 deliveries with 49 (13%) women identified with risk factors and adequate prophylaxis was achieved in 42% of women.

Despite changes to the protocol and circulation of the results to medical and midwifery staff, the percentage of women receiving adequate prophylaxis is low. Areas for further improvement include greater awareness of the indications for prophylaxis through education and better documentation of risk factors present before labour. Despite the benefits of adopting a protocol of intrapartum prophylaxis it is important to recognise its practical limitations and to continue to be vigilant in identifying and treating neonates whose mothers have not received adequate treatment.