Maternal Infection with Listeria monocytogenes in Twin Pregnancy

Listeria monocytogenes is the conditional pathogenic bacteria, and pregnant women are at higher risk of infection due to depressed immunity. Infection with Listeria monocytogenes in twin pregnancy is rare but devastating, which puts forwards a great challenge for clinical management. Here, a 24-year-old woman was diagnosed with twin pregnancy, intrauterine death of one fetus and fever at 29(+4) week of gestation. Two days later, she developed into pericardial effusion, pneumonedema and potential septic shock. The emergent cesarean delivery was performed after anti-shock treatment. One alive and another dead fetus were delivered. Then, she developed postpartum hemorrhage after the surgery. Urgent exploratory laparotomy was conducted at the sites of cesarean section and B-Lynch suture to stop bleeding. The culture of blood and maternal side of both placentas indicated Listeria monocytogenes. Following anti-infection therapy with ampicillin-sulbactam, she recovered well and discharged with negative result of blood bacterial culture and normal inflammatory indicators. The patient was hospitalized for a total of 18 days including 2 days in the intensive care unit (ICU), and the anti-infection treatment was conducted throughout the course. Symptoms of the Listeria monocytogenes infection in pregnancy are non-specific, which should be paid more attention in case of unexplained fever and fetal distress. The blood culture is effective for accurate diagnosis. Listeria monocytogenes infection is associated with poor pregnancy outcomes. Close monitoring of fetal condition, early intervention with antibiotics, timely termination of pregnancy and comprehensive management of complications are essential for better prognosis.