PFD report

Baby Olsberg · Prevention of Future Deaths report

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Issued 7 May 2015•Manchester North

Report record

Published report and response evidence

This page connects the concerns raised in this report with statements found in recipients’ published responses. A link shows a clear evidence connection; it does not assign responsibility.

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Concerns
3

Raised in this report

Recipients
4

Named on the report

Responses found
3

Of 4 recipients

Stated actions
6

Described in responses

Recipients and published responses

Source document

Full report text

This is the full text from the original published report.

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Concerns and recipient responses

Select any concern, action or position to view the source wording.

Concerns raised3

  1. Risk of serious harm or death to babies from GBS infection
  2. Failure to routinely offer prophylactic intrapartum antibiotics to women with current or previous positive GBS tests
    Part of recurring concern: Failure to provide indicated antibiotic prophylaxis
  3. Failure to routinely offer antenatal GBS screening to all pregnant women during the final weeks of pregnancy
    Part of recurring concern: Failure to reliably provide antenatal GBS screening
Responses linked to these concerns

Each statement is shown once, even when linked to more than one concern.

Actions described in response An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised.6

  1. Action

    Review evidence and consult stakeholders to assess whether the antenatal GBS guideline requires updating.

    Stated by National Institute for Health and Care ExcellenceStated completedThe respondent said that this action was complete when they made their response on 7 May 2015.
  2. Action

    Encourage research into the clinical and cost effectiveness of intrapartum antibiotic prophylaxis guided by routine antenatal GBS screening.

    Stated by National Institute for Health and Care ExcellenceStated completedThe respondent said that this action was complete when they made their response on 7 May 2015.
  3. Action

    Encourage further research into GBS screening during pregnancy.

    Stated by National Institute for Health and Care ExcellenceStated completedThe respondent said that this action was complete when they made their response on 7 May 2015.

Respondent positions A position is what a recipient says about a concern when it does not describe a specific action.5

  1. Position

    Routine GBS screening was not recommended because evidence was insufficient, and later review found insufficient new evidence to update the guideline.

    Stated by National Institute for Health and Care ExcellenceNo action considered necessaryThe respondent said that no further action was needed.

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Risk of serious harm or death to babies from GBS infection

Wider context from the report

“3. That GBS infection is a very serious illness and in the absence of a national screening and prophylactic treatment programme, babies are potentially being put at risk of harm/death. ”

Is this part of a recurring concern?

No recurring-concern membership is currently published.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Failure to routinely offer prophylactic intrapartum antibiotics to women with current or previous positive GBS tests

Wider context from the report

“2. That prophylactic intrapartum antibiotics are not routinely offered to all women who test positive for GBS (or have done so in the past). ”

Is this part of a recurring concern?

Yes — Failure to provide indicated antibiotic prophylaxis.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Failure to routinely offer antenatal GBS screening to all pregnant women during the final weeks of pregnancy

Wider context from the report

“1. That antenatal screening for GBS is not routinely offered by the NHS, to all pregnant women, during the final weeks of pregnancy. ”

Is this part of a recurring concern?

Yes — Failure to reliably provide antenatal GBS screening.

Open source report

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Review evidence and consult stakeholders to assess whether the antenatal GBS guideline requires updating.

Verbatim wording from the response

“We most recently reviewed the evidence in 2014, and after consulting with stakeholders, we decided that there was not enough new evidence to justify updating the guideline.”

Source location

2015-0177-Response-by-N.I.C.E
Page 2 · response
Published 7 May 2015

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Encourage research into the clinical and cost effectiveness of intrapartum antibiotic prophylaxis guided by routine antenatal GBS screening.

Verbatim wording from the response

“You may also be interested in our clinical guideline on Antibiotics for early-onset neonatal infection (CG149, 2012). The guideline provides a framework outlining risk factors and clinical indicators that may be used to direct antibiotic management decisions. Once again, we have encouraged further research into the clinical and cost effectiveness of intrapartum antibiotic prophylaxis targeting group B streptococcus and guided by routine antenatal screening. Further information is available on our website at: www.nice.org.uk/CG149.”

Source location

2015-0177-Response-by-N.I.C.E
Page 2 · response
Published 7 May 2015

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Encourage further research into GBS screening during pregnancy.

Verbatim wording from the response

“As you are aware, our guideline does not recommend routine screening for GBS. This is because there was insufficient evidence to support a positive recommendation. However, we have encouraged more research to be carried out in this area and we will keep our recommendations under review, pending new evidence emerging. Our consideration of the evidence informing this recommendation is available in the full guideline which is available on our website: www.nice.org.uk/cg62. Screening for GBS is discussed in section 10.9.”

