Abstract
Objective
To elucidate the association between GBS infection and maternal risk for obstetric hemorrhage (OBH) and OBH-related morbidities (OBH-M).
Methods
This was a retrospective cohort study of all deliveries with a documented GBS status at a single large academic medical center from 2018 to 2019. GBS status was determined by either urine culture or rectovaginal culture collected during the antepartum period. The primary outcomes were quantitative blood loss (QBL), OBH, and a composite of OBH-M. Secondary outcomes were individual components of the OBH-M composite and frequency of hemorrhage-related interventions utilized intrapartum and postpartum. A stratified analysis was conducted examining only patients who were diagnosed intrapartum with an intrapartum intraamniotic infection (III).
Results
Of 4679 pregnant individuals who delivered a live infant between January 1, 2018 and January 1,2019 with a documented GBS status, 1,487 were identified as GBS positive (+) and 3192 were identified as GBS negative (−). The GBS + group did not have significantly higher QBL (p = 0.29) or rate of OBH (p = 0.35). There were no significant differences by GBS status in OBH morbidity (p = 0.79) or its individual components or frequency of individual pharmacologic or non-pharmacologic OBHrelated interventions. There were also no significant differences by GBS status among patients with an III.
Conclusions for Practice
GBS infection at the time of delivery was not associated with increased risk for OBH or OBH-M. Further research is needed to further explore the relationship between peripartum infections and OBH risk.
Significance
GBS infection in neonates has long been feared due to life-threatening outcomes for the neonate, yet few studies have studied the impact of GBS infection on mothers Vornhagen (Trends Microbiol 25(11):919–931, 2017); Chun-Chih (Pediatr Neonatol 59(3):231–237, 2018); Hirsch (Nat Commun 9(1):263, 2018). Our study fills this gap by exploring the effects of GBS infection on maternal OBH while using quantitative blood loss (QBL) methods, which have been shown to be more accurate than the visually estimated methods used in previous studies.
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References
Al Kadri, H. M., Al Anazi, B. K., & Tamim, H. M. (2011). Visual estimation versus gravimetric measurement of postpartum blood loss: A prospective cohort study. Archives of Gynecology and Obstetrics, 283(6), 1207–1213.
Casey, B. M., & Cox, S. M. (1997). Chorioamnionitis and endometritis. Infectious Disease Clinics of North America, 11(1), 203–222.
Centers for Disease Control and Prevention. Group B strep. 2020
Chun-Chih, P., Jui-Hsing, C., Hsiang-Yu, L., Po-Jen, C., & Bai-Horng, S. (2018). Intrauterine inflammation, infection, or both (Triple I): A new concept for chorioamnionitis. Pediatrics & Neonatology., 59(3), 231–237.
Gabel K, Lyndon A, Main E. Risk factor assessment. California Maternal Quality Care Collaborative. 2015
Hirsch, A. J., Roberts, V. H. J., Grigsby, P. L., et al. (2018). Zika virus infection in pregnant rhesus macaques causes placental dysfunction and immunopathology. Nature Communications, 9(1), 263.
Kalin, A., Acosta, C., Kurinczuk, J. J., Brocklehurst, P., & Knight, M. (2015). Severe sepsis in women with group B Streptococcus in pregnancy: an exploratory UK national case–control study. British Medical Journal Open. https://doi.org/10.1136/bmjopen-2015-007976
Kobayashi, M., Schrag, S. J., Alderson, M. R., et al. (2019). WHO consultation on group B streptococcus vaccine development: Report from a meeting held on 27–28 April 2016. Vaccine., 37(50), 7307–7314.
Muller, A. E., Oostvogel, P. M., Steegers, E. A. P., & Dorr, P. J. (2006). Morbidity related to maternal group B streptococcal infections. Acta Obstetricia Et Gynecologica, 85, 1027–1037.
Rossen LM, Womack LS, Hoyert DL, Anderson RN, Uddin SFG. The Impact of the pregnancy checkbox and misclassification on maternal mortality trends in the United States, 1999–2017. Vital Health Stat 3. 2020;(44):1–61
The American College of Obstetricians and Gynecology. Group B Strep and pregnancy. 2021
The American College of Obstetricians and Gynecology. Quantitative blood loss in obstetric hemorrhage. 2019
Vornhagen, J., Adams, W. K. M., & Rajagopal, L. (2017). Perinatal Group B Streptococcal infections: Virulence factors, immunity, and prevention strategies. Trends in Microbiology, 25(11), 919–931.
World Health Organization and United National Children’s Fund. Countdown to 2015: maternal, newborn and child survival. 2012
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Tummala, S., Wang, M.J., Srivastava, A. et al. Group B Streptococcus Infection and Obstetric Hemorrhage Risk. Matern Child Health J (2024). https://doi.org/10.1007/s10995-023-03892-1
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DOI: https://doi.org/10.1007/s10995-023-03892-1