Title

The adherence to group b streptococcus screening guidelines amongst pregnant women in Western Australia – A quantitative descriptive analysis

Author Identifiers

Sabine Pangerl

https://orcid.org/0000-0002-1159-7661

Date of Award

2021

Degree Type

Thesis

Degree Name

Master of Midwifery (Research)

School

School of Nursing and Midwifery

First Advisor

Deborah Sundin

Second Advisor

Sadie Geraghty

Abstract

Colonisation with Group B Streptococci (GBS) is a major risk factor for neonatal infection acquired via vertical transmission during pregnancy, labour, or birth, potentially resulting in significant morbidity and mortality. Universal screening at 35 – 37 weeks gestation for maternal GBS colonisation and the use of intrapartum antibiotic prophylaxis has resulted in substantial reductions in the burden of neonatal Early-Onset GBS Disease (EOGBSD). Women in Western Australia (WA) are offered GBS screening in pregnancy and intrapartum antibiotic prophylaxis. Anecdotal evidence suggests variations in viewpoints and thus low adherence to relevant clinical guidelines amongst midwives and pregnant women in the midwifery led model of care. To date, no research has been undertaken to provide empirical evidence for these anecdotal reports, suggesting the need for research.

This study has aimed to investigate the adherence to recommended GBS screening guidelines across five maternity hospitals in metropolitan and regional WA. Three objectives guided this research conducted within two different cohorts (midwifery and non-midwifery led) plus subgroups including Midwifery Group Practice (MGP), Community Midwifery Program (CMP) and Private Midwives (PM): 1) determination of GBS colonisation rates; 2) the examination of adherence to antenatal GBS screening; and 3) examination of adherence to the intrapartum antibiotic prophylaxis protocol.

This retrospective WA study has employed a quantitative research design using administrative health data that included 22,417 pregnant women who gave birth between 2015 – 2019. Descriptive statistics were applied using secondary data analysis to describe the characteristics and patterns of GBS screening guideline adherence. The results were compared between all involved study cohorts.

The study revealed similar GBS colonisation rates amongst pregnant women in all included study groups. A lower adherence to the GBS screening guidelines was found in the midwifery led model of care when compared to the non-midwifery led model of care. Over the five-year period, screening rates trended down in the midwifery led population whilst the numbers remained stable in the non-midwifery led cohort. When the MGP groups were compared across the five hospitals, vast variations were discovered. Further, when rates of adherence were investigated in relation to intrapartum antibiotic prophylaxis, discrepant findings emerged between the study groups.

This study not only fills an important gap in the existing literature, it also seeks to assist guidance and improvement of clinical protocols in relation to GBS screening to reduce the risk of neonatal infection. Recommendations include educational interventions and the need for further research.

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