w/ positive GBS screening culture
(unless a culture was also positive during the current
pregnancy)
-
Planned cesarean delivery performed in the absence of
labor or membrane rupture (regardless of maternal
GBS status)
-
Negative vaginal/rectal GBS in late gestation during the
current pregnancy, regardless of intrapartum risk
factors (except GBS bacteriuria)
-
In the post term pregnancy where it has been > 5
weeks since GBS testing, either
o repeat culture in clinic (and treat according to
results)*, or
o treat according to risk factors*
*
If GBS (+) @ 35 weeks, treat in labor unless GBS ( - )
at repeat culture
1. Positive maternal GBS culture during current pregnancy (see Table 1 for
clinical situation where GBS prophylaxis not indicated), or
**To properly obtain
culture, do not use
speculum. Swab lower
half of vagina
circumferentially, then
insert into rectum 2 cm
and rotate 360 degrees.
Place in selective media
for transport.
2. GBS bacteriuria during pregnancy, or
3. Prior infant with GBS disease, or
4. GBS status unknown within 5 weeks of delivery, and
Conventional
Management

a. <37 wks GA (unless delivered by cesarean section
with intact membranes and no labor (table 2), or
No

b. ROM >18 hours, or

c. Maternal temperature >100.4 F (38.0
° C) use ampicillin and
gentamicin if chorioamnionitis suspected as cause of fever
Table 2. Onset of Labor at < 37 weeks of Gestation with
Significant Risk of Imminent Delivery (not PPROM).
GBS unknown (or no
GBS culture in last 5
weeks)
GBS +
GBS -
(within 5
wks)



Obtain vaginal and
rectal GBS culture
and start IV penicillin
(see Table 3)
Start IV
penicillin
No GBS
prophylaxis






If chorioamnionitis suspected, initiate Diagnostic
Evaluation
A
and Empiric Antibiotic Therapy
B
in newborn
Yes
Decision Making
Blue font = newborn
Black font = maternal
GIVE IAP
(Table 3)
Table 3. Recommended Regimens for Perinatal
Disease Prevention*

Regimens
Antimicrobial

Recommended
Penicillin G, 5
million units IV
initial dose, then 2.5
million units IV every
4 hours until delivery

Alternative
Ampicillin, 2 g IV initial
dose, then 1 g IV
every 4 hours until
delivery

If penicillin allergic

Pts at high risk* for anaphylaxis
o
GBS susceptible to
clindamycin

o
GBS resistant to
clindamycin or
susceptibility unknown


Clindamycin, 900 mg
IV every 8 hours until
delivery
Vancomycin, 1 g IV
every 12 hours until
delivery


Patients NOT at high risk* for
anaphylaxis
Cefazolin, 2 grams IV,
then 1 gram q 8 hours

* High risk includes pts who have had any of the following
reactions to a penicillin drug: 1. anaphylaxis, 2. urticaria or, 3.
patient w/ any penicillin allergy + asthma.

Patients with PCN allergy who have used cephalosporins in the
past without reaction should receive Cefazolin.
Signs of
sepsis?
<37 wks GA, or ROM
>18 hrs, or maternal
temp >100.4F (38.0C),
or signs of sepsis
>3 hrs
No
Appropriate
antibiotic
given?
(Table 3)
Yes
Yes
No
B
No
Yes
Yes
No
B
GA <35 wks?
Yes
Diagnostic Evaluation
A
Empiric Antibiotic Therapy
B

Single dose:
IM Aqueous Penicillin G
2kg = 60,000 Units
< 2kg = 50,000 Units
C,D
No

Author: Mark Pearlman, MD for the Perinatal Joint Practice
Committee
A
Blood culture, LP if signs of sepsis or at MD discretion, CXR if cardiopulmonary signs, CBC/diff at discretion.
B
May d/c if culture negative after 36 hr incubation and infant well.
C
Does not need IM Penicillin if clindamycin IAP >3 hr and maternal GBS sensitive to Clindamycin.
D
No early discharge < 36 hours.
No evaluation
No empiric therapy
Observe >36 hrs
D