Source location

2015-0177-Response-by-N.I.C.E
Page 1 · response
Published 7 May 2015

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Keep recommendations on antenatal GBS screening under review pending new evidence.

Verbatim wording from the response

“As you are aware, our guideline does not recommend routine screening for GBS. This is because there was insufficient evidence to support a positive recommendation. However, we have encouraged more research to be carried out in this area and we will keep our recommendations under review, pending new evidence emerging. Our consideration of the evidence informing this recommendation is available in the full guideline which is available on our website: www.nice.org.uk/cg62. Screening for GBS is discussed in section 10.9.”

Source location

2015-0177-Response-by-N.I.C.E
Page 1 · response
Published 7 May 2015

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Publish an audit report surveying NHS obstetric units and analysing routinely collected maternity data on Group B streptococcal disease prevention.

Verbatim wording from the response

“The RCOG has recently published a report of an audit (https://www.rcog.org.uk/globalassets/documents/guidelines/research--audit/gbs-audit-first-report.pdf) which contains the results of a survey of NHS obstetric units in the UK and analyses of routinely collected maternity data, which you may also find useful.”

Source location

2015-0177-Response-by-Royal-College-of-Obstetricians-and-Gynaecologists
Page 2 · response
Published 7 May 2015

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Publish and maintain guidance on preventing early-onset neonatal Group B streptococcal disease.

Verbatim wording from the response

“The 2nd edition of the RCOG Green top guideline number 36, Prevention of Early-onset Neonatal Group B Streptococcal Disease was published on 1st July 2012. It gives guidance based on the recommendations of the National Screening Committee.”

Source location

2015-0177-Response-by-Royal-College-of-Obstetricians-and-Gynaecologists
Page 1 · response
Published 7 May 2015

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Routine GBS screening was not recommended because evidence was insufficient, and later review found insufficient new evidence to update the guideline.

Verbatim wording from the response

“As you are aware, our guideline does not recommend routine screening for GBS. This is because there was insufficient evidence to support a positive recommendation. However, we have encouraged more research to be carried out in this area and we will keep our recommendations under review, pending new evidence emerging. Our consideration of the evidence informing this recommendation is available in the full guideline which is available on our website: www.nice.org.uk/cg62. Screening for GBS is discussed in section 10.9.”

Source location

2015-0177-Response-by-N.I.C.E
Page 1 · response
Published 7 May 2015

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Local clinicians and organisations are responsible for deciding the best approach to care, using evidence and guidance provided.

Verbatim wording from the response

“I should point out that our role is to provide the evidence for decisions to be made by local clinicians and organisations on the best approach to care by providing guidance on treatments and other forms of practice. In developing the recommendations in our clinical guideline on antenatal care (CG62, 2008), we referred to the evidence-based recommendations of the UK National Screening Committee (NSC), which is part of Public Health England.”

Source location

2015-0177-Response-by-N.I.C.E
Page 1 · response
Published 7 May 2015

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Routine antenatal GBS screening is not recommended because evidence of benefit is insufficient and screening may cause harms and require substantial changes and funding.

Verbatim wording from the response

“Point 4.1 in the RCOG guidelines states that Routine bacteriological screening of all pregnant women for antenatal GBS carriage is not recommended. Until it is clear that antenatal screening for GBS carriage does more good than harm and that the benefits are cost-effective, the National Screening Committee does not recommend routine screening in the UK. Initiating national swab-based screening for antenatal GBS carriage would have a substantial impact on the provision of antenatal care within the UK. Major organisational changes and new funding would be required to ensure an equitable and quality-assured service.”

Source location

2015-0177-Response-by-Royal-College-of-Obstetricians-and-Gynaecologists
Page 1 · response
Published 7 May 2015

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Current evidence does not support intrapartum antibiotics for women whose GBS carriage was detected only during a previous pregnancy.

Verbatim wording from the response

“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.”

Source location

2015-0177-Response-by-Royal-College-of-Obstetricians-and-Gynaecologists
Page 2 · response
Published 7 May 2015

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Universal antenatal GBS screening is not considered necessary because evidence does not show its benefits outweigh its harms.

Verbatim wording from the response

“evidence for programmes against a set of internationally recognised criteria. In the case of GBS carriage in pregnancy, the current evidence does not support universal screening.”

Source location

2015-0177-Response-by-Department-of-Health
Page 2 · response
Published 7 May 2015

Open published response
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Information checked against the published report and official responses · Data reviewed 7 Sep 2026 · About data quality and limitations

Data last updated 7 September 2026