module 4

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Questions and Answers

What is a strong recommendation when GBS status is unknown and one or more intrapartum risk factors are present?

Expectant management should be preferred over any intervention.

Corticosteroids should be administered to the mother.

Intrapartum antibiotic prophylaxis (IAP) should be offered. (correct)

Induction of labor should be immediately initiated.

What does the evidence suggest about induction of labor for GBS-positive clients experiencing PROM?

Induction is required for all clients regardless of PROM duration.

Induction leads to higher rates of maternal complications.

Induction may reduce cases of neonatal infection compared to expectant management. (correct)

Induction is not recommended under any circumstances.

For GBS-positive clients who experience PROM for less than 18 hours and have no other risk factors, what is the recommended approach?

Only expectant management is appropriate.

Mandate immediate cesarean section.

Offer a choice between expectant management and immediate induction. (correct)

Induction should be strongly encouraged regardless of circumstances.

Which statement about IAP timing for GBS-positive pregnant individuals with PROM is true?

Evidence comparing different timings of IAP is lacking. Signup and view all the answers

What recommendation is made for clients who are GBS positive and experience PROM for 18 hours or more?

Induction of labor is recommended with IAP at the start of labor. Signup and view all the answers

What is the recommended minimum observation period for well-appearing newborns exposed to chorioamnionitis?

24 hours Signup and view all the answers

How does the duration of Intrapartum Antibiotic Prophylaxis (IAP) affect the risk of early-onset GBS disease?

Shorter durations pose a higher risk. Signup and view all the answers

According to the latest guidance, when is a CBC particularly helpful for assessing newborns?

After 4 hours of age Signup and view all the answers

What approach is suggested for infants with multiple risk factors for sepsis?

Individualized investigation and treatment approach Signup and view all the answers

What is indicated about the effectiveness of expectant observation compared to laboratory testing?

Expectant observation is equally effective. Signup and view all the answers

What should parents understand before their well-appearing baby is discharged after 24 hours?

Signs of sepsis and when to seek medical care Signup and view all the answers

What does the guidance suggest for infants born to GBS-positive parents with adequate IAP and no other risk factors?

They do not require investigation or treatment for sepsis. Signup and view all the answers

How often should vital signs be monitored in the first 24 hours for at-risk infants?

Every three to four hours Signup and view all the answers

What should midwives discuss with all clients regarding newborn transition in the first 24 hours?

What to expect as normal newborn transition and behaviour Signup and view all the answers

Which symptom would NOT typically indicate possible sepsis in a newborn?

Increased appetite Signup and view all the answers

What immediate action should a midwife take if EOGBSD is suspected?

Conduct a physical assessment of the newborn promptly Signup and view all the answers

What factor is strongly predictive of early-onset group B streptococcus disease (EOGBSD) in neonates?

Chorioamnionitis Signup and view all the answers

What should midwives do when signs of sepsis are noted during an in-person examination?

Immediately arrange a consult Signup and view all the answers

What does IAP stand for in the context of newborn care?

Intrapartum Antibiotic Prophylaxis Signup and view all the answers

Why might routine laboratory testing not be compared with expectant observation for asymptomatic newborns in a specific study?

Insufficient participants for a reliable comparison Signup and view all the answers

What is a critical factor to communicate to parents about contacting a midwife?

How to access urgent care when necessary Signup and view all the answers

What maternal condition is indicated by a temperature greater than 38°C during labor?

Chorioamnionitis Signup and view all the answers

Which statement about midwives' roles is true regarding newborn care management decisions?

Midwives should discuss hospital protocols and care plans with clients Signup and view all the answers

How often do studies indicate that septic infants present within the first 24 hours of life?

Signup and view all the answers

What is a key consideration in offering IAP options to GBS-positive clients with PROM?

Clients' preferences regarding IAP timing Signup and view all the answers

Which of the following factors may affect the assessment of neonates for EOGBSD?

Clinical signs observed in the first 24 hours Signup and view all the answers

Why is it important for parents to be educated about signs of illness in their newborns?

To ensure timely identification and response to potential infections Signup and view all the answers

What is a characteristic of EOGBSD related to its occurrence?

It can develop despite negative prenatal GBS screenings. Signup and view all the answers

What is the purpose of assessing clinical signs in neonates for EOGBSD?

