Intrapartum management relating to the risk of perinatal transmission of group B streptococcus

To review the incidence of neonatal group B streptococcal (GBS) sepsis and its associated risk factors in our obstetrical population.

A computerized perinatal database of over 17,000 births (from 1992 to 1996) was queried for the incidence of neonatal GBS sepsis. A more detailed review of 895 births (from the first quarter of 1997) was undertaken to identify the incidence of risk factors known to be associated with neonatal GBS sepsis.

In our institution, 30 cases of neonatal early-onset GBS sepsis were identified in over 17,000 births (or 1.7/1,000 deliveries). Risk factors were identified in 17 of those cases (56%). There were two neonatal fatalities. Chemoprophylaxis was provided in 15% of the total deliveries.

In spite of the lack of a uniform policy for identifying patients suitable for GBS chemoprophylaxis, we found only a 43% incidence of neonatal GBS sepsis occurring without risk factors present. Identification of antepartum or intrapartum risk factors in our series, therefore, would have identified the majority of cases resulting in neonatal GBS sepsis, which may have benefited from intrapartum therapy. Some negative potential consequences of chemoprophylaxis are discussed, raising questions regarding the recent recommendations of the Centers for Disease Control and Prevention.