Prof Neena Modi started the Q&A by asking what has been done to improve the evidence base in order to form the development of really robust guidelines.
Prof Philip Steer responded that there was a need to improve the information about the impact of screening versus risk factors, but that it was highly unlikely that a screening RCT (randomised control trial) would be funded in the UK. This meant reliance on evidence from experts.
This was followed by a discussion about the use of antibiotics, their potential to affect a mother’s faecal flora and the potential impact on development of the neonatal immune system. There was also a discussion about how much the RCOG guidelines were actually being followed, and what that meant in practice.
“I don’t think the [RCOG] audit was set up to give us all the answers, it was just to inform about what is current UK practice, but is current UK practice the right thing?”
“So there is a potential risk of harm from a potential to increase antibiotic usage. That’s always been used as an argument not to offer mothers intrapartum prophylaxis. However actually, the published data paradoxically shows the opposite, that if you know whether or not a woman is colonised with GBS then actually the antibiotic usage goes down”
“while the deaths have gone down, the non-healthy outcomes has probably gone up. And in terms of meningitis, also again, while the deaths has gone down, meningitis with all that is associated with that, certainly in terms of negative outcomes for the family has not gone down. And if anything has gone slightly up…”