Group B Strep (GBS) on the NCLEX
GBS screening timing, who gets intrapartum antibiotics, and newborn surveillance.
GBS questions are about timing: when to swab, when to treat, and how long the antibiotics need before delivery.
Screening
Rectovaginal swab at 36 to 37 6/7 weeks. GBS is normal gut and vaginal flora in a significant fraction of women; colonization is harmless to the mother but can cause newborn sepsis, pneumonia, and meningitis if transmitted during birth.
Who gets intrapartum antibiotics
GBS-positive screen this pregnancy. GBS bacteriuria at any point this pregnancy (treat, and no rescreen needed). A previous infant with invasive GBS disease (no rescreen needed). Unknown status in labor with risk factors: preterm labor, membranes ruptured 18 hours or more, or intrapartum fever.
The antibiotic and the timing rule
IV penicillin G during labor is standard (ampicillin is an alternative; allergy pathways exist per protocol). Oral antibiotics before labor do not clear colonization for delivery. Adequate prophylaxis means the first dose is given at least 4 hours before delivery. That number drives triage: a GBS-positive multipara progressing fast gets the antibiotic started early. A scheduled cesarean with intact membranes and no labor does not require GBS prophylaxis.
Newborn surveillance
Watch every exposed newborn for early-onset sepsis, most cases in the first 24-48 hours: respiratory distress, temperature instability, poor feeding, lethargy. Infants born with inadequate prophylaxis get extended observation per protocol. Newborn sepsis signs are subtle; a baby who was feeding and now is not is a report, not a recheck-later.
Frequently asked
GBS positive last pregnancy. Does she need antibiotics this time?
Not automatically. She is rescreened this pregnancy. The exceptions that skip rescreening are GBS bacteriuria this pregnancy or a previous baby with invasive GBS disease.
Why not treat GBS with oral antibiotics at 36 weeks?
Colonization returns by delivery. The goal is high antibiotic levels in the birth canal and fetus during labor, which is why the drug is IV and intrapartum.
She arrived 9 cm and delivered in an hour. Antibiotics were started 50 minutes before birth. Now what?
That is inadequate prophylaxis (under 4 hours). The newborn gets closer observation for sepsis per protocol; the pediatric team is notified.
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