Group A streptococcal puerperal sepsis preceded by positive surveillance cultures

Background: Screening of pregnant women for vaginal and rectal carriage of group B streptococci may also identify group A streptococcal carriers. Ile clinical significance of prenatal group A streptococcal carriage is unknown . Cases: Two women developed group A streptococcal puerperal sepsis after del ivery at one hospital 15 months apart. The first patient required hysterect omy and suffered complications including subcapsular hepatic hematoma, pleu ral effusion, and prolonged ileus. She recovered after a 35-day hospitaliza tion. The second patient had endometritis and recovered. Both had had group A streptococci isolated from vaginal and rectal cultures taken for prenata l group B streptococcal screening. The acute sepsis isolates were both M-ty pe 28, but pulsed-field gel electrophoresis determined that the strains wer e unrelated. Conclusions: Finding group A streptococci on prenatal culture may presage s erious postpartum infection. (Obstet Gynecol 2001;98:846-8. (C) 2001 by the American College of Obstetricians and Gynecologists.).