title: [Puerperal fever: an old enemy in aggressive form].
abstract: Two previously healthy women, aged 30 and 35 years, suffered pain in the lower abdomen, one before and the other after spontaneous delivery at 40 and 33 4/7 weeks of amenorrhoea, respectively, while a third woman, aged 33, at 36 weeks of amenorrhoea developed pain in the lower abdomen, fever, vomiting, and diarrhoea. All three women were found to have a uterine infection caused by streptococci of Lancefield group A (group A Streptococcus, GAS). In one woman, the diagnosis was made rapidly so that antibiotic treatment could be instituted in time; the other two developed sepsis and multiorgan failure, with a fatal issue in one of them. The three children also were septic, two recovered after treatment and one died. Since the eighties, serious GAS infection has been on the increase. The worst manifestation is the toxic shock syndrome caused by streptococci. Abdominal pains after delivery may be a first sign of this, and should not too readily be interpreted as just after pains. The condition may also develop before delivery. In view of the high mortality rate, early diagnosis and antibiotic treatment are of vital importance for mother and child.
authors.affiliation: Afd. Verloskunde en Gynaecologie, Høfpoort Ziekenhuis, Woerden.
authors.forename: W A
authors.initials: WA
authors.lastname: Schöls
authors.forename: G A
authors.initials: GA
authors.lastname: Hoogendoorn
authors.forename: P C
authors.initials: PC
authors.lastname: Scholten
authors.forename: E
authors.initials: E
authors.lastname: van Kregten
authors.forename: G H
authors.initials: GH
authors.lastname: Visser
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005260:Female; D005313:Fetal Death / Q000209:etiology; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology; D011247:Pregnancy; D011645:Puerperal Infection / Q000150:complications / Q000382:microbiology*; D012772:Shock, Septic / Q000209:etiology; D013290:Streptococcal Infections / Q000382:microbiology*; D013297:Streptococcus pyogenes / Q000472:pathogenicity; D014774:Virulence