Conference moira::parenting

    Loreen-
    
    I just had my 2nd child (she was 9 weeks old yesterday). They did the
    Strep B test this time around. They do it routinely for all pregnancies
    at by OB/GYN's now. I think it was at about 36 weeks. I think the 
    rationale for waiting til the end of the pregnancy was that they could 
    get the test results, and, if positive, treat you with antibiotics to 
    clear it up in time for the delivery. They did not do this test with 
    my first pregancy (my older daughter is 2 yrs. 4 mo.) All they do is 
    take a culture...just like a pap smear.
    
    Hope this helps.
    Lisa

    I am due June 2.  They did the test for me at 28 weeks.  I *think* the
    doctor told me that if it were positive, they treat it just prior to
    delivery.  It was just a culture that they had me do myself when I was
    in the office for my regular OB visit.
    
    Chris

    Our son was born at 22 weeks, just too young to survive.  Cultures were
    done on the placenta that indicated a Strep infection.  It is *very*
    possible according to my OB that the Strep infection caused a thinning
    of the mucus and then my water to break, resulting in the premature
    birth.  Since I've had the infection I am now a "carrier" of sorts for
    this.  (It's possible that I was a "carrier" before but just didn't
    know because of the lack of testing.)  The way this was explained to me
    is that it may be a problem with a future pregnancy or it may not. 
    It's basically a guessing game as to whether it will show up again. 
    Being a "carrier" doesn't necessarily mean that the infection will
    become active during pregnancy, I guess I just have more of a chance
    then non-carriers.  Pretty vague huh?  We have been trying to find a
    reason for the premature birth since it happened 7 months ago, Strep is
    the only identifiable problem that was found so far.  I've discussed in
    depth with my OB (a new OB from the one I was seeing during my
    pregnancy) what he could do differently with a future pregnancy.  He
    will be testing for the Strep immediately in my case.  Testing will
    continually be done throughout the pregnancy, I believe every other
    week.  Strep can be treated safely with antibiotics.  

    I wish I had known all of this during the pregnancy, I would have
    insisted on the testing if I knew it was possible that it could have
    caused us to lose our son.  I would definitely talk to your OB about
    having the test done.  In our case, waiting until the 26th thru 28th
    week was too late.

    Jean
    
    

    
    re -1
    
    I know I've talked to you off-line about your loss and I thought I
    remembered you saying (maybe somewhere in here) that it's possible your
    infection could have been a result of the water breaking instead of
    visa versa, is that true?  I know you don't know any reasons for sure
    and that makes it so darn hard.  Even though I know what was wrong with
    the son we lost at 20 wks, I still search for the 'reason' why it even
    happened to us at all.  Eventually I've found some answers that I could
    live with, but it doesn't completely stop the never ending, 'but why
    me'?
    
    I will definitely bring up the test now at my next visit next week.  I see
    him almost weekly now because of cramping and scattered braxton-hicks
    contractions.
    
    thanks and hang in there, looking forward to hearing good news from
    you!
    
    Loreen
    
    

    Hi Loreen,

    Yes, it is possible that my water broke first, then the infection set
    in.  And I haven't found a Dr yet who could to tell us definitely which
    came first, probably will never know.  I have talked with several OBs
    and Drs on this though, all have suggested that "most likely, since
    nothing else appears to be wrong, it was the infection that caused my
    water to break."  Maybe that answer just makes sense to me which is why
    I believe it.  After all, it is an answer opposed to "we just don't
    know why."  Either case though, Strep can be *very* dangerous to unborn
    babies even if it does not cause premature delivery.  My understanding
    is that the majority of infections to the baby occur during delivery. 
    However, it is NOT considered rare for the Strep to reach the baby
    before delivery.   My OB told me that if the baby is infected during
    delivery and it is detected immediately and treated, there most likely
    won't be any problems and all that is needed is antibiotics to treat.
    If the baby is infected prior to delivery, or is infected during
    delivery but it is not detected or treated, it can potentially be
    fatal.  

    Also, just one example to confirm some things in the article... I
    didn't have a single symptom that anything was wrong.  Actually, I had
    been feeling just great in the days before all this happened.  The
    morning that I did deliver, I had a slight fever but that was all. 
    There were *no* other symptoms of this infection.  Testing specifically
    for this is the only way to find it.