To identify immediate medical treatment needs for infection Signup and view all the answers

Which symptom is commonly associated with EOGBSD?

Temperature instability Signup and view all the answers

What should midwives consider when managing GBS-positive clients?

Client involvement in decision-making regarding IAP Signup and view all the answers

What is the significance of the recommendation about the timing of IAP for PROM?

It acknowledges the lack of direct evidence on specific timing. Signup and view all the answers

When should immediate assessment and consultation be initiated for a neonate?

Upon recognizing any clinical signs suggestive of infection Signup and view all the answers

In what way can midwives support parents during the neonatal period?

By providing ongoing education and responding to health inquiries Signup and view all the answers

Which clients should be offered Intrapartum Antibiotic Prophylaxis (IAP)?

Clients with a GBS-positive swab at 35 to 37 weeks’ gestation Signup and view all the answers

What is a significant risk factor for early-onset GBS disease?

Prolonged rupture of membranes (≥ 18 hours) Signup and view all the answers

What is the first-line antibiotic treatment for a GBS-positive client in labor?

Penicillin G 5 million units IV Signup and view all the answers

Which of the following is a risk factor for neonatal infection associated with GBS?

Gestation < 37 weeks Signup and view all the answers

In which scenario should clindamycin be prescribed as an alternative antibiotic?

If the isolate is susceptible to clindamycin with no inducible resistance Signup and view all the answers

What does heavy colonization with GBS correlate with in terms of pregnancy outcomes?

Adverse outcomes such as preterm labor Signup and view all the answers

Which maternal condition indicates a need for IAP during labor?

Maternal fever of ≥ 38°C Signup and view all the answers

What does the term EOGBSD stand for and why is it important?

Early Onset Group B Streptococcus Disease, a critical infection in newborns Signup and view all the answers

What is an associated symptom of late-onset GBS disease in newborns?

Bacteremia Signup and view all the answers

What is the recommended gestational period for screening women for group B streptococcus (GBS) colonization?

35 to 37 weeks’ gestation Signup and view all the answers

Which of the following groups of women should receive intravenous antibiotic prophylaxis for GBS?

Women with GBS bacteriuria in the current pregnancy Signup and view all the answers

What is the minimum observation period for women < 37 weeks’ gestation in labor if they have an unknown GBS status?

48 hours Signup and view all the answers

If the GBS colonization status is unknown and membranes have been ruptured for more than 18 hours at ≥ 37 weeks’ gestation, what should be administered?

Intravenous GBS antibiotic prophylaxis Signup and view all the answers

What should be done if more than five weeks have elapsed since the initial GBS swab culture?

Offer re-screening for GBS Signup and view all the answers

What is the recommended method for collecting a GBS culture?

One swab from the vagina followed by the rectum Signup and view all the answers

Which scenario does NOT warrant antibiotic prophylaxis for GBS during labor?

Negative GBS culture within 5 weeks Signup and view all the answers

Why might a client be instructed on how to perform their own GBS swab?

To streamline the testing process Signup and view all the answers

What is the significance of heavy colonization of GBS?

It is associated with early onset neonatal disease Signup and view all the answers

What action should be taken for women with pre-labor rupture of membranes at < 37 weeks’ gestation who have a positive GBS culture status?

Administer intravenous GBS prophylaxis for 48 hours Signup and view all the answers

What is the primary purpose of assessing fetal heart rate (FHR) characteristics during electronic fetal monitoring (EFM)?

To evaluate fetal well-being and potential compromise Signup and view all the answers

Which understanding is crucial when interpreting abnormal fetal heart rate patterns?

Classification of findings must correlate with broader clinical factors Signup and view all the answers

What does 'baseline variability' in fetal heart rate monitoring indicate?

The stability of the fetal heart rate, indicating fetal well-being Signup and view all the answers

What should be established first when initiating electronic fetal monitoring?

Confirm the mode of monitoring as either internal or external Signup and view all the answers

What classification applies when there is no evidence of fetal compromise?

Normal Signup and view all the answers

What was the main finding regarding cesarean section rates between IA and EFM for low-risk healthy women?

There was no statistical difference in cesarean section rates between IA and EFM. Signup and view all the answers

Which method of fetal surveillance is recommended for low-risk pregnancies upon admission to triage?

