We’re just back from the Royal College of Midwives’ Annual Conference.

We had a table in the Charity Area of the exhibition and, from the moment the doors opened on Thursday morning, were inundated with midwives and student  midwives keen to get the most up to date information about group B Strep.

Thousands of our latest leaflet, “Group B Streptococcus (GBS) in pregnancy and newborn babies” were taken, and a similar number of our summary of the latest GBS guidelines. Hundreds of pens and GBS ALERT stickers made their way into midwives’ bags, together with order forms to be taken away and filled in at a later date.

There were some great conversations! It was also good to catch up with friends attending the conference, speakers and those who also had stands. And to know that so many midwives were going back to their Trusts keen to ensure that their local GBS prevention guidelines had been updated, and were being followed.

It was also fabulous the number of questions we were asked – the most common were:

How much do you charge for your materials?

They’re free to the NHS, and to individuals, on request – we do ask private companies to cover the costs.

Why aren’t we offering all pregnant women testing for group B Strep?

We agree that the NHS should be offering tests to all pregnant women. Sadly this is out of our control, the UK National Screening Committee are the people who decide this. They argue that there’s not enough high-quality evidence that screening all pregnant women for GBS carriage would do more good than harm. We completely disagree – countries which have introduced screening have seen their rates of GBS infection fall by between 70-86%. The rate in the UK has risen substantially and our current rate of early-onset GBS infection is about 2.5x that of the USA’s, where they routinely test pregnant women for GBS.

Is it worth testing for GBS carriage, because it’s so transient?

Well, that depends on what you mean by transient. The result of the test specifically to detect GBS carriage – known as the ECM or Enriched Culture Medium test – is highly predictive for the next 5 weeks. This is why the time usually recommended to test for GBS carriage is 3-5 weeks before the anticipated birth date, or at around 35-37 weeks of pregnancy. So, while GBS carriage status may well change between, say, 12 weeks and 40 weeks, it’s really not very likely to do so between weeks 37 and 42.

Do you sell the private tests?

No we don’t. But we do signpost at www.gbss.org.uk/test to organisations that offer the ECM tests, following the same methodology recommended by Public Health England, and the Royal College of Obstetricians & Gynaecologists)

What’s new in the RCOG’s 2017 update to their group B Strep guideline?

Quite a lot, really. The top four key changes are listed below, and there’s more information at www.gbss.org.uk/RCOG, plus links to free downloads.

  • All pregnant women should be provided with an information leaflet about GBS
  • IV antibiotics in labour is recommended for all women in preterm labour
  • Clindamycin is no longer recommended for women allergic to penicillin – it should be either a cephalosporin (such as cefuroxime) or vancomycin, depending upon the level of allergy
  • Women who tested positive in a previous pregnancy and whose baby did not develop GBS infection should be offered the option of either
    • being treated as if she’s carrying GBS this time round, or
    • testing late in the next pregnancy using a GBS-specific (ECM) test, and offered IV antibiotics in labour if the result is positive

Are the private tests reliable?

Usually. Companies listed at www.gbss.org.uk/test are ones we have vetted and know are following the UK Standards for Microbiology Investigations B58 published by Public Health England. To put this simply, they’re doing the right test for GBS carriage – the ECM test.

Research has shown that, when the ECM test was properly performed within 5 weeks of delivery, a negative result was 96% predictive of not carrying GBS at delivery (4% of women acquired GBS carriage between the test and giving birth) and a positive result was 87% predictive of carrying GBS at delivery (13% of women lost carriage between performing the test and giving birth).