Ignaz Semmelweiss made one of the most important contributions to modern medicine when he instituted hand washing in an obstetric clinic in Austria in 1847, decreasing mortality there from more than ten percent to two percent. Unfortunately, infections can still occur in pregnancy and during delivery and can have associated mortality rates of up to 30 to 50 percent if not treated quickly and properly.
Brenna Anderson, MD, director of the Women’s Infectious Diseases Consultative Service at Women & Infants of Rhode Island and an associate professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University, has published an article as part of a Clinical Expert Series in the April 2014 edition of Obstetrics & Gynecology, now available online. The article, entitled “Puerperal Group A Streptococcal (GAS) Infection: Beyond Semmelweiss,” offers a description of the recommended approach to diagnosing and treating GAS in pregnant and postpartum women.
“Basically, GAS is the same organism that causes strep throat. But when the infection occurs in the uterus, it can be life threatening,” said Dr. Anderson. “This is a very unusual but serious infection, and recognition of it is often a stumbling block to treatment.”
Group A streptococcus (GAS) can cause invasive infections in the form of endometritis, necrotizing fasciitis, or streptococcal toxic shock syndrome. These infections, when associated with sepsis, have associated mortality rates of 30 to 50 percent. When a pregnant woman presents with GAS infection, her symptoms are often atypical, with extremes of temperature, unusual and vague pain, and pain in the extremities. Imaging may appear normal, but removing a small sample from the uterus along with a blood culture may be a useful, rapid diagnostic tool.
“When suspected, invasive GAS infections need to be treated quickly. Very specific antibiotics are often helpful, although the infection may require surgery, which can be lifesaving,” Dr. Anderson explained.
Obstetrics & Gynecology, also called “The Green Journal,” is the most widely read journal in the specialty of obstetrics and gynecology, with more than 46,000 subscribers worldwide, and has the highest ranking impact factor for all general obstetrics and gynecology journals. Obstetrics & Gynecology publishes a series of practical, clinical articles by outstanding experts in the specialty. Clinical Expert Series articles are evidence-based, clinical reviews of challenging obstetric or gynecologic conditions.
About Women & Infants Hospital
Women & Infants Hospital of Rhode Island, a Care New England hospital, is one of the nation’s leading specialty hospitals for women and newborns. A major teaching affiliate of The Warren Alpert Medical School of Brown University for obstetrics, gynecology and newborn pediatrics, as well as a number of specialized programs in women’s medicine, Women & Infants is the eighth largest stand-alone obstetrical service in the country with nearly 8,400 deliveries per year. In 2009, Women & Infants opened the country’s largest, single-family room neonatal intensive care unit.
New England’s premier hospital for women and newborns, Women & Infants and Brown offer fellowship programs in gynecologic oncology, maternal-fetal medicine, urogynecology and reconstructive pelvic surgery, neonatal-perinatal medicine, pediatric and perinatal pathology, gynecologic pathology and cytopathology, and reproductive endocrinology and infertility. It is home to the nation’s only mother-baby perinatal psychiatric partial hospital, as well as the nation’s only fellowship program in obstetric medicine.
Women & Infants has been designated as a Breast Center of Excellence from the American College of Radiography; a Center of Excellence in Minimally Invasive Gynecology; a Center for In Vitro Maturation Excellence by SAGE In Vitro Fertilization; a Center of Biomedical Research Excellence by the National Institutes of Health; and a Neonatal Resource Services Center of Excellence. It is one of the largest and most prestigious research facilities in high risk and normal obstetrics, gynecology and newborn pediatrics in the nation, and is a member of the National Cancer Institute’s Gynecologic Oncology Group and the National Institutes of Health’s Pelvic Floor Disorders Network.