Group B Streptococcal Testing During Pregnancy: Survey of Postpartum Women and Audit of Current Prenatal Screening Practices

Awareness of Pregnancy Screening for Group B Streptococcus Infection Among Women of Reproductive Age and Physicians in Jeddah, Saudi Arabia

Background Group B Streptococcus is part of the normal flora of the female urogenital tract and rectum. Vaginal colonization and transmission of this bacteria during delivery can lead to neonatal life-threatening complications, which can be prevented by screening and the administration of intrapartum antibiotics. This study's aim was to assess the level of awareness of antenatal screening of Group B Streptococcus among women and physicians in Jeddah, Saudi Arabia. Methods A cross-sectional study using an online survey from a previously published study was distributed among 767 participants in Jeddah from June to August 2020. The participants were family medicine or obstetrics and gynecology physicians and women of reproductive age. Results Our results revealed a good level of knowledge of the physicians, although almost half of them reported the need for training to correctly perform screenings. The level of the women's knowledge was relatively poor, their mean knowledge was 50.7%, and the majority were unaware of this infection (85.3%). Conclusions This study found a low level of knowledge of Group B Streptococcus among women of reproductive age and physicians in obstetrics and gynecology and family medicine. These findings confirm the importance of increasing the awareness of Group B Streptococcus among these populations to avoid complications associated with this infection.

Knowledge, attitude and current practices of pregnant women towards group B streptococcus screening: cross-sectional study, Al-Madinah, Saudi Arabia

AIMS

Group B streptococcus (GBS) is one of the most frequent bacterial pathogens causing invasive infections in neonates. It can be transmitted from colonised mother to neonates around delivery. Screening strategies for GBS during pregnancy include either universal culture-based or risk-based screening. The present study aimed to assess the knowledge, attitude and current practices of pregnant women towards GBS screening in Al-Madinah City, Saudi Arabia.

METHODS

A hospital-based cross-sectional study was conducted at Madinah Maternity and Children Hospital, Al-Madinah, Saudi Arabia, from May to July 2018. Participants were recruited from postnatal wards. Participants were interviewed using a previously published validated survey that was divided into the following domains: demographic data, knowledge, experience and attitude towards different GBS screening strategies.

RESULTS

A total of 377 out of 450 women (response rate 83.7%) were enrolled. The results showed that the overall mean knowledge score of the pregnant women towards GBS screening was 59.8%. Majority of the women (66.8%) were not aware of the GBS bacterium, while 86.5% of them had never been informed of GBS risk assessment during their pregnancies. The mean knowledge score among women who were aware of GBS (62.8%) was significantly higher than that among women who were not (58.4%) (p=0.015). However, majority of the pregnant women (61.8%) showed preference for universal culture-based GBS screening strategy over risk-based strategy.

CONCLUSION

The study results have concluded that the level of awareness and knowledge about GBS among pregnant women were relatively poor; however, majority of the pregnant women prefer universal culture-based screening.

Institution of universal screening for Group B streptococcus (GBS) from a risk management protocol results in reduction of early-onset GBS disease in a tertiary obstetric unit

AIM

To determine the effect of institution of a universal screening protocol as per CDC 2002 guidelines had on the incidence of early-onset Group B streptococcal (GBS) and non-GBS disease in a tertiary obstetric unit.

METHODS

A prospective study with historical control data reporting the incidence of early-onset GBS and non-GBS disease following institution of a universal screening strategy at John Hunter Hospital, Newcastle, Australia. We compared the incidence of early-onset GBS and non-GBS disease during prescreening (1994-2002) with screening period (2004 to June 2006). The outcome measure was the incidence of early-onset GBS disease. We specifically reported the number of women needed to treat (NNT) with antibiotics and the number of women needed to screen.

RESULTS

The incidence of early-onset GBS and non-GBS during the prescreening period was 0.84/1000 and 0.94/1000 live births, respectively. After institution of universal screening, the incidence was 0.00/1000 and 0.72/1000 live births, respectively. This is a statistically significant reduction in early-onset GBS disease by 84% (chi(2) = 5.75; P = 0.016). There was no difference in non-GBS disease (chi2 = 0.14; P = 0.71). The NNT is 1191 and we needed to screen 5704 women to prevent one case of early-onset GBS disease.

CONCLUSION

Screening for GBS rather than by assessing risk factors has significantly reduced the incidence of early-onset GBS disease in our unit. Despite low incidence of early-onset GBS prior to screening period, we still found a significant decrease in early-onset GBS disease after institution of universal screening protocol. These results support the screening-based approach at 34-37 weeks gestation.