Recommendations for improvements in care in the prevention of early-onset Group B Streptococcal disease are identified in the second and final part of an audit by the RCOG.
Group B streptococcus (GBS) is a bacteria that occurs naturally in the digestive system and lower vaginal tract of around a quarter of women at any one time and normally causes no harm. For pregnant women who carry GBS, the bacteria can be passed to their baby during labour. Most babies experience no effect, but in a small proportion this can cause illness. GBS infection in the first six days of life is called early onset disease (EOGBS) and around 350-400 babies will develop the condition each year. Around 25 babies will suffer a long-term disability as a result of GBS and 40 babies do not survive.
The second part of the audit examining the current practice in preventing early-onset neonatal Group B Streptococcal disease focuses on the care provided in midwifery-led units, local guidelines in obstetric units and available patient information. The previous part of the audit reviewed practice in obstetric units and adherence to national guidance.
Increasingly more women are choosing to give birth in settings other than obstetric units. In order to examine the care provided in midwifery-led units, a survey was conducted across 89 of the estimated 175 units in the UK. Results found that nearly 40% of participating midwifery-led units accepted women in labour for delivery with confirmed GBS colonisation in her current pregnancy but fewer units accepted women with other risk factors for GBS. Reported practice on whether women with current GBS colonisation were accepted for delivery did not always reflect the admissions policy and the decision was made on a case by case basis. Appropriate antibiotics were available in over 90% of units where women were accepted.
On reviewing local guidelines from 123 obstetric units, only a third of units showed evidence of regular review and contrary to national guidelines, a small proportion of protocols (6.5%) stated that selective (risk-based) testing for GBS was offered to pregnant women.
Additionally, over half (57.6%) of the GBS patient information leaflets which was reviewed did not reference any clinical evidence or national guidelines. Most of the information was consistent in describing risk factors, signs and symptoms and detection of GBS in pregnancy, however, the audit found that the leaflets were not easy to understand.
The audit concludes by making a number of recommendations including:
- National guidelines should be revised to reflect the findings from this audit, the forthcoming guidance from the UK National Screening Committee and the forthcoming results from the recent national GBS surveillance study. To reduce future deviations in local practice and policy, the national guidelines should be applied to all NHS trusts.
- Local protocols must be reviewed every three years to ensure they are fit for purpose and that they reflect current national guidance.
- Future studies on preventive care for EOGBS should address care provided in midwife-led units as well as obstetric-led units.
- Admission criteria and practice in midwife-led units should be informed by national guidelines.
- A nationally produced patient information leaflet should be used locally by all NHS trusts.
Dr Rhona Hughes, audit clinical lead and Clinical Director for Obstetrics and Neonatology, NHS Lothian, said:
“Both audits have found that care in the prevention of EOGBS in the UK varies. In both obstetric and midwifery-led services, we have found some discrepancies between national guidelines, local protocols and current practice. We have also noted some key areas where improvement is needed, for example in the readability of the available patient information and improved education and communication between staff in trusts with inconsistencies in practice were identified.
“Having collated the available evidence, we now have a national picture of current practice across all aspects of maternity care. Moving forwards, our focus will be on revising our national guidelines and patient information to ensure consistency in care and achieving the best outcomes for both mother and baby.”
Dr Anne Mackie, Director of Programmes for the UK National Screening Committee (UK NSC) said:
“The UK NSC welcomes the RCOG audit. What the audit highlights is that while much practice in England does follow the guidance there are improvements to be made. The management of women at risk of passing GBS onto their baby remains a vital part of reducing illness and deaths caused by this bacterium, and every effort to assist doctors and midwives to do this should be made.
“Regular audit at local level and new evidence-driven information for pregnant women and their partners will be important.”
Jane Plumb, Chief Executive of Group B Strep Support, said:
“Group B Strep Support welcomes the audit’s recommendation to update national guidelines. The rate of Group B Strep infections in newborn babies in the UK continues to rise and it vital that we establish the cause behind this increase and focus on turning this rise into a fall.
“It is promising that almost 40% of midwife-led units offer care to women who are carrying Group B Strep. In the past, this has been a barrier to many women being able to give birth in these units. However, we are concerned that in almost 10% of these units, the recommended antibiotics are not available.
“GBSS and the RCOG share the common goal of better prevention of group B Strep infections in babies, and we look forward to working with them and other professional bodies to achieve this.”
For more information and a copy of the full audit, please contact Rebecca Jones, RCOG Media and PR Manager, on 020 7772 6444 or firstname.lastname@example.org
Read the first part of the RCOG audit on EOGBS.
Read the RCOG Green-top Guideline on EOGBS.
Read the RCOG Patient Information on GBS.
Read the RCOG audit's key messages.
This audit was commissioned by the UK National Screening Committee (UK NSC) and conducted by the RCOG in partnership with the London School of Hygiene & Tropical Medicine and with the support of the Royal College of Midwives (RCM).
The Royal College of Obstetricians and Gynaecologists is a medical charity that champions the provision of high quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology.
The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with more than 4,000 students and 1,000 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, and among the world's leading schools in public and global health. Our mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice. www.lshtm.ac.uk
The UK National Screening Committee is independent of, but supported by Public Health England. Public Health England exists to protect and improve the nation's health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health.
Group B Strep Support is the only nationalcharity dedicated to providing up to date and evidence based information on group B Strep to families and their health professionals, and support to affected families. GBSS wants every pregnant woman to be given information on group B Strep as a routine part of her antenatal care. Ultimately, GBSS wants GBS infections in babies to be eradicated.