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Wednesday, October 30, 2013

Group B Streptococcal Infection in Pregnancy

Posted by Chantel Martiromo,  Article By Kyle J. Norton


Group B Streptococcal Infection, also known as Strep B and group B Strep, genus Streptococcus of the phylum Firmicutes found in the flora of the gut and genital tract of 20-40% women, is defined as a serious illness of bacteria infection. In pregnancy, the diseases is deadly as it can cause fatal to the fetus. In US, the disease causes approximately 1,600 early-onset cases and 80 deaths of newborn annually.

I. For the Mother
A. Symptoms
Most women who are infected by GBS have no symptoms, but in serious cases, it causes symptoms of
1. Urinary tract infection
2. Fever
3. Seizures
4. limpness or stiffness,
5. Heart palpitation and blood pressure abnormalities,
6. Vaginal infection
As a result of the bacteria infection
7. Sepsis
If the bacteria have entered the blood stream
8. Others include
Skin and soft-tissue infection, bone, lung joint infection, etc, depending to the onset of the infection.

B. Causes
1. Random spreading
Most people came to contact the bacteria are at risk of GBS infection but without showing any symptoms. That may the reason that 20% to 40% of pregnant women have the bacteria without knowing.
2. Existence
According to some study, some people can have the bacteria in their body throughout their entire life, while others only harbor the bacteria for a limited period of time.
3. Etc.

C. Diagnosis
Since there is no side effect in healthy women, there is no diagnosis required for general population, unless the women are pregnant. Once you are pregnant, in the 35- 37 weeks of gestation, it is recommended to the test of Vagina and Rectum are swabbed. Vagina and Rectum are swabbed is recommended by the The Centers for Disease Control and Prevention (CDC). The result of the test is usually reported within 24 -48 hours, due to the risk of infection to the newborn, women who are suspected of the diseases are given antibiotic through IV.

C. Prevention
Although there is no sure way to prevent the diseases from transmitting to the newborn, healthy diet and moderate exercise should be beneficiary to provide an optimal health and reduce the risk of the GBS.
C.1. The American Pregnancy Association recommends alterations to your diet, including
1. Protein
Protein in your foods positively affects the growth of fetal tissue, including the brain. It also helps your breast and uterine tissue to grow during pregnancy,
a. 75 to 100 grams of protein per day as it can be divided into 2-3 servings of meat (1 serving = approximately 3 ounces/ size of a deck of cards) from chicken lean beef, lamb, pork, nut and tofu (1 serving = approximately ⅓ cup), etc.
b. 2-3 servings of legumes (1 serving = approximately ½ cup) such as red and white kidney beans,black beans, navy beans etc..

2. Calcium Daily requirement of calcium is around 1000 milligrams during pregnancy. Calcium helps your body regulate fluids, and it helps build your baby’s bones and tooth buds, such as milk (1 serving = 1 cup), eggs (1 serving = 1 large egg), yogurt (1 serving = 1cup),pasteurized cheese (1 serving = approximately 1.5 ounces/ or 4 playing dice stacked together), tofu (1 serving = ½ cup), etc.

3. Iron
In combination with sodium, potassium, and water, iron helps increase your blood volume and prevent anemia. A daily intake of 27 milligrams is ideal during pregnancy.
a. 2-3 servings of green leafy vegetables (1 serving = approximately 1 cup)such as collard turnip, spinach, lettuce, etc.
b. 3 servings of whole grains (1 serving = approximately. ½ cup or one slice), such as bread, cornmeal, cereal, oatmeal, etc.

4. Folate/Folic Acid
Folic acid plays a key role in reducing the risk of neural tube defects, including spina bifida. Experts recommend 600 to 800 micrograms (.6 to .8 milligrams) daily.
a. 2 servings of dark green leafy vegetables (1 serving = approximately 1 cup), such as collard, turnip, spinach, lettuce. etc.
b. 2-3 servings of fruit (1 serving = approximately ½ cup), such as orange, strawberry, lemon, mango, tomato, etc.

5. Vitamin C
Fruits and vegetables rich in Vitamin C will help with wound healing, tooth and bone development, and promotes metabolic processes. Experts recommend at least 85 milligrams per day. 3 servings of fruit or vegetables (1 serving = approximately ½ cup), such as orange, strawberry, lemon, mango, tomato, etc. (Source)

6. Etc. for more healthy foods please visit 100+ Healthy Foods Classification

C.2. Antioxidants
Since GBS can cause serious effects as a result of weakened immune system. Intake of antioxidants should be beneficial for anyone to prevent the disease at the beginning, including pregnant women. For more information of the effects of antioxidants to cancers and diseases.

D. Treatments
There is no treatment but antibiotic to protect the newborns, unless the mother is serious sick as a result of the infection.

