How best to manage the patient in term labor whose group B strep status is unknown?
Chlorhexidine has no effect
Vaginal disinfection with chlorhexidine during delivery has been used to prevent GBS transmission, but no highly controlled trials have demonstrated a benefit or consequence of this approach. A systematic review of 5 randomized and quasi-randomized, variable-quality trials comparing vaginal disinfection with chlorhexidine with placebo found no statistically significant reduction in early-onset neonatal GBS sepsis (RR=2.32; 95% CI, 0.34-15.63), pneumonia (RR=0.35; 95% CI, 0.01-8.60), or meningitis (RR=0.35; 95% CI, 0.01-8.60).9
Recommendations
The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the CDC recommend screening all pregnant women at 35 to 37 weeks’ gestation and administering prophylaxis to all GBS carriers.5,10 They also advocate intrapartum antibiotic prophylaxis for pregnant women whose GBS status is unknown and who have a risk factor for GBS listed in TABLE 1.5,10 Rapid tests to detect GBS when status is unknown should replace the risk-based approach only if the test has a sensitivity of at least 85%.5
Acknowledgements
The opinions and assertions contained herein are the private views of the authors and should not be construed as official or as reflecting the views of the US Air Force Medical Service or the US Air Force at large.
