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These little things, be sure to remember...
Guests did not wash their hands after going to the toilet, touching the baby girl in March actually caused her death, and the family group photo was taken as a final souvenir.
5 days after her birth, her condition deteriorated, and her parents pulled out their ventilators and accompanied her on her last journey by the pillow of her beloved daughter.
You read that such a lovely and vivid life, before it has time to experience the love of its parents, has already boarded the train to heaven. At this point, many people will definitely ask, what have they experienced?
It all starts with the abhorrent baby killer, "Group B Streptococcus."
Murderer files, I want the world to know your ugly side
Group B streptococcus (GBS), also known as Streptococcus amaranth, has a mediocre name but is a wolf in sheep's clothing, which led to the tragedy.
It is a condition pathogenic bacteria that exists in the genitourinary tract and gastrointestinal tract, and the word "condition" is fully worthy of its characteristics of "wall head grass".
When the body's immunity is sufficient, there will be no impact. However, once the immune defense line has a loophole, it becomes an accomplice to the abuse, and the baby with insufficient immunity is its favorite target.
The RATE OF GBS colonization in pregnant women in the third trimester of pregnancy in mainland China is 3.5%-32.4%[1], which means that not everyone carries GBS, but nearly 50% of pregnant women can pass on the germs to the next generation.
Once GBS infection occurs, it can cause maternal reproductive tract and urinary tract infections, as well as chorionic amnioticitis, puerperal infection, maternal sepsis, etc., and can also lead to fetal stillbirth in the womb.
In addition, GBS is also closely related to miscarriage, preterm birth, premature rupture of membranes, etc.
GBS is also one of the most common causes of neonatal sepsis and meningitis, and even perinatal deaths, with survivors having severe neurological sequelae [2].
Seeing such serious consequences, are the mothers all pinching a cold sweat? Hurry up and call your doctor: "Shall we also add this GBS test?" ”
"Rest assured, arrange it."
How is screening done?
The American Association of Obstetricians and Gynecologists (ACOG) changed the screening time range to 36-38 weeks in its 2019 and 2020 guideline recommendations [3].
However, in the current maternity screening program in the mainland, it is still recommended that all pregnant women be screened for GBS at 35-37 weeks of gestation, which is also recommended by the 2010 US CDC guidelines.
At this time, quickly take out your mobile phone, circle the special day of 35-37 weeks on the calendar, and carefully write down the three letters of G, B, and S, but not E, G, M.
Of course, don't listen to the test and make your head bigger, screening is not as complicated as you think, but it is very simple to operate, and it does not use a duck-billed peep that scares you.
Only a cotton swab, that is, an extended version of the cotton swab, is first sampled in the lower part of the vagina, and then sampled in the rectum through the sphincter with the same swab, and sent to culture in time to get it in a few seconds.
Unlike the procedural operations of other machines such as blood testing, GBS requires culture. Only its strain seen in the medium is recognized as positive, but this is a lengthy process that takes at least 48 hours.
If the infection is confirmed and treated promptly, if it is negative, it should not be taken lightly.
What should I do if I test positive? Antibiotics on GBS have nowhere to escape!
For GBS-positive pregnant women, antibiotic prophylaxis should be given after delivery, which can reduce the amount of GBS bacteria in the vagina and rectum, which also significantly reduces the rate and severity of early-onset GBS infection in newborns.
Intravenous penicillin is generally used for antibiotics, and for women with penicillin allergy, cefazoline and clindamycin can be switched to cefazoline and clindamycin according to the level of risk, and vancomycin can be replaced when clindamycin is resistant.
The point is that the sooner the treatment, the better!
Studies have shown that it takes at least four hours to reach an effective drug concentration, with a 40 percent interval between initiation of antibiotics and delivery, an interval of >4 hours, and a vertical infection rate of only 1 percent [4].
So don't be fooled by the rumors that pregnancy uses antibiotics is not good for the fetus, this critical moment is absolutely necessary!
A negative test is all right? Always beware of Assassin attacks
As a "professional killer", GBS also came and went without a trace. Don't think that a negative culture result during the prescribed screening period gives you peace of mind, as 60% of infants diagnosed with sepsis have a mother whose mother is negative at 36 weeks [5].
Such uncertainty can also lead to increased medication burden on women who themselves do not need antibiotic therapy, while women who may be exposed to the risk of infection at the time of childbirth are not protected.
Therefore, in Europe, for the screening and GBS colonization status during childbirth, it is recommended to perform rapid PCR testing during labor to more accurately reflect the carrier situation and avoid the leakage and abuse of antibiotics.
But on the mainland, not all medical institutions can do this.
Even if we can't enjoy such a quick test, we still have a relatively complete set of prevention programs.
In addition to pregnant women with positive screening results, women with the following risk factors are also treated with antibiotics for prophylaxis [2]:
Previous birth history of a child with GBS disease;
GBS bacteriuria during pregnancy;
Delivery before 37 weeks' gestation;
Body temperature at birth ≥ 38 °C;
The time of film breaking ≥ 18h.
With the help of medical staff, the baby finally came into this world in good health, do you think this is a relief?
Judging from the above two infection news, one baby girl was infected at birth, while the other was infected through contact with others in March.
This suggests that it is not enough to control it at the time of delivery, and that neonatal GBS infection can also be divided into early-onset and late-onset infections depending on the time of onset.
About 90% of GBS infections are early-onset, which mostly occur within 7 days after birth, generally 24-48 hours after birth, and the source of infection is mostly from the mother, and GBS is inhaled into the lungs by the fetus during labor or when the membrane is prematurely ruptured. Such infections are predominantly pneumonia and sepsis.
Late-onset infection occurs within 7 to 3 months of birth, and the source of infection can either come from the mother or can be obtained through external infection. Such infections are more common in meningitis, with a high case fatality rate, many sequelae, and bamboo baskets through antibiotic prophylactic treatment.
Tips
For pregnant women and people who can be in close contact with the baby, paying attention to hand hygiene and sexual hygiene in daily life can not only reduce their own GBS infection, but also reduce the risk of infection in the baby's birth and postpartum life.
Children's affairs are no small matter, and daily infections should always be on the lookout.
GBS is pervasive, on this small screening, must be arranged!
bibliography:
[1] Shi Chunyan, Qu Shouhui, Yang Lei, et al. Detection of carrier status of Group B streptococcus in pregnant women in the third trimester of pregnancy and the effect of carrier bacteria on pregnancy outcomes[J]Chinese Journal of Obstetrics and Gynecology,2010,45(1):12-16.
[2] LI Zhu,YANG Huixia. Current situation and screening strategy of perinatal B streptococcal infection in mainland China[J].Chinese Journal of Perinatal Medicine,2017,20(8):560-563.
[3] Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG COMMITTEE OPINION, Number 797. [J] . Obstet Gynecol, 2020, 135: e51-e72.
[4] Verani JR，McGee L，Schrag SJ．Prevention of perinatal group B streptococcal disease--revised guidelines from CDC，2010[J]．MMWR Recomm Rep，20l 0，59(RR-10)：1-36
[5]https://newsroom.unsw.edu.au/news/health/group-b-strep-and-having-baby-what-pregnant-women-need-know
Source of this article: Medical Community Obstetrics and Gynecology Channel
Author: Pudding
Editor-in-Charge: CiCi