Group B Strep: A Patient/Provider Approach for Optimizing Care

OBGYN.net spoke with Marti Perhach about her endeavors to increase awareness of Group B Strep and its effects on pregnant women and their babies. Marti is a woman who has faced the effects of GBS first hand and has shared her personal story with other parents.  Mrs. Perhach believes that despite the statistics, when it happens to you, it's 100% all the time.

OBGYN.net: "Tell us a little about your background and how you got involved in this undertaking."

Marti Perhach: "My name is Marti Perhach. I lost my daughter, Julia Rose, at full-term to Group B Strep (GBS), pneumonia and chorioamnionitis on July 1, 1998. What I didn't know then was that her death could have been prevented had my doctor and I been more aware of the seriousness of GBS. I have since set out on a path to educate myself on GBS and share that knowledge with others.

I was cultured for GBS in early June of 1998. The doctors told me that I was positive and that I would get the IV antibiotics during labor, which was correct. What I did not know was that I needed to be in the hospital four hours before delivery for the IV antibiotics to work effectively, as well as the fact that fever during labor can be indicative of GBS. I specifically asked my doctors what GBS was and I was told it was an intestinal bacteria. According to the Center for Disease Control, GBS is the leading infections killer of newborns.  I feel that, as a mother, I should have had this information so I could protect my child.  I have heard from doctors that they don't want to alarm their patients with all the things that could or could not happen during pregnancy, but my belief is that knowledge is necessary for parents to fully exercise their responsibilities and do everything in their power to protect their children."

On three separate occasions during my pregnancy I saw my doctor for a complaint of external vaginal burning.  I later discovered this to be a symptom of GBS as well as the fever during labor. 

OBGYN.net: "Is GBS usually fatal, and if not, what are some of the results of GBS?"

Marti Perhach: "It can be fatal. I think what a lot of people fail to realize is that GBS is not only the leading infectious killer of newborns, but it also is a cause of miscarriage and stillbirth, as well as premature ruptures of membranes and preterm labors. I think Dr. Benirschke's book, The Pathology of the Human Placenta, clearly states that GBS can permeate or penetrate intact placentas and cause stillbirths. So even before the mother’s bag of water is broken, the bacteria can cross over to the baby."

OBGYN.net: "When did this information become available?" 

Marti Perhach: "This information has been available since 1959.  I believe I was heavily colonized with GBS because of the symptoms I was experiencing.  The symptoms continued through my postpartum period, abated, then returned.  At the time of my last prenatal visit I believe my daughter was still healthy even though I was heavily colonized and that the digital exam to check for dilatation may have caused the infection to invade the placenta and infect my daughter. Fourteen hours after that exam I was at the hospital twenty minutes after that there was no fetal heartbeat." 

OBGYN.net: "GBS is a rapid moving infection then."

Marti Perhach: "Yes, it is a very fast moving bacteria.  Doctors and their patients need to know this so the necessary precautions can be implemented. Dr. Sharon Hillier from the University of Pittsburgh School of Medicine has reported that GBS can definitely invade the placental membrane.  Dr. James McGregor of the Denver Health Medical Center has noted that uterine contractions as well as digital cervical exams can move micro-organisms such as GBS up into the uterus. It is my opinion that many stillbirths and miscarriages caused by GBS may be prevented by performing an ultrasound examination especially after the bag of waters has broken."

OBGYN.net: "It sounds like GBS is sometimes misdiagnosed as a yeast infection. Was that the case with you?"

Marti Perhach: "Yes. I didn’t have all of the symptoms of a yeast infection, but the doctor said he thought it looked like a yeast infection from what he saw in his manual exam. But he didn’t actually culture me, and then he kept prescribing or re-prescribing the same medicine for a yeast infection which, obviously, did not make it go away. It is my hope that doctors take any bacterial vaginosis or symptoms seriously and culture. Several of my friends on the GBS support list on the Internet have had different types of discharge. Several of them have had the exact same scenario as myself, except that their children were born sick and lived. They were also treated for yeast infections, which was not what they ended up having, as their children contracted GBS."

