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    Sep 20

    Induction? History of precipitous labor and group strep b positive.

    Karen Temple

    I am currently 33 weeks pregnant with my 3rd child. I have a history of precipitous labor and am group strep b positive. My doctor is discussing with me the possibility of inducing at 39 weeks. We have a 30 minute drive to the hospital in good traffic and have to get our two other children taken care of before we leave. My last labor/delivery was 2.5 hours total. 

    Without the strep b at play I would take my chances of not getting to the hospital in time but from what I'm reading it seems it can be very dangerous for the baby if I don't receive antibiotics in time.

    I'm wondering what your thoughts are.

    Is this a good reason to induce?

    Henci Goer

    I don't know that GBS is so very dangerous. Here is an excerpt from my and Amy Romano's new book, Optimal Care in Childbirth: The Case for a Physiologic Approach (c) 2012:

    The Problem of GBS

    First, the facts: GBS is an intestinal organism that can migrate to the vagina. Roughly 10-30% of U.S. women are colonized. Among all colonized women, 1-2% of newborns will develop early-onset (< 1 w after birth) disease if women are not treated, and in babies born at term, 2-3% of cases end in death. This calculates to a range in mortality of 2 to 6 per 10,000 in babies born to untreated colonized women. About one-quarter of all infections occur in preterm babies, however, which means the likelihood of colonization leading to disease in term infants is lower, making the calculated death rate in term infants of untreated colonized mothers likely higher than it really is. In women without risk factors (< 37 w, membrane rupture > 12 h, intrapartum fever > 99.5 degrees F), the incidence of early-onset newborn disease was 0.5%, which reduces the risk of death to 1 to 2 per 10,000. Other factors such as whether a woman is lightly or heavily colonized with the bacteria also moderate the likelihood of her newborn contracting disease.


    Centers for Disease Control and Prevention. Prevention of Perinatal Group B Streptococcal Disease -- Revised Guidelines from CDC, 2010. MMWR Recomm Rep 2010;59:1-36.

    Glantz JC, Kedley KE. Concepts and controversies in the management of group B streptococcus during pregnancy. Birth 1998;25:45-53.

    Nonetheless, the odds of your baby contracting serious disease are not zero, and, since you are not a first-time mother, you are at low risk of ending up with a cesarean because of the induction.

    If you decide to go ahead with the induction, make sure your doctor means 39 completed weeks, that is, not before one week before your due date. The studies of elective deliveries have found an increase in newborn respiratory problems in newborns delivered before this point in time. I would also refuse rupture of membranes. It both opens a pathway for ascending infection should labor be longer this time and commits to delivery. So long as membranes are intact, if the induction doesn't produce effective labor, you can stop and go home and try again another day. It is also likely that once progressive labor is established, the Pitocin drip can be turned off and just plain IV fluid left running, and labor will continue on its own. This will make for an easier labor for both you and your baby. If contractions die away, the Pit drip can always be re-started. I would refuse Cytotec (generic name: misoprostol). Even with usual dosages, it occasionally causes severe complications. Either way, you can take comfort in knowing that especially in the case of someone like you who has short labors, your baby is at very low risk of contracting GBS.   

    All Times America/New_York

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