GBS is present in the bowel flora of 20–40% of adults (this is called ‘colonisation’). People who are colonised are called
‘carriers’. This includes pregnant women (there is no evidence that its carriage rate is specifically affected by pregnancy).

Up to 10% of women scheduled for ERCS go into labour before
39+0 weeks. Therefore it is good practice to to discuss and document a plan for delivery if labour starts prior to the scheduled date.

Planned VBAC is associated with an approximately 1 in 200 (0.5%)
risk of uterine rupture

The recommended dose is - 3 g intravenous benzylpenicillin be given as soon as possible after the onset of labour  and 1.5 g 4 hourly until delivery.
The first dose should be given at least 4 hours prior to delivery.

Systemic chemotherapy is contraindicated in the first trimester because of a high rate of fetal
abnormality,but is safe from the second trimester.

When testing for GBS carrier status, a swab should be taken from the lower vagina and the anorectum.

A single swab (vagina then anorectum) or two different swabs can be used.

For potentially sensitising events after 20weeks gestation,
a minimum anti-D Ig dose of 500 IU should be administered within 72 h of the event.

Non-hormonal contraceptive methods are recommended.

According to UKMEC- For women with 'Current breast cancer' , Cu IUCD is Category 1 , all other contraceptive methods are category 4.

For women with 'Past' breast cancer' , Cu IUCD is Category 1 , all other contraceptive methods are category 3.

After collection, swabs should be placed in a non-nutrient transport medium, such as Amies or Stuart. Specimens should be transported and processed as soon as possible. If processing is delayed, specimens should be refrigerated. When testing for GBS, the lab should be specifically informed that the swab is for GBS testing.

Methotrexate adjuvant therapy should not be used for expectant management as it is of unproven benefit and has significant adverse effects.

The six elements considered to be reflective of good care are:
 Consultant obstetrician planning and directly supervising delivery.
 Consultant anaesthetist planning and directly supervising anaesthesia at delivery.
 Blood and blood products available.
 Multidisciplinary involvement in preoperative planning.
 Discussion and consent, including possible interventions (such as hysterectomy, leaving the placenta in situ, cell
salvage and interventional radiology).
 Local availability of a level 2 critical care bed.

According to the RCOG- Any lack of compliance with the care bundle by the clinical team for a woman with either placenta praevia or accreta
should be investigated.

According to MBBRACE-UK 2014 to 2016- Women who have had a previous caesarean section who also have either placenta praevia or an anterior placenta underlying the old caesarean section scar at 32 weeks of gestation are at increased risk of placenta accreta and should be managed as if they have placenta accreta, with appropriate preparations for surgery made.

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The likelihood of maternal GBS carriage in this pregnancy is 50%.
What should be done?- Discuss the options- a. Intrapartum antibiotic prophylaxis ( IAP).
b. Bacteriological testing in late pregnancy and the offer of IAP if still positive. ( This is the only group of women who are eligible for GBS screening funded by NHS)