    I'd be interested in hearing what your OB says about it, please let us
    know.  Seems that there really isn't a "standard" on how to deal with
    Strep just yet.  I think it's all too new. 
    (Now if we could only get to the point where I can use all this info
    that I've found out...)
    
    Jean 

    

    Jean,
    
    I was tested for strep at my first visit to the doctors with this
    pregnancy.   He tested me again around 23 weeks.  With any subsequent
    pregnancy after an undiagnosed preterm delivery, I would expect any
    doctor to test, test, test and do everything possible to keep history
    from repeating itself.  I am not at the same practice as I was last
    time, and my doctor will not speculate on why things happened the way
    they did.  However, he is committed to making this one go as close to
    full term as possible, and that's fine with me.  I needed the answers 
    after Shannon was born, but now, it isn't as important, things have 
    gotten better with time.  I am fortunate to have a healthy child in
    Shannon, so my situation is not quite the same, but I did suffer
    terribly for a long time.
    
    My first was born at 26 weeks, and I am almost 29 weeks with this one
    (sigh).  
    
    beth
    

    Thanks Beth, 

    Believe me, I plan to spend quite a bit of time at my OB's office for
    the next time.  I've already been assured that I will be tested
    repeatedly for the Strep infection.

    You mentioned that your doctor won't speculation as to why Shannon was
    born so soon, was there any indication that Strep could have been a
    problem?  Or does your OB routinely check for Strep at those times?

    Jean
    

    Jean,
    
    No one will ever know for sure what happened with me.  By the time I
    got to the hospital, birth was just minutes away, the neonatologist
    wasn't even around.  
    
    My current ob has done some testing, and anything that won't hurt the
    baby is fine with me.  Since strep does cause preterm birth, he tested
    me for that...he never said he suspected it, and I don't expect him
    to determine the cause since the attending ob could not.  When I was
    examined the morning before Shannon was born, the doctor I saw (not my
    regular dr, and not the one who delievered) suspected a
    urinary tract infection, so I was cultured...Never got the results as
    it was a holiday and Shannon decided to ring in the new year in person.
    
    What I want most from my current doctor is what I am getting: 
    personalized medicine (2 person practice), and cautious care (test for 
    anything within reason) and I am happy to say I am getting both!!
    
    Beth

    Does anyone know if the Strep B being discussed in this topic
    has any relation to Strep Throat?  During my last pregnancy, I
    had an ultrasound in the 11th week that indicated the baby was
    not alive and had probably died about 3.5 weeks prior.  Looking
    back 3.5 weeks was exactly the time when I had had Strep Throat.
    Although I was on antibiotics for the Strep, I've always kind of
    suspected that that is what caused the baby to die.  My doctor,
    of course, can't say for certain if that was it.  
    
    Is Strep B the same thing, or related, to the Strep virus that causes
    Strep throat?
    
    Jane

    Jane,

    About 2 months after we lost our son, I had a sore throat and went to
    my regular dr for it, thinking it was Strep throat.  He told me that
    the two are not related.  (I insisted on a throat culture anyway.)  I
    haven't asked my OB about this yet.  I'll see what he says the next
    time I talk to him. 

    Jean
    
    

    Hi,
    
    I think this is sort of controversial.  In my first pregnancy I tested
    positive for Strep B, was treated with antibiotics and the follow-up
    test was negative.  In my second pregnancy (last fall) I tested positive 
    again. This time my Dr. (same one) said he'd been doing a lot of reading 
    on the subject - essentially antibiotics clear things up for a while
    but they could just as easily test positive again a few weeks later. 
    he recommended we test on future visits and I tested positive, then 
    negative with no treatment.
    
    Basically he said that it is a problem if you go into premature labor, 
    but that in and of itself it did not cause premature labor.  He also said 
    that during labor I'd probably have IV antibiotics, but I acutally had
    a c-section and didn't have any antibiotics.
    
    Jane Marie
                      

The usual Strep bacteria associated with sore throats is Strep A ...
that's not to say that 'B' isn't possible, but highly unusual.

All Strep infections should be taken seriously because of complications.

