Fetal Monitoring: Can It Cause Group B Strep to Spread to Newborn?
At 34 weeks I tested positive for Group B strep. Can internal fetal monitoring cause this condition to spread to my baby?
Question:Peg Plumbo CNM
Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more
A 1993 study (abstract below), published in Clinical Obstetrics & Gynecology implies a relationship between internal fetal monitoring and the spread of Group B Strep to the newborn. Any puncture wound would be at risk for infection, but if the mother is colonized with Group B strep, then this becomes a site for infection in the neonate.
Author: Newton ER
Title: Chorioamnionitis and intraamniotic infection. [Review] [33 refs]
Source: Clinical Obstetrics & Gynecology. 36(4):795-808, 1993 Dec.
Abstract: Intraamniotic infection (IAI) is a common (two to four percent) event in labor. The predictors of IAI include:
-- Preterm labor or rupture of membranes
-- Abnormal vaginal flora (e.g., GBS, sexually transmitted disease, bacterial vaginosis)
-- Obstetric manipulations (e.g., vaginal exams, internal fetal monitoring) in the presence of ruptured membranes, and diminished host response (due to smoking, drug abuse, obesity, immunodeficiency states, etc.)
Group B Streptococcus and Enterobacteriaceae are the most important organisms associated with the polymicrobial infection. Anaerobes predict post-cesarean section complications. Neonatal pneumonia (two to five percent) and early neonatal sepsis (one to four percent) are the outcomes of the greatest concern and are caused by Group B streptococcal or aerobic gram-negative rod infections. These outcomes are kept to a minimum if maternal antibiotic chemotherapy is started interpartum with agents that are safe, that cross the placenta and are active against GBS and Escherichia coli (e.g., ampicillin plus gentamicin). Anaerobic coverage should be added (clindamycin) if a cesarean section is performed.
Antipyretics such as acetaminophen will reduce the hyperthermic stress on the fetus, and persistent fetal tachycardia after antipyretics may indicate fetal infection. Continuous electronic fetal monitoring is appropriate in cases of IAI, and providers should be prepared for neonatal resuscitation, early neonatal intravenous antibiotics, and respiratory support at delivery.
