Serious group A streptococcal infection around delivery

Objective: To differentiate the features of serious, perinatal, group A str eptococcal infection from other types of streptococcal toxic shock syndrome . Data sources: Thirty-eight obstetric cases that were fatal or fulfilled the criteria of Centers of Disease Control and Prevention for streptococcal to xic shock syndrome were reviewed. Three cases were from Asahi General Hospi tal, 26 from MEDLINE (1966-December 1998), four from Japana Centra Revuo Me dicina (1987-November 1998) using, the search terms "Streptococcus," "Strep tococcus pyogenes," "Streptococcal infection," "pregnancy," "labor," "deliv ery," "sepsis," and "shock," and five from official records of the Ministry of Health and Welfare of Japan. Cases of early pregnancy or cases that had unclear intervals between delivery and deterioration were eliminated. Integration ann Results: The 30 cases were divided into two groups by inter val between delivery and deterioration. Seventeen cases deteriorated before , during, or within 12 hours of delivery (perinatal group). They were compa red with 13 cases of the puerperal group. The mortality rates for infants a nd mothers in the perinatal group were higher than those of the puerperal g roup (infant: ten of 17 versus zero of 13, mother: 15 of 17 versus seven of 13). The other differences of description were unusually strong labor (eig ht of 17 versus one of 13), obvious serious inflammation (zero of 17 versus ten of 13), and evidence of serious sepsis (eight of 17 versus zero of 13) . Purulent myometritis without neighboring inflammation was found in our th ree cases. In ten cases, subjects or their family members had preceding sor e throats. Conclusion: The cases in the perinatal group had characteristic features. W e suspected that after invading the myometrium through the upper respirator y tract, large amounts of cocci were dispersed into the systemic circulatio n of the mother by active uterine contractions caused by purulent myometrit is. Unusual clinical signs were important for diagnosis. (C) 1999 by The Am erican College of Obstetricians and Gynecologists.