Stuart

    
    My water broke 2 days before labor set in.  It's not necessarily that
    the infection caused premature labor, the infection *possibly* caused a
    thinning of the mucus membranes which caused the sac to weaken and
    break.  Labor set in as a result of the water breaking, not as a result
    of the infection.

    It's more of a problem (as I understand it) with premature babies due
    to their lack of antibodies to fight the infection.  This is also true
    of full term babies, but the premature ones have even less to fight
    with. 
    
    Jean
     

      


    

    
    I had my 2 week pre-natal visit today and asked about wether 
    or not they test for Strep-B.  She said that they just recently
    had a staff meeting on the subject as to wether or not they should
    test mom's to be for the Strep-B virus.  She said that the clinic 
    decided against it because she said that studies have shown that
    if a mother does indeed have Strep-B during pregnancy, that her 
    body fights it and the virus dies.  She also says that the strep-B 
    tests can be found inconclusive.   I'm also surprised that they
    don't do an HIV test but that's a whole other topic in itself.
    
    -Chris

    I asked my OB about this today.  He does not test for Strep B unless
    there is some indication to do so -- such as previous known infection
    of the mother, or premature rupture of the membranes on a previous
    pregnancy.  We decided to do the test as my waters broke a few
    weeks early with my first child.
    
    /Deb

    
    I did ask my OB and he does do routine testing for Strep B, not till
    later and I didn't ask in which week.
    
    Loreen

Testing for Strep B was not common with my Dr. either.  BUT...

Unknowingly, my sister had Strep B when she delivered my niece 3 years ago.

A few days (maybe a week) after her birth, my niece developed some type
of cyst on her cheek.  Turns out it was from being infected during
delivery.  She went on to develop a rather severe case of meningitis (is
there any case that is not severe??).  It was quite scary for sometime
wether or not she would make it.  Seems like she was in and out of the
hospital (more in than out) for the first 3 months or so of her life.
It was not until she was a year that any permanent neuorological damage
could be outruled.

so...when I was pregnant with Josh last year I asked my OB about being tested
for Strep B.  At first the nurse had no idea what I was talking about.  Then
when she found out she was not very encouraging about being tested, but I
insisted.  My results were negative thank God.  

I have also read an article on this virus maybe in one of the Parenting
magizines.  They did state there is controversy on this subject.  But
because the test is non-intrusive (to the baby anyway) I would rather
err on the side of caution.

I am not trying to scare anyone or suggest that EVERYONE needs or should
be tested.  Just relating my experience on the subject.

Barbara

        
    I've tested positive twice now for the Strep-B infection.  I was tested
    on my first visit to the OB at 5.5 weeks along.  That test came back
    positive and I was given a 10 day prescription for ampicillin.   The
    second test was done at 11.5 weeks, which I just found out yesterday
    that it too was positive.  I'm now on my second round of ampicillin.

    My OB plans on testing about every 4 weeks for the infection and
    treating as often as necessary.  I've already been told to plan on an
    IV for antibiotics during delivery, which is common with any presence
    of Strep infection. 

    Since the infection doesn't cause any obvious symptoms but one of the
    possible problems is a weakened cervix, my OB has me in every week to
    check for that.  So far, we're doing ok, there hasn't been any
    weakening yet.  I'm at almost 13 weeks now and it looks like I'll have
    these every-week appointments for the rest of the pregnancy.  

    I'm told that the infection will never completely go away.  A negative
    test would only mean that there wasn't enough of the infection for
    the test to pick up, but it's still lurking there somewhere.  Also,
    it's not known why there are sometimes problems with the infection and
    sometimes there aren't.  It's possible that a pregnant woman could have
    the infection during the entire pregnancy and it wouldn't cause any
    problems.  On the other side though, it's possible the the infection
    can weaken the cervix and sac, causing premature delivery.  Very
    frustrating! 

    Jean
    

	Two of my sisters tested positive during their last pregnancies.

	In both cases, the doctors did not treat for the Strep-B during
	the pregnancy.  One sister, who just recently delivered, was
	not treated after the pregnancy either, but her child was monitored
	instead.  I don't think the other was treated either, because the
	birth was cesarian. 

	I wonder why all the different treatments ?

