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Pregnant mother

Lecture de 5 m

2 novembre 2026

LA SANTÉ COMMUNAUTAIRE ET MONDIALE

Article

Group B Strep: A Mother’s Story of Diagnostic Uncertainty

A journey through childbirth, diagnostic uncertainty, and the critical importance of timing.

 

Understanding the Risk

Group B Streptococcus (GBS) is a well-recognized cause of infection in newborns, but its impact extends beyond neonatal disease to include infections in pregnant and postpartum women.1

Norway currently follows a risk-based approach under which routine GBS screening was not recommended for all pregnant women. Testing was considered in the presence of defined clinical risk factors.² For women who did not meet those criteria, GBS colonization status could therefore remain unknown.

 

My Experience: When Status Is Unknown

Given my background in molecular diagnostics, including PCR-based testing for GBS, I was aware of the importance of assessing infection risk before and during labor.

During pregnancy, I therefore asked whether my GBS status could be tested. However, as I did not meet the criteria under Norwegian guidelines,2 testing was not performed, and my colonization status remained unknown at the onset of labor.

At full term, I experienced rupture of membranes without the onset of contractions. Expectant management was initiated, as there were no initial signs of infection. However, it is well established that the risk of ascending infection increases with time after rupture of membranes, particularly when it exceeds 24 hours.3 No microbiological testing was performed at that stage, so my GBS status remained unknown.

As labor did not start spontaneously, induction was initiated. During this period, I developed a fever—an early clinical sign that may indicate intrauterine infection.4 However, no diagnostic testing was performed to identify a causative organism, and clinical decisions continued to rely on symptoms rather than microbiological confirmation.

My condition worsened, and fetal distress was identified, leading to an emergency caesarean section. The final diagnosis was chorioamnionitis, a uterine infection commonly associated with ascending bacteria after prolonged rupture of membranes.5 My newborn also presented with signs of infection and required immediate treatment. Thankfully, my baby recovered well.

New born baby in hospital

Photo: Courtesy of Jimita Toraskar

Following my baby’s recovery, I was discharged without a clear understanding of my status and the source of infection. No microbiological testing had been performed to confirm whether the infection had resolved or to identify its cause. A day after returning home, I developed a high fever again and was readmitted. A vaginal swab was collected, and I was started on different broad-spectrum antibiotics immediately. Due to delays in culture-based testing over the weekend, the results became available only after I had already been discharged. The result confirmed the presence of GBS.

Clinically, my infection was considered likely polymicrobial, and GBS was not definitively identified as the sole cause. For me, however, the result raised a broader question about when diagnostic information becomes available during care.

 

Clinical Perspective: The Importance of Timing

This experience highlights a potential gap between risk onset and diagnostic insight.

Without microbiological information available at the time of rupture of membranes, healthcare professionals had to rely on clinical signs to assess and manage risk as the situation evolved. Treatment was initiated when those signs indicated a possible infection. 

The key issue is not whether treatment was provided, but whether earlier diagnostic information could have supported risk assessment before complications developed.

 

Key Moments in the Patient Journey

Step

 

Clinical Situation

 

Potential Limitation

Colonization status

 

Unknown at onset of labor

 

No early risk stratification

Diagnostics

 

Performed after clinical deterioration

 

Results not available during labor

Treatment

 

Initiated after symptoms

 

Treatment initiated after clinical symptoms emerged

 

When colonization status is unknown and diagnostic testing is delayed, opportunities for earlier risk assessment may be limited.6

Today, rapid molecular diagnostics, including PCR-based testing, enable identification of GBS within a rapid timeframe that may support clinical decision-making, supporting assessment of GBS colonization status and identification of candidates for antibiotic prophylaxis.7, 8

While infections such as chorioamnionitis are often multifactorial and cannot always be prevented, timely access to microbiological information can provide additional information to support clinical decision-making.

 

Author's Reflection

As a parent reflecting on the experience, I recognize the care team followed the protocols in place. Yet I still wonder: if we had known my GBS status sooner, might our journey have been different? Jimita Toraskar

Jimita Toraskar is an authorized pharmacist with a Ph.D. in Medicine and experience in molecular diagnostics, evidence-based medicine and digital health. As Cepheid's Clinical Solutions Manager for the Nordics, she partners with clinicians and laboratory professionals to translate scientific evidence into clinical practice and improve patient care.

Avis de non-responsabilité : Le contenu présenté sur cette page est destiné à des fins informatives et éducatives. Bien qu’il soit disponible à l’échelle mondiale, il peut refléter des pratiques cliniques ou des enjeux en matière de système de santé propres à une région particulière.

 

Références :

1.    Di Renzo GC, Melin P, Berardi A, et al. Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference. J Matern Fetal Neonatal Med. 2015 May;28(7):766-82.

2.    Fødselshjelp (NGF). (2023). Gruppe B streptokokker hos gravide og fødende (GBS). Metodebok. Consulté en octobre 2026

3.    Seaward PG, Hannah ME, Myhr TL, et al. International multicenter term prelabor rupture of membranes study: evaluation of predictors of clinical chorioamnionitis and postpartum fever. Am J Obstet Gynecol. 1997 Nov;177(5):1024-9.

4.    American College of Obstetricians and Gynecologists. Intrapartum management of intraamniotic infection. Obstet Gynecol. 2017 Aug;130(2):e95-e101.

5.    Jung E, Romero R, Suksai M, et al. Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment. Am J Obstet Gynecol. 2024 Mar;230(3S):S807-S840.

6.    Verani JR, McGee L, Schrag SJ. Prevention of perinatal group B streptococcal disease—revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010 Nov 19;59(RR-10):1-36.

7.    Alfa MJ, Sepehri S, De Gagne P, et al. Real-time PCR assay provides reliable assessment of intrapartum carriage of group B Streptococcus. J Clin Microbiol. 2010 Sep;48(9):3095-9.

8.    Nusman CM, Snoek L, van Leeuwen LM, et al. Group B Streptococcus early-onset disease: new preventive and diagnostic tools to decrease the burden of antibiotic use. Antibiotics (Basel). 2023 Mar 1;12(3):489.

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