title: Invasive group A streptococcal infection in pregnancy.
abstract: We conducted a literature review of 55 pregnancies with symptomatic Group A streptococcus (Streptococcus pyogenes) infection reported in English (20 cases), French (2 cases) and Japanese (33 cases) to seek ways of improving prognosis. Multiparous women (83% [39/47]) in the third trimester (90% [47/52]) were prone to infection from winter to spring (75% [21/28]). Onset was heralded by flu-like symptoms, such as high fever (94% [46/49]), with upper respiratory (40% [22/55]) and/or gastrointestinal symptoms (49% [27/55]). Characteristic findings were early onset of shock (91% [50/55]) and infection-induced strong uterine contraction (73% [40/55]) suggestive of placental abruption. The clinical course was too acute and severe to rescue the mother (58% [32/55] died) and/or infant (66% [39/59] died). However, outcome has improved over the last decade, with rescue of 68% (15/22) of the mothers since 2000, and early use of antibiotics (71% [22/31] survived) and use of intravenous immunoglobulin (91% [10/11] survived) were associated with favourable outcome. Early use of antibiotics and intravenous immunoglobulin may improve outcome of pregnant women suffering from flu-like symptoms, shock and strong uterine contractions suggestive of placental abruption.
authors.affiliation: Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7 Kita-ku, Sapporo 060-8638, Japan. taka0197@med.hokudai.ac.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yamada
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamada
authors.forename: Mie K
authors.initials: MK
authors.lastname: Yamamura
authors.forename: Kenichi
authors.initials: K
authors.lastname: Katabami
authors.forename: Mineji
authors.initials: M
authors.lastname: Hayakawa
authors.forename: Utano
authors.initials: U
authors.lastname: Tomaru
authors.forename: Shigeki
authors.initials: S
authors.lastname: Shimada
authors.forename: Mamoru
authors.initials: M
authors.lastname: Morikawa
authors.forename: Toshio
authors.initials: T
authors.lastname: Seki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ariga
authors.forename: Kaoru
authors.initials: K
authors.lastname: Ishikawa
authors.forename: Tadayoshi
authors.initials: T
authors.lastname: Ikebe
authors.forename: Satoshi
authors.initials: S
authors.lastname: Gando
authors.forename: Hisanori
authors.initials: H
authors.lastname: Minakami
mesh_terms: D005260:Female; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000382:microbiology*; D011379:Prognosis; D012772:Shock, Septic / Q000382:microbiology; D013290:Streptococcal Infections / Q000382:microbiology*; D013297:Streptococcus pyogenes / Q000302:isolation & purification* / Q000472:pathogenicity; D016019:Survival Analysis