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Pregnancy, Group B Streptococcus and Bonkers NHS Policies

February 10, 2011 1 comment

Unfortunately the wife has it. It means that all plans for a water birth and a home birth have gone out the window. Monique, who dislikes both hospitals and needles, will have to be fed antibiotics intravenously through the labour. Bad though this all, the more we think about it the more grateful we are that it was discovered at all. We had gone to see a GP about an unrelated matter. The locum doctor, an older chap who seemed much more interested in treating patients rather than rushing them out the door, decided that Monique should have a precautionary swab taken. On reflection we think this doctor just used the other matter as a pretext to conduct a de facto screening for GBS. Which isn’t NHS policy.

In fact, the more  I read about it the more puzzled I’m becoming about the NHS policy regarding this disease. Here is what I’ve found about GBS;

Group B streptococcus is found naturally in the vagina of about 20-30% of pregnant women. It usually has no symptoms and no harmful effects to the carrier. However, a baby born to a woman with untreated GBS has a 1 in 300 chance of contracting a number of diseases through it. These included blood poisoning, pneumonia and meningitis. Of course these can be fatal or cause lasting damage to the baby. Treatment, IV antibiotics during labour, drastically reduces the risks, right down to 1 in 4,000 (or 1 in 6,000. Depends what you read).

With such a high incidence of latent GBS and such a dramatic lengthening of the odds on treatment, at first glance it seems this would be a prime candidate for screening. In fact in the US they already do this; at 36 weeks all pregnant women are screened for it. So why not here?

Apparently one argument it that the current screening process is unreliable; 50% of cases are not detected. Yes, OK NHS,  so what? 50% of cases would be detected! We’ve got the numbers; about 700,000 babies are born in the UK every year. At least 20% of these will be exposed to GBS, that’s 140,000 babies. 50% of those at risk, 70,000, could benefit from the treatment under a screening regime. 1 in 300 of 70,000 is 233. So screening could prevent 233 babies contracting life threatening illness’. If the problem is actually cost, then one wonders what the cost of care is for 233 seriously ill babies, or the lifetime cost of a person with meningitis (not just to the NHS, but to society as a whole). Then there is the human cost to consider. Now here’s the next argument for screening; the unreliable tests are being superseded by newer tests with much greater chance of detecting GBS.

So, there seems less and less reason for the NHS to not conduct screening of all pregnant women for Group B Streptococcus. Because not everyone will bump into a wile old doctor who cares more about patients than the NHS does.

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