A mum-of-two had no idea she was carrying a deadly infection which could have been passed to her baby during birth until just moments before she went into labour.
Amy Winters went into hospital to give birth to her second child in May of 2023 after her waters broke early at 34 weeks. Amy was she going to have her baby weeks earlier than planned, but that turned out to be a potentially life-saving coincidence.
Amy happened to be in the Saint Mary’s maternity unit at North Manchester General Hospital which is trialling a rapid bedside test to protect newborns from group B streptococcus (GBS) – a type of bacteria that can be passed onto babies during birth. GBS is the most common cause of life-threatening infection in newborn babies in the UK.
READ MORE: ‘I wasn’t told anything about life-threatening illness until my newborn nearly died from it’
Approximately one in four pregnant women in the UK carry GBS, often without realising it, and there is a 50 per cent chance that the baby will be exposed to GBS during birth. While most of these babies will not get sick and be healthy, around one in 1,750 newborns develop early onset GBS infection, such as sepsis (blood infection), pneumonia (infection in the lungs) or meningitis (infection of the fluid and lining around the brain), with possibly devastating outcomes.
The current UK strategy for testing for GBS is ‘risk factor-based screening’ which offers antibiotics during labour to women who have had GBS detected during pregnancy or have had a previous baby who has been unwell with GBS. This approach means that many women who carry GBS without it being previously detected are not identified.
Sixty-five per cent of UK newborn babies who develop early onset GBS infection have mothers who had no risk factor. But now, there is a trial ongoing to establish the best way of identifying and treating the condition
More than 1,100 pregnant women who have been at the Saint Mary’s maternity unit of North Manchester General Hospital, part of Manchester University NHS Foundation Trust (MFT), have now taken part in a rapid beside test for GBS.
Amy Winters, from Middleton, was among the patients who took part in the bedside test at the North Manchester maternity unit earlier this year. Amy had no risk factors but tested positive for GBS moments before being induced, which kickstarts labour, to give birth to her second child, Lilah.
As she was being given the drugs to start her induction, Amy was also given antibiotics immediately in light of the positive test. Amy said: “Taking part in this research was an easy decision for me, knowing that taking this test could help to prevent my baby becoming poorly.
“My brother and I were both premature babies and my mum was given antibiotics during labour due to the likelihood of us being exposed to GBS. When I gave birth to my son Leo, three years ago, I knew about the risks of passing GBS but there was no test available then.”
For Amy, getting involved with the trial was a no-brainer. “As soon as it was mentioned this time I said yes. I was waiting to go down to the labour ward,” she told the Manchester Evening News.
“It was really simple and easy, just a quick swab. I was honestly relieved I got the chance to have the test and then minimise any risk.
“I could have the antibiotics intravenously while I was being induced. I felt at ease that everything that could be done was being done.
“If I hadn’t been offered that test, my baby might have been poorly and we might not have had any warning. I think it should be offered to everybody for the sake of having a series of antibiotics, you can prevent so much harm to someone so young.
“Lilah is now six months old; she was absolutely fine after she was born, which is such a relief, she didn’t become ill, and she is doing brilliantly.”
The ‘GBS3’ study, funded by the National Institute for Health and Care Research (NIHR) and sponsored by the University of Nottingham, aims to learn if testing all pregnant women to see if they carry GBS reduces the risk of infection in newborn babies. The study is investigating two different tests, which will be compared against the current standard practice: a test at an antenatal appointment at approximately 36 weeks of pregnancy, or a rapid bedside test where a swab is taken at the start of labour, which is being carried out at NMGH.
Sachchidananda Maiti, a consultant obstetrician who is leading the study in North Manchester maternity unit, said: “This is the first trial of its kind in the world and the results will help to determine whether routine testing should be introduced in the UK.
“Identifying women with GBS with greater accuracy and treating them with antibiotics at the optimum time, could prevent approximately 40 newborn deaths and 25 cases of disability in the UK each year.”
As part of the study at North Manchester maternity unit, a swab is taken from the mother at the start of labour to test for GBS and the results are received within 40 minutes. If the mother is positive, antibiotics are offered to protect the newborn from potential illness.
16 per cent of the 1,123 women who had a swab taken at North Manchester maternity unit had GBS that had not previously been detected during pregnancy.
Ruth Morrello is a Manchester-based research midwife involved in the study. She told the M.E.N.: “GBS is very common and the vast majority of babies are absolutely fine – they don’t go on to develop any symptoms at all.
“Babies that do become poorly will likely need to spend time on the neonatal intensive care unit, and that has a big impact on early life like breastfeeding, bonding time – it’s never ideal for mothers and babies to be separated in this period. So if you can reduce the chance of that happening, that’s a great thing.”
Part of the trial has been working out, in practice, whether expectant mums will actually say yes to the test, when is the best time for midwives to swab women as they prepare to give birth, and where the testing infrastructure in the hospital should be. Ruth is thanking the midwives and medical staff who have, often after years of experience, had to adapt the way they work to fit in a new form of testing into their daily routine.
Ruth describes the process, saying: “Swabs are taken from the woman and put into a kind of cartridge. We have a new and exciting machine processing results within an hour – usually even within 45 minutes.
“Previously, they’d be sent to a lab and take a few days. We have those instant results and if the test comes back positive, we can put a canula in the patients and start antibiotics, they absorb much better if we give those antibiotics intravenously.
“We’d ideally give a mother two doses of antibiotics before birth which gives the baby good protection. Where there’s a rapid birth, we might observe the mother and baby more closely and monitor with the knowledge that there’s been this positive test – we know what we’re looking out for.”
At the moment, this kind of testing before birth has been given approval for the trial period, it would have to be approved again following any results before it could be used in regular prenatal care. The research midwife says she is looking forward to the results of the trial, which will more definitively determine what the best kind of care for GBS is – whether that’s routine testing of all pregnant mothers or continuing with testing those who are classed as being more at risk.
The GBS3 study is running in all three maternity units across the Saint Mary’s Managed Clinical Service (MCS), which include maternity units at Saint Mary’s Hospital on Oxford Road and in Wythenshawe Hospital. The Oxford Road and Wythenshawe maternity units were randomly assigned to follow usual care, involving risk factor-based testing, with North Manchester maternity unit randomly assigned to the rapid bedside test.
The study will be running until March 2024 and involves 71 hospitals in England, Wales and Scotland, 17 of which are rapid testing sites. The results are expected to be published within the year.
Sarah Carter is a health and wellness expert residing in the UK. With a background in healthcare, she offers evidence-based advice on fitness, nutrition, and mental well-being, promoting healthier living for readers.
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