Group B Strep (GBS) | Birth Injury Practice Areas
Group B Streptococcus (GBS) is a common bacteria in the gut and genital tract. When strep causes an infection, it can cause severe illness, brain damage and death in vulnerable populations (especially newborns and those with weak immune systems). Mothers may pass on the infection without being aware of it because the presence of strep rarely shows physical symptoms in adults. Standard practice dictates that expectant mothers be tested for GBS in the third trimester of pregnancy using a swab sample. This test can take 2-3 days to show results. If a mother tests positive, she is given a regimen of prophylactic antibiotics to control the infection and protect the baby from exposure. Babies who are suspected to have exposure to Group B Strep are closely monitored and treated at the first signs of infection in order to prevent infection-related damage.
Group B Streptococcus, also known as Group B Strep or GBS, is a bacterium that is part of the normal flora of the gut and genital tract. GBS infection is found in 20 – 40 % of women, and it can cause severe illness and death in newborn babies and patients with compromised immune systems. GBS infection can also result in maternal death by causing an upper genital tract infection which progresses to septicemia (infection in the blood), although this is rare.
GBS infection has no physical symptoms, so most carriers have no idea they are infected. This makes it very dangerous because a pregnant woman with GBS infection can transfer the bacteria to her newborn baby during the labor and delivery process. GBS infection can cause serious harm to a baby who may not have the antibodies to fend off the infection. Babies exposed to GBS bacteria risk developing conditions such as brain damage, cerebral palsy, meningitis, sepsis, pneumonia, hearing loss and blindness.
Causes of Group B Strep (GBS) Infection
GBS is a naturally occurring flora, so many healthy women carry GBS in their bodies. Women can carry the infection for just a short period of time, it may come and go, or a woman may always have it. In newborn babies, GBS infection can be acquired through direct contact with the bacteria while in the uterus. More frequently, babies can contract it during delivery from bacteria in the birth canal. When a mother has GBS infection, the rate of transmission to the baby is approximately 50% during vaginal delivery.
Risk Factors for Group B Strep (GBS) Infection
Maternal risk factors that increase the chance of transmitting GBS to the newborn include the following:
- Labor or membrane rupture before 37 weeks gestation
- Membrane rupture more than 18 hours before delivery
- Urinary tract infection with GBS during pregnancy
- Previous baby with GBS infection
- Fever during labor
- Positive culture for GBS colonization at 35 – 37 weeks
Signs and Symptoms of Group B Strep (GBS) Infection
Women with GBS typically have no signs or symptoms of the infection. However, early onset GBS infection can present with breathing problems and pneumonia; late onset GBS infection is more likely to present with meningitis and septicemia. Once symptoms are present, the condition can be difficult to treat
In newborns with early-onset GBS, the signs and symptoms usually develop within the first 24 hours of life. Babies who develop late-onset GBS infection are often healthy and thriving, with the signs and symptoms of the disease developing after the first week of life. Signs and symptoms of GBS infection in babies include the following:
- Fever or variation in body temperature
- Breathing problems / grunting sounds
- Apnea (periods without breathing)
- Cyanosis (bluish coloring of the skin)
- Limpness or stiffness
- Heart rate and blood pressure abnormalities
- Difficulty latching on to the mother’s breast or feeding
- Irritability and fussiness / unusually anxious behavior
Diagnosing Group B Strep (GBS)
Since women infected with GBS usually display no signs or symptoms of the infection, and since the potential danger to babies is severe, it is standard practice that all expectant mothers get tested for GBS during the third trimester of their pregnancy. The physician performs the test by taking a swab sample from the woman’s vagina and rectum. The swab is then sent to a lab for testing. If the test is positive for GBS, steps are taken to protect the baby from infection.
If the woman has already given birth and there is suspicion that the baby has GBS, a sample of the baby’s blood or spinal fluid will be sent to a lab for evaluation.
GBS infection and disease are diagnosed when the bacteria are grown from cultures of the fluid samples. The cultures take several days to grow, so it may be 2 – 3 days before results of the lab analysis are received.
Treating Group B Strep (GBS)
When a woman tests positively for GBS, the physician should devise a plan to minimize the baby’s exposure to the infection during the birthing process. The most common method of preventing GBS in babies is to administer antibiotics to the mother during labor. In fact, antibiotic prophylaxis is recommended for:
- Women who delivered a previous infant with GBS infection
- Women with GBS bacteriuria (bacteria in urine) in the current pregnancy
- Women with a GBS-positive screening result in the current pregnancy
- Women with unknown GBS status who deliver at less than 37 weeks’ gestation, have an intrapartum temperature of 38º C (100.4º F) or greater, or have rupture of membranes for 18 hours or longer.
