In addition to these evidence-based recommendations, the guideline development group also identifies points of best clinical practice in the original guideline document.
Classification of evidence levels (1++ to 4) and grades of recommendations (A–D) are defined at the end of the "Major Recommendations" field.
Should All Pregnant Women Be Offered Bacteriological Screening for Group B Streptococcal Disease (GBS)?
D - Routine bacteriological screening of all pregnant women for antenatal GBS carriage is not recommended.
If GBS Is Detected Incidentally Earlier in the Pregnancy, Should Women Be Treated Before the Onset of Labour?
C - Antenatal treatment with benzylpenicillin is not recommended.
Should Women Be Screened for GBS or Receive Intrapartum Antibiotic Prophylaxis (IAP) If GBS Was Detected in a Previous Pregnancy?
D - Current evidence does not support screening for GBS or the administration of IAP to women in whom GBS carriage was detected in a previous pregnancy.
Reducing the Risk of Neonatal GBS Disease in Women Known to Be Colonised with GBS
How Should GBS Bacteriuria in the Current Pregnancy Be Managed?
C - Clinicians should offer IAP to women with GBS bacteriuria identified during the current pregnancy.
Should Women Receive IAP If GBS Is Detected in the Current Pregnancy?
C - IAP should be offered if GBS is detected on a vaginal swab in the current pregnancy.
How Should Women with Known GBS Colonisation Undergoing Planned Caesarean Section Be Managed?
C - Antibiotic prophylaxis specific for GBS is not required for women undergoing planned caesarean section in the absence of labour and with intact membranes.
How Should Women Known to Be Colonised with GBS Who Experience Spontaneous Rupture of Membranes at Term Be Managed?
D - Immediate induction of labour and IAP should be offered to all women with prelabour rupture of membranes at 37+0 weeks of gestation or more.
How Should Women with GBS Colonisation and Suspected Chorioamnionitis Be Managed?
A - If chorioamnionitis is suspected, broad-spectrum antibiotic therapy including an agent active against GBS should replace GBS-specific IAP and induction of labour should be considered.
Management of Labour (Including Rupture of Membranes) to Reduce the Risk of Neonatal GBS Disease in Women without Known GBS Colonisation
Should Women Presenting in Preterm Labour with Intact Membranes Be Offered IAP?
C - Women presenting in established preterm labour with intact membranes with no other risk factors for GBS should not routinely be offered IAP unless they are known to be colonised with GBS.
How Should Women with Clinical Risk Factors Such as a Pyrexia (>38°C) in Labour Be Managed?
C - IAP should be offered to women who are pyrexial in labour (>38°C).
How Should Women with Term Prelabour Rupture of Membranes Be Managed?
C - The evidence for IAP for women with term prelabour rupture of membranes is unclear and National Institute for Health and Clinical Excellence (NICE) recommends that it is not given, unless there are other risk factors.
How Should Women with Preterm Prelabour Rupture of Membranes Be Managed to Reduce the Risk of Neonatal GBS Disease?
C - Antibiotic prophylaxis for GBS is unnecessary for women with preterm rupture of membranes.
Should Women with a Previous Baby with Neonatal GBS Disease Be Offered IAP?
D - IAP should be offered to women with a previous baby with neonatal GBS disease.
Which Antibiotics Should Be Given to Prevent Early-onset Neonatal GBS Disease?
B - For women who have accepted IAP, benzylpenicillin should be administered as soon as possible after the onset of labour and given regularly until delivery.
D - Clindamycin should be administered to those women allergic to benzylpenicillin.
Should Vaginal Cleansing Be Performed in Labour?
C - There is no evidence that intrapartum vaginal cleansing will reduce the risk of neonatal GBS disease.
How Should the Newborn Infant Be Managed?
Should Postnatal Antibiotic Prophylaxis Be Given to Low-Risk Term Infants?
C - Postnatal antibiotic prophylaxis is not recommended for asymptomatic term infants without known antenatal risk factors.
How Should the Well Infant with One or More Risk Factors Be Treated?
C - Randomised controlled trials have not provided a sufficient evidence base for clear treatment recommendations in well newborn infants.
How Should the Neonate with Clinical Signs of Early-onset Neonatal Group B Streptococcal (EOGBS) Disease Be Managed?
C - Infants with clinical signs of EOGBS should be treated promptly with appropriate antibiotics.
How Should the Infant of a Mother with a Previous Infant with GBS Disease Be Managed?
C - For a well infant whose mother has had a previous infant with GBS disease, either clinical evaluation after birth and observation for around 24 hours are necessary, or blood cultures need to be obtained and the infant treated with benzylpenicillin until the culture results are available. It is unclear whether further action is necessary for the well infant.
Classification of Evidence Levels
1++ High-quality meta-analyses, systematic reviews of randomised controlled trials or randomised controlled trials with a very low risk of bias
1+ Well-conducted meta-analyses, systematic reviews of randomised controlled trials or randomised controlled trials with a low risk of bias
1– Meta-analyses, systematic reviews of randomised controlled trials or randomised controlled trials with a high risk of bias
2++ High-quality systematic reviews of case-control or cohort studies or high-quality case-control or cohort studies with a very low risk of confounding, bias or chance and a high probability that the relationship is causal
2+ Well-conducted case-control or cohort studies with a low risk of confounding, bias or chance and a moderate probability that the relationship is causal
2- Case-control or cohort studies with a high risk of confounding, bias or chance and a significant risk that the relationship is not causal
3 Non-analytical studies, e.g., case reports, case series
4 Expert opinion
Grades of Recommendations
A – At least one meta-analysis, systematic review or randomised controlled trial rated as 1++ and directly applicable to the target population; or
A systematic review of randomised controlled trials or a body of evidence consisting principally of studies rated as 1+ directly applicable to the target population and demonstrating overall consistency of results
B – A body of evidence including studies rated as 2++ directly applicable to the target population, and demonstrating overall consistency of results; or
Extrapolated evidence from studies rated as 1++ or 1+
C – A body of evidence including studies rated as 2+ directly applicable to the target population and demonstrating overall consistency of results; or
Extrapolated evidence from studies rated as 2++
D – Evidence level 3 or 4; or
Extrapolated evidence from studies rated as 2+
Good practice point – Recommended best practice based on the clinical experience of the guideline development group