A B S T R A C T
Background: Maternal colonisation with group B streptococcus (GBS) is recognised as the most frequent
cause of severe early onset infection in newborns. National and international guidelines outline two
approaches to the prevention of early onset disease in the neonate: risk based management and
antenatal culture-based screening. We undertook an analysis of existing national and international
guidelines in relation to GBS in pregnancy using a standardised and validated instrument to highlight the
different recommended approaches to care.
Methods: English language guidelines on the screening and management of GBS colonisation in
pregnant women and the prevention of early-onset group B streptococcal disease in newborns were
sought.
Results: Four guidelines met the inclusion criteria, one from the United States of America (USA), the
United Kingdom (UK), Canada and New Zealand. All four were appraised as at a high standard in terms of
development using the AGREE II tool. Both approaches were recommended in the guidelines with
different regions of the world advocating different approaches often based on the same evidence.
Guidelines from the USA recommend an antenatal culture-based approach while the UK guidelines
recommend risk-based management.
Conclusion: Based on an AGREE II analysis, the standard of the guidelines was high despite having
disparate recommendations. Both approaches to the prevention of early onset GBS infection in neonates
are recommended with the split being geographically-based.