Group A streptococci cause a variety of diseases, such as scarlet fever and streptococcal sore throat. A group A streptococcal infection important in pregnancy and childbirth is puerperal sepsis, commonly caused by the Gram-positive organism Streptococcus pyogenes (S. pyogenes). The bacteria may enter via the placenta in the following situations:
- following prolonged rupture of foetal membranes
- following obstetric trauma
- after septic abortion
- in the presence of retained placental tissue.
Puerperal sepsis responds well to intravenous antibiotics, specifically those that are penicillin based. However, left untreated, an infection of this type can lead to an emergency situation. Endotoxins present in the bacteria release components that cause a severe immune response. A mother with an infection of S.pyogenes may present with a sudden onset of tachycardia (racing heart), fever, rigors (muscle stiffening) and tachypnoea (fast breathing rate). She may also show a change in her mental state. As the condition takes hold, signs of shock, such as hypotension (low blood pressure) will develop. Untreated, the infection will end in multiple organ failure and death.
Management of the condition is based on restoring circulatory volume by replacing fluid, and eradication of the infection. Full infection screening should be carried out to determine the cause of the infection. Infusion sites and catheters should be checked for signs of contamination and changed where required. Rigorous treatment with intravenous antibiotics after blood cultures have been taken will be necessary to halt the infection.