Admission IA assessment Signup and view all the answers

What is one potential outcome of using EFM monitoring in low-risk populations?

Increased unnecessary interventions Signup and view all the answers

In both studies mentioned, what was a common intervention for women allocated to admission EFM?

Increased fetal blood sampling Signup and view all the answers

For what type of patients is admission EFM recommended?

Patients with risk factors for adverse perinatal outcomes Signup and view all the answers

What was the cesarean section rate found for the IA group in the Smith et al. study?

8.6% Signup and view all the answers

Which group of women does the Canadian decision advocate for using admission IA?

Low-risk women without perinatal risk factors Signup and view all the answers

What outcome did the 2018 multicentre randomized trial by Smith et al. specifically show regarding the use of EFM?

No statistical difference in cesarean section rate Signup and view all the answers

Why is the use of admission EFM not recommended for healthy, term patients presenting in labor?

It may lead to unnecessary medical interventions. Signup and view all the answers

What is a primary characteristic defining low-risk pregnancies based on the recommendations?

Healthy, term pregnancies with no adverse risk factors Signup and view all the answers

What is the recommended frequency for assessments during the latent phase of labor?

At least every hour if admitted Signup and view all the answers

When should more frequent assessments of fetal heart rate (FHR) be considered?

If the FHR tracing does not meet interpretable criteria Signup and view all the answers

What is the minimum assessment frequency during the active phase of labor?

Every 15 minutes Signup and view all the answers

What should be done if there are atypical changes in fetal heart rate or other changes during labor?

Increase the frequency of fetal heart monitoring Signup and view all the answers

In the passive phase of the second stage of labor, what is the minimum recommended assessment frequency?

At least every 15 minutes if continuous tracing is not present Signup and view all the answers

Why might internal monitoring of fetal heart rate (FHR) be necessary?

When external monitoring is not interpretable Signup and view all the answers

What is indicated by the presence of atypical and abnormal fetal heart rate patterns?

There may be issues with the maternal-fetal condition Signup and view all the answers

How should assessments be individualized during labor?

Based on maternal-fetal status and condition Signup and view all the answers

What is one characteristic of artifact from external ultrasound in monitoring fetal heart rate?

It appears as small vertical lines that obscure baseline variability. Signup and view all the answers

When confronted with uninterpretable FHR tracing, which step should NOT be taken?

Immediately resort to internal monitoring without further assessment. Signup and view all the answers

What does an artifact from an internal fetal spiral electrode typically look like?

Long and uneven vertical lines. Signup and view all the answers

Which method is effective for clarifying ambiguous FHR readings?

Assessing if the fetal spiral electrode remains connected. Signup and view all the answers

What should be the primary concern when assessing FHR for fetal arrhythmia?

Differentiating between fetal and maternal heart rates. Signup and view all the answers

What is a common troubleshooting step if the FHR tracing is uninterpretable?

Reassessing the placement of the tocotransducer. Signup and view all the answers

In fetal heart rate monitoring, inappropriate artifact identification can lead to what major issue?

Delayed response to true fetal distress. Signup and view all the answers

If repositioning transducers does not yield a clear signal, which option should be considered next?

Anticipating the need for internal monitoring. Signup and view all the answers

What initial step should be taken if an artifact is suspected in the FHR tracing?

Evaluate possible machine-generated sources of error. Signup and view all the answers

What factor should always be considered when interpreting the findings from Electronic Fetal Monitoring (EFM)?

The total clinical picture Signup and view all the answers

Which of the following is NOT a perinatal risk factor that indicates the need for Intrapartum Electronic Fetal Monitoring?

Maternal anxiety disorders Signup and view all the answers

What is an indication for using Electronic Fetal Monitoring during labor?

Single umbilical artery Signup and view all the answers

What maternal perception may warrant the use of Electronic Fetal Monitoring?

Reduced or absent fetal movement Signup and view all the answers

Which of the following conditions is associated with abnormal findings that necessitate the use of Electronic Fetal Monitoring?

Significant fetal abnormality compatible with life Signup and view all the answers

Which of the following is a condition that may lead to the recommendation of Electronic Fetal Monitoring?

