Group B streptococcus in labour — emergency management station

Emergency management station: group B streptococcus in labour with penicillin allergy. Tests the IAP indication and regimen, the revised regimen when susceptibility changes, the timing rule, and the neonatal communication. Includes assessor timeline, marking domains, assessor key and fail criteria.

Prompt

You are the registrar on the labour ward. A 33-year-old G3P2 at 39+4 weeks gestation presents in established labour at 5 cm dilatation. Her vaginal-rectal GBS culture at 36 weeks was positive. She reports a history of an anaphylactic reaction to amoxicillin two years ago. The GBS isolate has been reported as susceptible to clindamycin. The membranes are intact. The CTG is reassuring. The assessor runs the clock and feeds you laboratory results and the woman's responses.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the registrar on the labour ward. A senior midwife and a neonatal SHO are with you; the consultant is in the building and can be at the bedside in three minutes. The assessor runs the clock and feeds you laboratory results and the woman's responses. ^[1]

Candidate instruction. Lead the management of a GBS-positive woman in labour with a penicillin allergy. Verbalise your clinical reasoning, your antibiotic choice with dose, your communication with the neonatal team, and your response to the change in laboratory susceptibility. ^[1]^[2]

References6Show

[1]American College of Obstetricians and Gynecologists' Committee on Obstetric Practice Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG Committee Opinion, Number 797 Obstet Gynecol, 2020.PMID 31977795
[2]Deegan B, Gourlay A, Eriksson L, et al. Benzylpenicillin Concentrations in Intrapartum Group B Streptococcus Prevention Guidelines; A Systematic Review of the Evidence Aust N Z J Obstet Gynaecol, 2026.PMID 42381244
[3]Ohlsson A, Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database Syst Rev, 2014.PMID 24915629
[4]Saunders M, Ojha S, Szatkowski L Impact of NICE clinical guidelines for prevention and treatment of neonatal infections on antibiotic use in very preterm infants in England and Wales: an interrupted time series analysis. Arch Dis Child Fetal Neonatal Ed, 2024.PMID 38802167
[5]Seale AC, Bianchi-Jassir F, Russell NJ, et al. Estimates of the Burden of Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children Clin Infect Dis, 2017.PMID 29117332
[6]Horváth-Puhó E, van Kassel MN, Gonçalves BP, et al. Mortality, neurodevelopmental impairments, and economic outcomes after invasive group B streptococcal disease in early infancy in Denmark and the Netherlands: a matched cohort study Lancet Child Adolesc Health, 2021.PMID 33894156

Group B streptococcus in labour — emergency management station

Station brief

References6Show

[1]American College of Obstetricians and Gynecologists' Committee on Obstetric Practice Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG Committee Opinion, Number 797 Obstet Gynecol, 2020.PMID 31977795
[2]Deegan B, Gourlay A, Eriksson L, et al. Benzylpenicillin Concentrations in Intrapartum Group B Streptococcus Prevention Guidelines; A Systematic Review of the Evidence Aust N Z J Obstet Gynaecol, 2026.PMID 42381244
[3]Ohlsson A, Shah VS Intrapartum antibiotics for known maternal Group B streptococcal colonization Cochrane Database Syst Rev, 2014.PMID 24915629
[4]Saunders M, Ojha S, Szatkowski L Impact of NICE clinical guidelines for prevention and treatment of neonatal infections on antibiotic use in very preterm infants in England and Wales: an interrupted time series analysis. Arch Dis Child Fetal Neonatal Ed, 2024.PMID 38802167
[5]Seale AC, Bianchi-Jassir F, Russell NJ, et al. Estimates of the Burden of Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children Clin Infect Dis, 2017.PMID 29117332
[6]Horváth-Puhó E, van Kassel MN, Gonçalves BP, et al. Mortality, neurodevelopmental impairments, and economic outcomes after invasive group B streptococcal disease in early infancy in Denmark and the Netherlands: a matched cohort study Lancet Child Adolesc Health, 2021.PMID 33894156