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GBS, Nuchal cord and eye infections. Oh my!

Shieva Ghofrany: [00:00:00] Okay, it's Friday and I decided I'm gonna talk about three things that are unrelated, but they come up a. During delivery. This is my delivery week. So later I'll talk about BRE babies and Sunny side up babies. But today we're gonna talk about three other things. One is nucle cord, NUCHAL. That means a cord around the neck. 

Second thing we're gonna talk about is the beta strep bacteria. And the third thing we're gonna talk about is. The erythromycin eye ointment. Okay. In no specific order. These are common things that happen. That's why I wanna discuss them. Cord around the neck, it sounds so scary. Well, a, we know how I feel about scary. 

It's not scary unless it needs to be like being chased by an animal in the wild. So cord around the neck is in fact, Patently not scary because of this, it's incredibly common. Estimates are anywhere from 25 to 40%. If you look at the literature with how common it is, meaning the baby's in the birth canal, the baby's in your uterus, the baby has a cord around its neck. 

Do you know when that [00:01:00] usually occurred? Like early on in fetal life, meaning when the baby is big enough, the baby did not wrap the cord around its neck. The baby early on got the cord wrapped around its neck, and then the baby was too big for the cord to unwrap. In your mind, you think the baby is being strangled, but the likelihood of that is actually incredibly small. 

When you think about the numbers, 25 to 40% of all babies, babies born for the vast majority of time alive, whether they're born vaginally or born by C-section, they have the cord around the neck often, and it's actually one of the things we're very trained to deal with. The baby's head comes out, the first thing we do is the head comes out. 

We quickly in depth. Put our hand around the neck to see is there a cord on the neck? If so, we try to reduce it. We say, meaning pull it off around the neck. If we can't because it's too tight, we clamp, we cut. It means dad can't cut the cord, no big deal. And that's it. Okay, so it's incredibly, incredibly common. 

Sometimes we know that it's occurring because during labor, we'll see the baby's heart rate drop into what we call variable deceleration. The heart rate drops precipitously, but it comes [00:02:00] right back up, and that's usually a sign that as the contraction is happening, the cord is decreasing the blood. It's quick. 

It is usually not dangerous. Now, occasionally it will drop and not come back up, or it'll repeatedly drop without a return to the baseline that we feel comfortable with, or the baby will show us other signs that he or she is not compensating well from repetitive loss of oxygen. So we intervene with a C-section. 

No big deal. Okay, so cord around the neck, 25 to 40% of the time, very common. Please don't freak out. And here's what's most important. Ah, please don't ask your doctor or your ultrasound tech or your nurse practitioner, or your midwife or anyone to look with an ultrasound and see if the cord is around the neck, because guess what that'll do. 

It'll freak out for no reason and then it'll back your doctor against the corner and make your doctor be like, well, I mean, uh, uh uh, like we wouldn't know what to do with it. Like, yes, our choice is either continue the pregnancy knowing you're freaked out even though we know the statistics or allow you to.[00:03:00]  

Induced completely unnecessarily because the cord is around the neck. And if you're below 39 weeks, you shouldn't be induced because the lungs might not be ready. And that has far more dire consequences or have a C-section merely because the cord is around the neck. And as we know, I'm the first one to say, if you need a C-section, you need a C-section. 

But you shouldn't have it just because the cord's around the neck for it to freak you out for no reason. Okay. Is it sometimes the cause of. Very untoward pregnancy outcomes, like God forbid a demise. It can be, but the truth is that it's just such a common thing that even when there is a fetal demise and we see the cord around the neck, we're actually not sure that's the reason because 25 to 45, 40% of the time it is there. 

Okay? So that is NUCO cord or cord around the neck, very common. Please do not freak. It happens all the time. I mean, the last three deliveries I did in the last three days, two out of the three, so I got a, what is that, a 66 point something percent. NUCO cord rate and those [00:04:00] babies were perfectly fine. In fact, the two that had it were the ones that came out of their mom's vagina. 

Okay? Second thing is beta strep, otherwise know that known as G B S Group B Strep. Group B strep is an incredibly common bacteria, probably 20 ish percent of all of us, male or female, Carrie Beta Strep in. Body. We carry it actually in our GI tract, and because in women our rectum is so close to our vagina, the B, the bacteria can climb up in there so we can get it in our vagina. 

It is not dangerous for us as adults. It's not even really an infection. It's just something that we carry. Many of us are colonized with G B S, and then if the baby gets exposed to it coming outta the birth canal, it might. Cause an infection for the baby, the infection it causes can be very serious. 

