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.

This is GBS bacteruria. GBS bacteriuria is associated with a higher risk of chorioamnionitis and neonatal disease. Women with GBS bacteriuria should be offered IAP.

Women with GBS urinary tract infection (growth of greater than 10^5 cfu/ml) during pregnancy should receive appropriate treatment at the time of diagnosis as well as IAP. 

Antenatal treatment for vaginal or rectal colonisation does not reduce the likelihood of GBS colonisation at the time of delivery and so is not indicated in this situation.

IAP should be offered to GBS-colonised women

Routine ultrasound screening is not useful. Selective ultrasound screening can be considered for women with breech presentation at term who are considering vaginal birth.

Read about Intrapartum Care in VBAC-

https://obgresource.com/2021/12/10/intrapartum-care-in-vbac-2/

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)

Previous vaginal delivery, particularly previous VBAC, is the single best predictor of successful VBAC and is associated with a planned VBAC success rate of 85–90%.

Previous vaginal delivery is also independently associated
with a reduced risk of uterine rupture.

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.

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.

Planned VBAC is contraindicated in women with previous uterine rupture or classical caesarean scar.

Women who have had two or more prior lower segment caesarean deliveries may be offered VBAC after counselling by a senior obstetrician. This should include the risk of uterine rupture and maternal morbidity, and the individual likelihood of successful VBAC.

• IAP( Intrapartum antibiotic prophylaxis)  is recommended for women in confirmed preterm labour.  The risk of GBS infection is higher with preterm delivery and the mortality rate from infection is increased (20–30% versus 2–3% at term). For this reason, IAP is recommended for women in confirmed preterm labour.
• There is no evidence that intrapartum vaginal cleansing will reduce the risk of neonatal GBS disease.
• Polymerase chain reaction or other near-patient testing at the onset of labour is not recommended.

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

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Successful VBAC is more likely among women with previous caesarean for
fetal malpresentation (84%) compared with women with previous caesarean for either labour dystocia (64%) or fetal distress (73%) indications.