	(I think I might insist on the antibiotics for a vaginal delivery
	if I had tested positive, given the risks to the child that I've
	heard of...)

    I am curious for those who tested positive for Streb B.  did any of
    your doctors think of checking your partners for this as well?  
    
    Meg

    When I tested positive, my OB brought up the issue of my husband also
    being infected.  He said that they wouldn't bother testing him because
    they just assumed that he has it.  It sounded like it would be almost
    impossible for me to have the infection and him not to.  So, going
    under the assumption that he is also infected, we've been told to make
    use of condoms.  (As if I didn't see enough of them when we were trying
    not to get pregnant!)  

    The main concern is that the infection can more or less "attach" to the
    sperm and then it could possibly be carried, along with the sperm, into
    the cervix and beyond.  
    
    Jean
    

    There was a segment on the Today show today about this. (I'm on
    vacation this week.) The doctor that presented the report said that
    12000 children are affected by strep infections at birth every year
    and 2000 of them die. They went on to say that some number of thousand
    are disabled in some manner. I didn't catch what organizations do and
    don't recommend testing as a normal practice but the doctor that gave
    the report said that if all the pregnant women were tested and treated
    (if needed) that could reduce the number of infections by 75%. The
    doctor (Dr. Holly Atkinson) suggested that if a woman's doctor doesn't
    do the test routinely then the woman should reuquest that it be done.
    
    

    I went to the doctors for some spotting on Friday. I am currently at 20
    weeks.  The Dr did a pap, and ran some tests. 
    
    They diagnosed me with a Yeast Infection, and put me on medication for
    that.  Today I got a call from the Dr's office and the test came back
    as being positive for Strep B.
    
    So tonight I am going to start a 10 day regemin of amoxicylicin (3X's
    day), and hopefully it will clear up.
    
    My question is, (since I didn't read the answer in here anywhere), if
    this clears up, is it going to come back?  are the chances good that I
    will have premature labor? 
    
    The nurse mentioned that if it did not clear up, I would have an IV at
    delivery (if natural), but thats 20 weeks away....I hope this clears up
    by then!
    
    Anne Marie
    

    Strep B is a bacteria like any other bacteria.

    	Antibiotics will eradicate it from your body as long as:

    	*it has not developed a resistance to that antibiotic

    	*you take the antibiotic as prescribed (no skipping doses)

    	*you do not get re-exposed (your husband should also be on
        Antibiotics or he should be using a condom for the next 20 weeks)


	I'm sure that once you have tested positive (which you have) your
    Doctor will keep a close eye on the situation, you will probably be
    tested several times in the weeks to come.

    	Also, Strep B is not a "bad" bacteria, you did nothing wrong to get
    it, when we used to do vaginal cultures, in a healthy adult a few Strep
    B bacteria was considered "normal flora" It is only when your system
    gets out of whack (like getting a yeast infection) that the balance
    changes and it flourishes.

    	This does not mean that you should take it seriously, and it would
    be wise to have an IV if you test positive, it only means that you
    don't have to "blame" yourself or think that you've done a bad thing.

    	(reminds me of the story of when I was sniffing a culture of
    gonorrhea and accidentally smearing it all over my nose, I did not
    get the bacterial infection but if I had, imagine how I would have
    tried to explain that one to my Doctor! "really, ah, really, I didn't
    do a thing!")

    	Lastly, the antibiotics will most likely negate the medication for
    the yeast infection. When I was pregnant, I had several infections
    requiring antibiotics and each time I consistently got a yeast
    infection. Garlic tablets and yogurt daily finally put an end to that.

    			Wendy

>>    	Antibiotics will eradicate it from your body as long as:

    Wendy, are you sure about this?  Of all the Drs that I've talked to,
    they all have told me that you will *not* get rid of this infection. 
    It's there to stay.  I've been told that a negative result after a
    positive result is just an indication that there was so little of the
    infection that the test didn't pick it up.  A negative result didn't
    necessarily mean that the infection was completely gone.

    After finishing my first round of antibiotics, I had a test done about
    a week and 1/2 later, still came back with a positive result.  I
    finished my 2nd round of antibiotics and had a test done on Monday (5
    days after finishing the second round of medication).  I won't get the
    results until I go back again on Tuesday.  