II. For the newborns (Early onset of the GBS)
A. Causes and risk factors of having a newborn with early onset of GBS
1. If a woman is test positive in the 37 weeks of gestation
2. Fever during delivery, if tested BBS positive
3. Women who had previous incidence of the disease
4. Rupture of membrane 18 hours or more before delivery
5. Risk of the baby with early onset increases 2000% if left untreated
6. Rupture of membrane before 37 weeks
7. Fever during delivery
8. Etc.

B. Diagnosis to prevent the onset of the diseases to the baby 1. In the 35- 37 weeks of gestation.
All pregnant women are needed to have a Vagina and Rectum swabbed, because of the bacteria come and go status and approximately 25% of pregnant women are infected with the diseases, Vagina and Rectum swabbed is recommended by the The Centers for Disease Control and Prevention (CDC). The result of the test is usually reported within 24 -48 hours, women who are suspected of the diseases are given antibiotic.
2. Blood or spinal fluid test of the newborn
If a mother is infected with GBS, the new born is usually tested to make sure the baby is not infected by the disease with the test of the blood or spinal fluid.

C. Prevention of having giving birth of a bay with the early onset GBS
Antibiotics
Women who are tested positive of GBS and whose membranes are ruptured more than 18 hours accompanied with fever are given antibiotics through the vein (IV) during labor to prevent the early-onset group B strep disease to the baby, but not Late-Onset Disease.
According to the study of " Duration of intrapartum prophylaxis and concentration of penicillin G in fetal serum at delivery." by Barber EL, Zhao G, Buhimschi IA, Illuzzi JL., researchers found that Short durations of prophylaxis achieved levels significantly above the MIC, suggesting a benefit even in precipitous labors. The designation of infants exposed to fewer than 4 hours of prophylaxis as particularly at risk for GBS sepsis may be pharmacokinetically inaccurate.

2. Planned Cesarean Delivery
According to the article of "Prevention of Perinatal Group B Streptococcal Disease" by Stephanie Schrag, D. Phil., Rachel Gorwitz, M.D.,Kristi Fultz-Butts, M.P.H. and Anne Schuchat, M.D., researchers found that although a risk does exist for transmission of GBS from a colonized mother to her infant during a planned cesarean delivery performed before onset of labor in a woman with intact amniotic membranes, it is extremely low, based on a retrospective study at a single hospital (99) and a review of CDC active,.... Patients expected to undergo planned cesarean deliveries should nonetheless still undergo routine vaginal and rectal screening for GBS at 35--37 weeks because onset of labor or rupture of membranes may occur before the planned cesarean delivery.

3. Etc.

III. For the newborns (Later onset of GBS in newborns)
( It may happen but rarely, as all newborns are test (blood or spinal fluid test) for the diseases, as soon as they are born)
Baby born with GBS infection mother, may be OK at birth, but may develop the disease in the first week to 3 months after birth
A. Symptoms as a result of infection effects
1. Fever
2. Difficulty feeding
3. Irritability
4. Difficulty breathing
5. Gastrointestinal and kidney problems
6. Heart and blood pressure instability
7. Sepsis, pneumonia and meningitis depending to the infected organs.
8. Etc.

B. Diagnosis
The aim of the diagnosis is to find out where is the infection located and treat accordingly to the onset of the disease
1. Blood clotting tests
It is the test to measure the the clotting tendency of blood, the time it takes blood to clot.

2. Blood gases
The test is to measure the levels of oxygen and carbon dioxide in the blood to determine how well your lungs are working and if oxygen therapy is required or not.

3. Complete blood count
It is the test to measures 3 Types of Cells in Blood, Abnormally high or low counts may indicate the presence of many forms of disease.

4. CSF culture
It is a test to determine if a newborn has exhibited the symptoms of meningitis.

5. Urine culture
The aim of the test is to determine the existence of the bacteria in urinary tract.

6. X-ray of the chest
It is to determine if the diseases has infected the lung.

7. Etc.

C. Treatments
1. Antibiotics given through a vein
Group B strep infections in newborns and older babies are treated with antibiotics (e.g., penicillin or ampicillin) given through a vein (IV). If the baby is severe illness, other medication and therapies in addition to antibiotics may be needed.

2. Oxygen therapy
If the diagnosis indicated that the abnormality of levels of oxygen and carbon dioxide.

3. Medication
Medication will be used to treat the later onset of the GBS in the newborn according to the diagnosis, including
a. Fluids given through a vein
It may be result of rapid fluid loss or blood loss due to hypovolemic shock
b. Medicines to reverse shock
Shock is generally a result of inadequate levels of oxygen in the blood, medication is given depended to the diagnosis
c. Medicines to treat blood clotting problems, such as blood thinner, medication forantithrombin deficiencies, etc. depending to the diagnosis.
d. Etc.

4. Etc.

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