OBGYN.net:  "You said you tested positive for GBS later, as well, correct?"

Marti Perhach: "Yes, that's correct, I was again experiencing the external vaginal burning about seven or eight months postpartum, and again, treatments for yeast infection failed. By this point I had pain in my ovaries in addition to the vaginal burning.  A culture was done and I was found to be heavily colonized with GBS. I was treated with oral antibiotics at that time. I explained to my healthcare provider the situation of losing my daughter to GBS. We had an autopsy performed on Julia Rose, which at first the doctors tried to discourage us from doing, but I needed to know why my baby had died. I needed that closure. The autopsy results showed that Rose had pneumonia and chorioamnionitis due to GBS.  I would suggest to parents who experience stillbirth or miscarriage to have pathology sampling and testing done on the placenta.  Autopsy is a difficult and heartbreaking choice to make and valuable information can be gleaned from the placenta that could help avoid another tragic ending to a future pregnancy.

OBGYN.net: "In your opinion, why do you think so little is known about GBS?"

Marti Perhach: "I don’t really know why it is not more publicized. Along with several other mothers, I am working to publicize GBS and tell women what mothers can do to protect themselves and their children. I hope the doctors will educate their patients as to what GBS is. I would also like the medical community to make use of several resources for GBS patient-friendly literature. The Jesse Cause, the GBS Association, and the Center for Disease Control all have informational pamphlets that doctors can place in their offices so women can learn about GBS and know how to protect themselves.

There are many symptoms of GBS in newborn children that can arise once babies are brought home from the hospital. Mothers and fathers should be aware of them so that if their baby displays any of these symptoms at home, they can recognize them and get to a hospital in a timely manner. There are several symptoms such as grunting or a blank trance-like expression that can be indicative of GBS meningitis, and some parents might not pick up on that and assume it's a normal behavior for a newborn. I think the doctors need to give mothers and fathers the knowledge to protect their babies, especially once they go home from the hospital. I also would hope the doctors would have a birth plan with each woman for their labor."

OBGYN.net: "In case it is a long distance to the hospital, for example?"

Marti Perhach: "Yes, because IV antibiotics actually needs four hours in order to be effective, and unfortunately, I was unaware of the importance of timing, had I known, I would have been at the hospital much sooner. I think specific instructions should be given to the mother about when to call the doctor and when to report to the hospital once labor has begun in a situation where GBS has been identified or suspected."

OBGYN.net: "You mentioned that pamphlets and literature in doctors offices is one way to spread the word. Do you think this is catching on?"

Marti Perhach: "Yes, but awareness is also being promoted in other ways. The Jesse Cause, which was started by Shelene, a woman whose son, Jesse, had contracted GBS meningitis and had two brain shunt surgeries, as a result. She is also trying to raise funding to distribute her pamphlet and get nationwide distribution to as many doctor's offices as possible so more women will be aware of this." 

OBGYN.net: "Is the Jesse Cause something you’re associated with, as well?"

Marti Perhach: "Yes, I’m working with the Jesse Cause to plan the convention at the American College of Obstetricians and Gynecologists this May in San Francisco. So I’m working with her in that regard, and I’m also working independently. We all kind of work together, and I’m helping her with that."

OBGYN.net: "Are you going to be hosting a booth at ACOG?"

Marti Perhach: "Yes, the Jesse Cause will have a booth there and we’re going to be passing out the brochures and other GBS information, and we hope to educate the doctors. We also have some GBS Awareness pins that were donated; OBGYN.net donated the material and we’re going to be pinning those on all the doctors and people who come by our booth. We’re also planning an awareness walk in Ventura on October 28^th to further inform women that testing is available and there are steps they can take to protect themselves and their babies from this devastating bacteria."

OBGYN.net: "It sounds like you’re really doing a lot to make people more aware of it."