Prolonged rupture of membranes at term (greater than 24 hours) Signup and view all the answers

What does the Society of Obstetricians and Gynecologists of Canada recommend regarding the use of EFM?

It should be used when perinatal risk factors are present Signup and view all the answers

Which abnormal condition specifically suggests the need for Electronic Fetal Monitoring?

Polyhydramnios Signup and view all the answers

In the context of EFM, what should be done when abnormal fetal heart rate (FHR) patterns are observed?

Adjust the management plan based on the findings Signup and view all the answers

What is an applicable reason for initiating EFM when maternal health is compromised?

Presence of significant maternal anemia Signup and view all the answers

Study Notes

Group B Streptococcus (GBS) Summary

This document provides a summary of the most essential content of the AOM CPG No. 19, focusing on antepartum, intrapartum, and postpartum management of GBS.
The prevalence of GBS colonization in pregnant individuals ranges from 15% to 40%, variable across populations and testing methods.
In Ontario (2019), approximately 19% of pregnant people screened for GBS between 35 and 37 weeks' gestation had a positive result.
Early-onset GBS (EOGBSD) occurs within the first 7 days of life and was estimated at 3/1000 live births before widespread intrapartum antibiotic prophylaxis (IAP) in the 1980s.
In 2019, Ontario saw only 35 cases of EOGBSD, representing a rate of 0.23 per 1000 live births.

Understanding GBS Prevalence, Incidence, and Complications

Untreated, 40% to 70% of babies born to GBS-positive mothers may become colonized.
15% to 40% of pregnant individuals are GBS positive.
1% to 2% of colonized babies develop an infection if untreated.
5% of babies with developed infections die.
In a group of 50,000 pregnant people, an estimated 7,500 to 20,000 would be colonized with GBS.
In the same group, 3,000 to 14,000 babies would be colonized with GBS.
30 to 280 babies might develop infections, with related breakdown by types: bacteremia (19–232), pneumonia (3–64), and meningitis (2–35).
2 to 14 babies might die from GBS infection.

Risk Factors for GBS Colonization

Colonization in a prior pregnancy is a strong predictor for colonization (OR 5.80).
Pregestational diabetes is a moderate predictor (OR 1.34).
Gestational diabetes has a weaker predictive effect (OR 1.17)
BMI over 25kg/m2 increases colonization likelihood (OR 1.21).

Risk Factors for EOGBSD in Newborns

A previous infant with EOGBSD is a strong predictor (OR 27.81).
GBS-positive parent is also a powerful predictor (OR 10.44).
Frequent vaginal exams raise EOGBSD likelihood (OR 6.32).
GBS bacteriuria augments the likelihood (OR 5.34).
Chorioamnionitis may increase the likelihood (OR 4.19).
Intrapartum fever may increase the likelihood (OR 3.62).
Membrane sweeping slightly increases EOGBSD likelihood (OR 2.52).
Preterm birth (<37 weeks) is a significant predictor (OR 2.02).
Prolonged rupture of membranes (PROM) >18 hours may increase likelihood.
Low birth weight (<2500 g) slightly increases likelihood (OR 2.01).
Multiple pregnancies slightly increase the likelihood (OR 1.98).

Antibiotic Prevention of GBS Colonization

Studies suggest that the use of oral probiotics near delivery can reduce GBS colonization.
Some studies suggest that vaginal-rectal swabs are highly specific (90%) and sensitive (77%) in identifying GBS in pregnancy.
Observation intervals of greater than 6 weeks between sampling and birth may reduce accuracy of results.
Self-collection swabs can be an option.

Timing of Screening and Diagnosis

Offer GBS screening at 35–37 weeks of gestation, with vaginal-rectal cultures.
Consider re-screening clients after an interval of 5 weeks if delivery has not taken place.

Facilitating Decisions with Clients

Provide general information about GBS and the implications of a positive GBS result to the clients.
Allow time for questions and concerns.
Discuss treatment options, risks, and client preferences.

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Description

This quiz provides a comprehensive summary of the management of Group B Streptococcus (GBS) based on AOM CPG No. 19. It discusses the prevalence, incidence, and complications associated with GBS in pregnant individuals, including the impact on newborns. Test your knowledge on crucial aspects of GBS screening, intrapartum care, and outcomes for infants.