Obstetrical and Gynecological-Related Infections

The vast majority of pregnancies occur amongst a generally healthy patient population, i.e. females from the teenage years in to the 40s. In most cases, the pregnancy is uneventful and where infections do arise, these are often relatively minor and easily treatable, e.g. urinary tract infection and vaginal thrush. However, sepsis is now the leading cause of maternal deaths in the UK accounting for 26 deaths between 2006 and 2008 and there has been an increase in death due to community-acquired Group A streptococcal (GAS) (also known as Streptococcus pyogenes) disease [1]. A literature review of 55 pregnancies with symptomatic Groups A streptococcal infection since 1966 recorded early onset septic shock in 91 % with a maternal mortality rate of 58 % but the mortality has improved to 32 % in recent years [2]. Furthermore, when toxic shock syndrome due to Group A streptococci (can also be caused by Staphylococcus aureus) occurs during pregnant, it can have devasting consequences with multi-organ failure and a mortality of over 50 % in reported cases [3]. A recent review from the UK covers many of the important issues associated with GAS in the obstetrical setting including the its diverse manifestations, the need to manage puerperal sepsis caused by GAS quickly, suggested initial antibiotic therapy (e.g. cefuroxime and metronidazole until confirmed), and issues such as prophylaxis for contacts and the possible role of intravenous immunoglobulins [4].