Barriers to prevention of perinatal group B streptococcal disease

During 1992 the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) issued statements on prevention of group B streptococcal (GBS) disease. To assess prevention practices and identify barriers to preventing GBS disease, we surveyed obstetricians, family practitioners and general practitioners in Georgia during 1993. A standard questionnaire was mailed to 1190 clinicians in August and to nonresponders again in September. Of 436 (38%) physicians who responded, 192 (44%) provided obstetric care. Among these 192 obstetric care providers, 121 (63%) screened patients for GBS carriage antenatally. The most frequently cited reasons for not screening were "no clear guidelines" and "not cost-effective" (52 and 39%, respectively). Clinicians who screened patients were significantly more likely to believe that screening was cost-effective (P = 0.05). Of obstetric care providers who screened, only 9% obtained specimens using culture sites recommended by ACOG or AAP. Although most clinicians were aware that antenatal antibiotic treatment of carriers does not prevent perinatal GBS disease, 64% of those who screened reported that they gave oral antibiotics when carriage was detected during pregnancy. Of clinicians who reported using obstetric risk factors to guide prophylaxis choices, < 15% reported using intrapartum antibiotics for the conditions identified in the ACOG and AAP statements as those that suggest the need for prophylaxis when screening is not performed. Many Georgia obstetric care providers do not use effective practices to prevent perinatal GBS disease. Education on appropriate culture methods, obstetric risk factors and the cost effectiveness of prevention strategies might lead to more effective preventive practices.