Neonatal gbs, septicemia, meaning fluoride infection in the baby's blood supply, basically can be very dangerous. They become [00:05:00] septic, they can become sick, but it's not common for a couple reasons. First of all, even babies who are exposed to GBS in the birth canal luckily don't often get floridly sick, even if they're exposed. 

There are some that do get very sick, and because we've recognized that as a medical community, this is one of the times we can really change outcomes. So in the old days, we used to just treat BA patients based on risk factors. Like if it looked like they had an infection or if they had had a previous baby who had beta strep infection, we would've said, oh, you were colonized. 

Let's treat you. Now we're a little bit more sophisticated. So actually it's pretty much nationwide and probably somewhat global in places where they can handle. They, we will do a vaginal peroneal culture, meaning, so the Q-tip will go just inside the vagina. It'll sweep down the perineum and it'll go just around the anus because those are the areas where you can harbor it. 

And we will send that to the lab at 36 weeks to check for GBS in. every single pregnant patient. So that's one way we know. Second is that we send your urine, the beginning of your [00:06:00] pregnancy to make sure you're not carrying beta strep, cuz you can carry it in your urine as well. And then third is occasionally it'll just show up, meaning you have an infection in your vagina, you think it's yeast, your bacteria, and it just turns out to be beta. 

But most common is we find it at 36 weeks from a routine vaginal culture. And then once we know you're positive, if you're delivering vaginally, the idea is the baby shouldn't get exposed to it for too long. So the guideline is that you get prophylaxis. We call it prevention with antibiotics like penicillin for beta strep. 

When you're in active labor, if you are allergic to penicillin, you can either use Clindamycin or something called vancomycin. But then the beta strep has to be cultured for that because sometimes it is not sensitive to those things. So the doctor would know to write this culture, penicillin, allergic, and then they look for the other bacteria sensitivity, the other antibiotic, sensit. 

What happens if you go so fast? It's your second baby. The baby comes flying out, you get to the hospital, no chance for antibiotics. Guess [00:07:00] what? It's usually fine cuz if you go that fast, that means the baby has not spent that much time in the presence. Of the beta strep. So that's kind of a win. Um, okay. 

That's pretty much all I have to say about beta strep. If you have it, don't freak out. It's very common, but get your prophylaxis. Third erythromycin eye ointment. Why do we put that goopy ointment in your baby's eyes right after the delivery? Many of you probably don't even know why. , um, on a lot of birth plans, people are resisting it. 

And the truth is, if someone doesn't want the goop eye ointment, our hospital just says, okay, sign this. Don't do it. But the reason why is actually because of chlamydia, chlamydia and gonorrhea can very much be a source of blindness in infants. Well, you might be saying, I don't have chlamydia. I mean, where would I get chlamydia? 

I'm monogamous. I'm only with one man or one woman. How could I get it? And the answer is, We believe you. But imagine the conundrum now, right? If we said to everyone, so, um, are you having sex with other people besides your husband, or do you think your husband's having sex with anyone else? The answer is often gonna [00:08:00] be no, legitimately because you're not. 

But what if the answer is no because you don't know? What if the answer is no, because you don't wanna tell us. And then we're in this conundrum of you could have been exposed to chlamydia. But we're losing the opportunity to prevent blindness because just that simple eye ointment can prevent it. All. 

Right, well, how about instead of that, we just check every single person for, for gonorrhea and chlamydia, like right before they deliver. Well, that's been proposed. There are some rapid tests that are available on labor and deliveries, but the truth is, from a public health perspective, it actually poses more of a conundrum. 

did you get there on time? Is there someone to run the test? How expensive is the test? Sometimes it's cheaper to have those teen little tubes of antibiotic eye ointment and put that in every single. Excuse me, baby's eyes at the delivery and help prevent it. So again, these are the reasons behind these things that I want you guys to know about, because they're not just like the medical community trying to foist antibiotics on you or pretend like they don't care about the quarter on the baby's neck. 

There are [00:09:00] actually good reasons for all these things, and I think it's perfectly appropriate, appropriate for you guys to ask these questions of your provider. Assuming that you do not assume that your provider is trying to harm you, because that is what it sometimes seems like. Not in my patient population, by the way. 

I think that people ask and we talk about it a lot, um, but out on the internet interwebs, I hear that kind of rhetoric a bit. Um, so those three things, quarter on the neck, very common. Um, J B G B S very common. Gonorrhea and chlamydia not so common from what we know, but those are the reasons we use those. 

algorithms and treatments. Okay. Okay. I hope that helped. Bye.