Invasive GAS infections in pregnancy
Ignaz Semmelweiss made one of the most important contributions to modern medicine when he instituted hand washing in an obstetric clinic in Austria in 1847, decreasing mortality there from more than ten percent to two percent. Unfortunately, infections can still occur in pregnancy and during delivery and can have associated mortality rates of up to 30 to 50 percent if not treated quickly and properly.
Brenna Anderson, MD, director of the Women's Infectious Diseases Consultative Service at Women & Infants of Rhode Island and an associate professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University, has published an article as part of a Clinical Expert Series in the April 2014 edition of Obstetrics & Gynecology, now available online. The article, entitled "Puerperal Group A Streptococcal (GAS) Infection: Beyond Semmelweiss," offers a description of the recommended approach to diagnosing and treating GAS in pregnant and postpartum women.
"Basically, GAS is the same organism that causes strep throat. But when the infection occurs in the uterus, it can be life threatening," said Dr. Anderson. "This is a very unusual but serious infection, and recognition of it is often a stumbling block to treatment."
Group A streptococcus (GAS) can cause invasive infections in the form of endometritis, necrotizing fasciitis, or streptococcal toxic shock syndrome. These infections, when associated with sepsis, have associated mortality rates of 30 to 50 percent. When a pregnant woman presents with GAS infection, her symptoms are often atypical, with extremes of temperature, unusual and vague pain, and pain in the extremities. Imaging may appear normal, but removing a small sample from the uterus along with a blood culture may be a useful, rapid diagnostic tool.
"When suspected, invasive GAS infections need to be treated quickly. Very specific antibiotics are often helpful, although the infection may require surgery, which can be lifesaving," Dr. Anderson explained.