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RCOG release: New audit into GBS finds variation in practice across obstetric units

News 5 March 2015

The majority of obstetric units in the UK have written protocols to prevent early-onset Group B Streptococcal disease (EOGBS) in newborn babies, however, there is still variation in practice across units, finds a new audit published today by the Royal College of Obstetricians and Gynaecologists (RCOG).

The audit, conducted by the RCOG in partnership with the London School of Hygiene and Tropical Medicine and supported by the Royal College of Midwives (RCM), was commissioned by the UK National Screening Committee (UK NSC).

It examines current practice in preventing early-onset neonatal Group B Streptococcal disease, by investigating the implementation of the RCOG Green-top guideline on preventing the disease (2nd edition published in 2012), and identifies key areas for improvement.

Group B Streptococcus (GBS) is the most common cause of severe infection in babies during the first three months of life. GBS disease can be defined as early-onset (before seven days old) or late-onset (seven to 90 days old). Early-onset GBS disease (EOGBS) is most often due to transmission from mother to baby around the time of birth.

The incidence of EOGBS in the UK is estimated to be at least 1 case per 2,000 live births, with a mortality rate of between 5-10%.

In this first of two reports from the audit, a survey was undertaken at 161 obstetric units in the UK. It found that all except one of the participating units reported having a written protocol for preventing EOGBS. The majority of participating units (94.4%) were reported to provide written information on GBS to patients but only 36.8% of these units provided material published by the RCOG.

Universal screening of all pregnant women for GBS carriage is not recommended in the RCOG guidelines and few units (3.7%) reported this practice.

The audit, however, identified discrepancies between reported practice and the RCOG guidelines. This includes offering swab-based testing for GBS in pregnant women with risk factors in over half of units (55.9%) which is contrary to guidance.

The RCOG guidelines recommend GBS-specific intrapartum antibiotic prophylaxis (IAP) is offered to women who had a previous baby with neonatal GBS or who have been identified as carrying GBS in their current pregnancy. The audit found that the majority of units (at least 97%) follow this advice.

The audit also found that 41.2% of units were reported to offer GBS-specific IAP to women with preterm prelabour rupture of membranes, which is contrary to RCOG guidance on the management of this condition.

In addition, there were discrepancies in responses from obstetricians and midwives working in the same unit around some elements of practice and policy.

The audit concludes by making a number of recommendations including:

  • Local guidelines on prevention of EOGBS and information on GBS provided to patients in obstetric units must be reviewed regularly to ensure that they reflect national guidelines and are updated.
  • Reviews of practice to prevent EOGBS and other neonatal infections should be regularly undertaken in all obstetric units to ensure high quality and consistent care.
  • National guidelines, including those published by the RCOG, must be clear, coherent and consistent with other guidance.
  • Inconsistencies in practice or knowledge regarding EOGBS prevention among staff in the same unit or provider should be challenged, and education and communication between all staff improved.
  • More evidence is needed about the care received by women to refine the national policy on the prevention of EOGBS, standardise local guidelines and to ultimately reduce the incidence of the disease.

Dr Rhona Hughes, audit clinical lead and Clinical Director for Obstetrics and Neonatology, NHS Lothian, said:

“This report on current practice to prevent early-onset neonatal Group B Streptococcal disease in the UK is an important contribution to efforts in maternity services to reduce the incidence of neonatal infections.

“Maternity services should follow national guidelines on the topic, including the RCOG Green-top guideline on the prevention of this disease.

“This report highlights the need to improve the consistency of preventive care for EOGBS in UK maternity units as it has identified marked variations in some areas of practice.”

Louise Silverton, director for midwifery at The Royal College of Midwives, said:

“This is a welcome report looking at current practice around a topic that is important to health professionals, women and their babies. It highlights the challenges in implementing guidelines as well as inconsistencies in information provided to women and the actual practice taking place on maternity wards.

“I hope that this will stimulate individual units to review their processes so that midwives and doctors are working together to produce multi-disciplinary guidance and evaluation of the information given to women. This in turn will increase the ownership of guidelines and lead to increased compliance with the agreed processes and guidelines.

“To this end the education of all staff who work in maternity services is key to ensuring consistency in practice and both the RCM and RCOG will be working together to raise awareness about this amongst our members.

“Enabling women to have greater continuity in their care, and continuity of carer will contribute significantly to improving outcomes for women. This will enable the midwife to know the women and her circumstances well and detect changes or developing problems. This is also of course dependant on having the right number of midwives to ensure continuity of carer can happen.”

Dr Anne Mackie, Director of Programmes for the UK National Screening Committee said:

“The UK NSC welcomes this audit and recognises the importance of the RCOG and NICE guidance in advising which women should be offered antibiotics to avoid passing GBS infection onto their babies.

“Following the guidance plays a crucial role in preventing GBS infections and the focus needs to be on ensuring that all women identified as at risk are managed in line with this.”

Ends

For further information, please contact the RCOG Media and PR team on +44 20 7772 6300 or email pressoffice@rcog.org.uk

The RCOG Green-top Guideline on EOGBS is available here

For further information on why screening for GBS is not recommended in the UK see information from the UK National Screening Committee.

Read the GBS audit key messages.

Notes to editors

The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with 3,900 students and more than 1,000 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, and was recently cited as the world’s leading research-focused graduate school. 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.

The Royal College of Midwives is the only trade union and professional association dedicated to serving midwifery and the whole midwifery team. We provide workplace advice and support, professional and clinical guidance and information, and learning opportunities with our broad range of events, conferences and online resources. For more information visit the RCM website.