Marti Perhach: "We’re trying to, and I’m hoping this convention will certainly alert people to it. The Jesse Cause is trying to raise funding to pursue all these educational efforts and get the pamphlets distributed to the doctors. I had to find my information on the internet, my doctor's office had no literature on GBS available. There are still a lot of people who do not have access to the internet, all women should be educated about GBS but especially those who have positive cultures."

OBGYN.net: "What has been your biggest challenge in this endeavor to raise GBS Awareness?" 

Marti Perhach: "I think the biggest challenge has been getting people to understand the seriousness of this. Many treat it as though it is no big deal, nothing to worry about, occurrences are something like only a 1 in 13,000 chance of a baby actually dying from GBS; but when it happens to you it's 100%.  Newborns have a PKU heel prick test and the likelihood of testing positive is approximately 1 in 25,000 so GBS is actually much more common, especially  when you consider that nearly one-third of the population carries the bacteria in their intestinal or reproductive tracts.

I was offered several tests during my pregnancy for Down Syndrome, Spina Bifida and other conditions and defects.  I was given the knowledge and reassurance that my baby was healthy, yet for lack of enough information I was unable to protect her from the GBS infection that caused her death.  Women are interested in knowing the risks and taking the necessary precautions to avoid them. Parents, prenatal educators, and the medical community can work together to spread the information and prevent another unnecessary death or the devastating effects that GBS can have on a baby that survives."

OBGYN.net: : "What are some of the newer techniques being devised for testing for GBS?"

Marti Perhach: "There’s something called the rapid test, but I’m really not too knowledgeable about that. One thing that many, many people have suggested is that the fetal head monitors that are attached to the head can cause little cuts. If a mother has GBS in her birth canal, it can actually be introduced into the head, and it makes a nice place for the bacteria to get in and cause sepsis in the baby."

OBGYN.net: "What about the Phem-Alert? Do you know anything about this?"

Marti Perhach: "Dr. James C. Caillouette has been working on the Phem-Alert product and he’s trying to get it approved by the FDA as an over-the-counter product. I think that would be such a valuable product for women to have. If they experience any symptoms during pregnancy, they can test themselves at home and know if it’s a yeast infection or if it’s indicative of a bacterial infection. That way, they can get to a doctor right away and get treated appropriately with antibiotics, rather than just assuming they have a yeast infection and do nothing or treat it inappropriately.  This is especially important now that yeast medications are available over-the-counter and a diagnosis is no longer needed."

OBGYN.net: "That’s much less invasive, right?"

Marti Perhach: "Right. I think they just use a little pH strip, and it isn't even inserted very far."

OBGYN.net: "You mentioned Dr. James McGregor earlier, how did you meet him?"

Marti Perhach: "I had called Dr. Sharon Hillier because she was on the GBS Advisory Board list, and she then referred me to this doctor in Denver who had done a dye test study on a pregnant colleague showing how GBS or other micro-organisms can pass up into the placenta. I called Dr. McGregor, and he was kind enough to call me back and discuss my specific situation in length, and then we just started brainstorming from there. We’ve done a couple of videos together, since then."

OBGYN.net: "GBS is a rapid moving infection then?"

Marti Perhach: "Yes, it is a very fast moving bacteria.  Doctors and their patients need to know this so the necessary precautions can be implemented. Dr. Sharon Hillier from the University of Pittsburgh School of Medicine has McGregor of the Denver Health Medical Center has noted that uterine contractions as well as digital cervical exams can move micro-organisms such as GBS up into the uterus. It is my opinion that many stillbirths and miscarriages caused by GBS may be prevented by performing an ultrasound examination (using perineal or vaginal ultrasounds as an alternative to digital examination) especially after the bag of waters has broken."

OBGYN.net: "Thank you Marti for sharing your sad journey with GBS and let's hope that by doing so we can help others."

Marti Perhach: "Thank you."

References:

Since the above interview from early 2000, Marti Perhach has co-founded Group B Strep International www.groupbstrepinternational.org along with John MacDonald whose daughter was also stillborn due to GBS