When should I consider referring a pregnant patient with a history of GBS infection in previous pregnancies to a specialist?

Consider referring a pregnant patient with a history of Group B Streptococcus (GBS) infection in previous pregnancies to a specialist if:

• They have not had a negative test for GBS by enrichment culture or PCR on a rectovaginal swab taken between 35 and 37 weeks' gestation (or 3 to 5 weeks before the anticipated delivery date) in the current pregnancy.
• They have had a previous baby with invasive GBS infection.
• There are additional risk factors such as prolonged prelabour rupture of membranes, preterm labour, or clinical signs suggestive of chorioamnionitis.

Referral is important to ensure appropriate intrapartum antibiotic prophylaxis and specialist management to reduce the risk of early-onset neonatal GBS infection.

Specialist involvement is also advised to guide antibiotic choice, especially in cases of penicillin allergy or complicated clinical scenarios.

Informing the maternity care team and the GP about the history of GBS infection is essential for coordinated care planning.

These recommendations align with NICE guidance on neonatal infection prevention and treatment.

References: NICE NG195