    Anne Marie, to answer your question, yes it's very possible that you
    will get the infection back even if you test negative after taking the
    meds.  (It's also possible that you won't.)  I don't know if your
    chances of premature labor are better because of this, talk to your OB
    and have him explain what to look for.  

    I'd make sure your OB is keeping a close eye on the infection (ie
    testing often).  Also, my OB is concerned about the infection weakening
    the cervix, which could possibly lead to premature rupture of the
    membranes.  I'm having my cervix checked every week for this.  Just
    something else you might want to talk to your OB about.

    Jean

    

    	There is nothing extremely virulent about Strep B, you can get rid
    of it (just as you can get rid of Strep A which is the bacteria that
    causes Strep Throat). 

    	There may be a few reasons why you would test negative and then
    test positive again (or continue to test positive):

    	You may be getting reinfected by your partner

    	As I said earlier a *small* amount of Strep B is considered normal
    flora and so the antibiotics may have gotten rid of the initial
    infection but once the antibiotics "let up" it may grow out of balance
    again

    	In rare cases the bacteria may develop a resistance to the
    antibiotic. 

    	Just like many of us (if we had throat cultures done right now)
    would show positive for *small* amounts of Strep A, it does not mean
    that we have an "infection". Run us down, change the PH of the
    environment, in other words, stress our bodies and yes, what was
    initially a normal amount could grow into an "infection" that our
    bodies can no longer control and that would need antibiotics.

    	The tricky things during pregnancy is that you do not want to give
    the mother too much antibiotics and there very well may be an issue
    with the cervix weakening (this would be an issue with any infection
    not just Strep B). There may also be something with reduced blood flow
    to an area which would allow an infection to continue (reduced blood
    flow means reduced antibiotics to that area).

    	In any event, Strep B can cause difficulty to the baby if it is
    infected (usually during birth) for that reason alone, it is far better
    to be cautious than sorry with regard to testing and antibiotic use
    during pregnancy. 
    
    	
    			Wendy

    I saw the DR again last week, and got a few more questions answered. I
    will put down what I learned, maybe it will help other people.
    
    It seems there are 2 types of Strept B....High Risk and Low Risk.
    
    High risk lives in the area of the Kidneys, ovaries etc...  The low
    risk lives in urethra (sp?).
    
    Anyways, if you tested positive for s-b  through a urine test, it would
    be considered high risk.  If you tested + for s-b in a pap-smear, its
    considered low risk.
    
    With both types they treat it when patients are showing signs of
    it...ie...bleading/spotting.
    
    When you are diagnosed with "High" risk s-b you have a great chance of
    the baby getting infected during vaginal delivery.  Thats why they put
    an antibodic drip before you start labor.
    
    When you are diagnosed with "low" risk, (which is what I have), Its not
    as bad (thank god (-: )...anyways.  The Dr that when my water broke, it
    if I was not in labor, they would only let me go 10 hours before they
    induced, or I had a  C section.  It seems that the longer you go after
    the 10 hours, the more chance of infection for the Baby and mother.
    
    I was told, however, that I am to remind them when I go into the
    hospital, that I have tested positive for S-B. 
    
    They also said, that they would not treat it agian, unless I showed
    symptoms again, (spotting), but to be careful, because s-b can cause
    thinning of the membranes, which in turn leads to early delivery.
    
    I was happy with the info I recieved, and I hope it can be helpful for
    anyone else...
    
    23 weeks and still counting :-)
    Anne Marie
    

I asked the Dr. (not my primary, but she was a "substitute" since mine
was on sabbatical) at my 34 week visit if they would be testing for
Strep B and she said no, that they didn't do it routinely without some
symptoms to suspect it.

However, the nurse teaching my refresher lamaze class last night did
mention that once admitted to the hospital for labor, it was common
for nurses to draw blood for testing, and when someone asked what kinds
of things they tested for, she answered - any type of infection, inclu-
ding Strep B.  She didn't go into details, but it seems to at least be
good that they are doing the testing, even if it's at kind of a late
point in the process! (I assume if the test did show positive, they
would do an emergency C-section - I'll have to ask that one next time...)

So many questions!

-Cori