Penicillin is the preferred medication for intrapartum antibiotic prophylaxis, and ampicillin is an acceptable alternative.
While antibiotics and other preventative measures may reduce a baby’s chance of contracting GBS, all newborns born to mothers who are GBS carriers should be carefully monitored to identify the earliest manifestations of the disease.
Generally, the type of birth (C-section versus vaginal delivery) does not affect how a physician will proceed with regards to GBS prophylactic treatment. What is most important is whether the baby is exposed to the bacteria and how best to protect him or her from possible infection. If the water remains intact, the baby is not exposed to the bacteria. And if it is broken, the baby is exposed. The antibiotics will wipe out the bacteria in the vagina, and they will transfer to the baby to help him or her fight a possible infection.
When risk factors for GBS infection are present, it is essential that the physicians monitor the mother and baby very closely and follow guidelines and medical standards of care for treatment and prevention of GBS. It is negligence when a mother and baby are not properly tested for GBS, and when standards for treating the condition are not followed. If GBS infection is not diagnosed and treated right away, it can lead to very serious problems, such as seizures, cerebral palsy, meningitis, sepsis, blindness, intellectual and developmental disabilities, deafness, speech delays, language delays, or even death. This constitutes medical malpractice.
Legal Help for Group B Strep (GBS) Cases
The Reiter & Walsh ABC Law Centers team is dedicated specifically to birth injury cases. We understand the complex legal issues involved with pregnancy infection cases and will help you to obtain the compensation to which you are entitled. Our attorneys and in-house medical staff determine the causes of our clients’ injuries, the prognoses of birth injured children and areas of medical negligence. We consult closely with leading medical experts, forensic specialists and life care-planning professionals to secure our clients’ future care and their parents’ peace of mind, knowing their child will be cared for, no matter what. Our specific focus on birth injury allows our attorneys to provide unparalleled legal service to our clients.
Our attorneys handle cases all over the United States, in places including Pennsylvania, Tennessee, Mississippi, Texas, Wisconsin, Michigan, Ohio, Washington D.C., Arkansas, and more. Additionally, our team handles cases involving military hospitals and federally funded clinics. To begin your free case review, please contact Reiter & Walsh ABC Law Centers in any of the following ways:
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Video: Group B Strep Attorneys Discuss the Causes of and Treatments for Hypoxic Ischemic Encephalopathy (HIE)
Watch a video of Group B Strep Lawyers Jesse Reiter and Rebecca Walsh discussing how birth asphyxia can cause numerous birth injuries, including hypoxic ischemic encephalopathy and cerebral palsy.
- Edwards MS, Nizet V, Baker CJ. Group B Streptococcal Infections. In: Infectious Diseases of the Fetus and Newborn Infant, 7th ed, Remington JS, Klein JO, Wilson CB, et al (Eds), Elsevier Saunders, Philadelphia 2011. p.419.
- Eichenwald EC. Perinatally transmitted neonatal bacterial infections. Infect Dis Clin North Am 1997; 11:223.
- Verani JR, McGee L, Schrag SJ, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease–revised guidelines from CDC, 2010. MMWR Recomm Rep 2010; 59:1.
- Phares CR, Lynfield R, Farley MM, et al. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA 2008; 299:2056.
- Regan JA, Klebanoff MA, Nugent RP, et al. Colonization with group B streptococci in pregnancy and adverse outcome. VIP Study Group. Am J Obstet Gynecol 1996; 174:1354.
- Krohn MA, Hillier SL, Baker CJ. Maternal peripartum complications associated with vaginal group B streptococci colonization. J Infect Dis 1999; 179:1410.
- Zaleznik DF, Rench MA, Hillier S, et al. Invasive disease due to group B Streptococcus in pregnant women and neonates from diverse population groups. Clin Infect Dis 2000; 30:276.
- Schrag SJ, Zywicki S, Farley MM, et al. Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med 2000; 342:15.
- Sheehy, Annabel, Deborah Davis, and Caroline SE Homer. “Assisting women to make informed choices about screening for Group B Streptococcus in pregnancy: A critical review of the evidence.” Women and Birth (2012)