As of July 2018, The Joint Commission added new requirements for pregnant women, specifically in labor and delivery:
To prevent neonatal infection during delivery, pre-assessing pregnant women’s status for HIV, syphilis, hepatitis B, and group B strep (GBS) is needed. If prenatal care is unknown or inadequate, testing should occur at the time of admission to labor and delivery.
Here are the differences in GBS testing:
|
|
Antepartum, 35-37 weeks |
Intrapartum, labor/delivery |
|
Test Code |
BSCRN, LAB70014 |
GBSI, LAB------ |
|
Test Name |
Group B Strep Screen, PCR |
Intrapartum Gr B Strep Screen, PCR |
|
Collection Swab |
Eswab, Stores item # 1772
|
Copan swab, Stores item # 7647
|
|
Collection Site |
Vaginal/Rectal swab |
Vaginal/Rectal swab (before exam, lubricants interfere with testing) |
|
Stability |
<24 hours room temperature, 6 days refrigerated |
<24 hours room temperature, 6 days refrigerated |
|
Turnaround time |
24-36 hours |
Within 2 hours of collection |
|
Performed |
Daily 0500-2200 at Regional Lab |
24/7 at Priority Lab |
Current guidelines from the Centers for Disease Control and Prevention and American College of Obstetricians and Gynecologists recommend universal screening of all pregnant women at 35 to 37 weeks of gestation for vaginal-rectal GBS colonization. The guidelines recommend antibiotic prophylaxis of patients who screen positive, have GBS bacteria during the pregnancy, history of prior affected newborn, are less than 37 weeks gestation or develop other risk factors such as prolonged ruptured membranes beyond 18 hours or fever greater than 100.4 degrees.
The Joint Commission now additionally requires women more than 37 weeks with unknown GBS status to receive intrapartum antibiotic prophylaxis unless the result of a rapid intrapartum nucleic acid amplification test is available and negative.
We now have this intrapartum test available at Salem Hospital with an expected two-hour turnaround for results. This test should be limited to select patients at least 37 weeks admitted with unknown GBS results who are not expected to deliver imminently. This intrapartum test should not replace routine GBS screening at 35 to 37 weeks gestation in the majority of patients. Patients who have a negative intrapartum NAAT for GBS but later develop risk factors of ruptured membranes for more than 18 hours or fever greater than 100.4 degrees would then meet indications for antibiotic prophylaxis.