The case for routine Group B Strep screening during pregnancy

by Sharon Williams and Richard Kayser, medical negligence lawyers at Irwin Mitchell

What is Group B Strep and how is it treated?

Group B Strep (GBS) is a common bacteriological infection found in both men and women.  It is usually found in the bottom or vagina of the infected person and according to the NHS, affects two to four women in 10.

GBS is normally harmless but in newborn babies can cause serious complications that can be life threatening. There's a small risk that GBS can pass to the baby during childbirth or in the early weeks of life.

If GBS is identified in a baby, then treatment is a course of penicillin - Amoxicillin or Cephalexin - at the time of diagnosis. If it is identified during pregnancy prophylactic antibiotics should be administered at least four hours before delivery to prevent the baby picking up the infection during the delivery.

Why is testing important?

Group B Strep is the most common cause of severe infection in newborn babies and can cause sepsis, meningitis or in some cases sadly, death of the baby.

Each year, on average there are approximately 700,000 babies born in the UK.  Without preventative medicine, GBS infections affect an estimated 1 in every 1,750 of those babies.  On average:

• Two babies a day develop GBS infection
• One baby per week dies from GBS infection
• One baby per week survives with long-term disability

In around 12 per cent of the survivors, the disabilities may be severe and may include long-term mental and/or physical problems from mild-severe learning disabilities, loss of sight and loss of hearing, lung damage and many more effects.

How is GBS detected in the UK?

Currently in the UK, GBS is not routinely tested for, but may be found during tests carried out for another reason, such as a urine test or vaginal swab.  In other countries, such as the USA, France, Canada, Spain and Germany, testing of pregnant women for GBS is part of the routine antenatal care offered to all pregnant women.

The guidelines for Group B Strep screening are currently contained in the Royal College of Obstetricians and Gynaecologists Green-top guideline no 36 – Sept 2017.  Those guidelines provide that:

• All pregnant women should be provided with an appropriate information leaflet
• The various risk factors ought to be discussed with the pregnant woman and if appropriate risk; factors identified, then option of IAP (intrapartum antibiotic prophylaxis)  or bacteriological testing in late pregnancy with IAP if there is a positive result;
• If performed, bacteriological testing should be ideally be carried out at 35-37 weeks or 3-5 weeks prior to the anticipated delivery date for women carrying twins;
• Women with a GBS urinary tract infection during pregnancy should receive appropriate treatment at the time of diagnosis as well as IAP and;
• Where GBS carriage is detected incidentally or by intentional testing, women should be offered IAP.

As can be seen, the UK works very much on a risk based system to determine which women should be tested.  There will be many women that do not fit any of the risk profiles yet are unknown carriers of the infection and therefore risk passing the infection to their babies during childbirth.

The case for routine testing in the UK 

As mentioned above, many developed countries include screening for Group B Strep as part of their routine antenatal care. 

The cost of a screening swab to the taxpayer is £11.  The cost of a seven day course of Amoxicillin to the taxpayer is £1.68.   Based on the figures above, the routine testing of every pregnant woman would cost the NHS in the region of £7.7 million per year, with the costs of antibiotics for women testing positive costing less than £900,000 per year. When compared against one successful negligence claim per year the numbers speak for themselves. 

Clinical trial

Currently there is a huge clinical trial of routine testing pregnant women for group B Strep (GBS) in the UK. It is designed to establish whether testing all pregnant women is better than the UK’s current approach. It will also compare two different testing approaches (ECM at 35-37 weeks of pregnancy or a PCR test in labour). The trial will involve 80 hospitals in England, Wales and Scotland, and will report its findings in 2023.

You can find out if your local hospital is taking part at https://gbss.org.uk/gbs3/ More information can be found on the Group B Strep Support website or watch their video.

Litigation

GBS infections can have devastating consequences for many children and their families, whether this be death or a lifelong disability.

GBS infections in babies are, in a number of cases, preventable / treatable.  It often also gives rise to costly litigation.

As lawyers, we pursue cases on the basis of (but not limited to):

• failures regarding consent;
• failures to consider infection as a possible cause of complications during pregnancy;
• failures to prescribe and administer early antibiotics during labour;
• failures to prescribe and administer antibiotics for early-onset neonatal infection and;
• failures to recognise and treat sick babies in the first hours after birth.

Where a child has suffered a devastating brain injury the compensation they recover can run into millions of pounds to ensure they have the life-long care, support and rehabilitation they need.  

However, no amount of compensation can ever actually compensate the claimant or their family for the injuries they have suffered.  

Find out more about Irwin Mitchell's expertise in supporting families affected by Group B Strep at our dedicated Group B Streptococcus Claims section.  

As can be seen, the UK works very much on a risk based system to determine which women should be tested. There will be many women that do not fit any of the risk profiles yet are unknown carriers of the infection and therefore risk passing the infection to their babies during childbirth.”