Kerstin Kubiak writes about the signs and symptoms of Group A Streptococcus infection which can affect women during pregnancy and childbirth, and why prompt diagnosis and treatment is essential.
I have written a number of blogs previously about Group B Streptococcus infection and how it can cause serious, and potentially fatal, infections in newborn babies if they are not treated, and the ongoing national campaigns to seek routine testing for women during pregnancy to reduce the number of babies suffering these injuries. There is a, seemingly, less well know infection, Group A Streptococcus, which can cause very serious problems for women during pregnancy and after childbirth if not diagnosed and treated, and this blog seeks to raise further awareness.
Group A Strep (GAS) infection is an unusual but very serious infection, which can be life threatening to women if contracted in the uterus during pregnancy or during/after childbirth. GAS can go on to cause invasive infections such as endometritis, necrotising fasciitis or toxic shock syndrome. Infections which are not treated early enough and develop into sepsis have a very high mortality rate of between 30-50%. Early diagnosis of sepsis is essential so as to allow for targeted antibiotic therapy and avoid radial surgery or worse.
GAS infections are the most common cause of severe puerperal infections (infection of the female reproductive tract following childbirth). Following childbirth women can be particularly vulnerable to infection and medical staff must remain vigilant to early signs of sepsis so as to avoid delayed diagnosis and its consequences. Diagnosis of the condition can be difficult, however the onset of GAS infection can be rapid and its severity such that death can occur in previously healthy women within a very short period of time without treatment.
Between 2006 and 2008 there was a significant rise in the number of maternal deaths caused by GAS infection. In response to the 8th (2011) report on confidential enquiries into maternal deaths in the UK the Royal College of Obstetricians & Gynaecologists produced guidance for its members on “Bacterial Sepsis following Pregnancy”.
The document lists risk factors for maternal infection which include:
The guidance makes clear that all health professionals, including midwives, should be aware of the signs and symptoms of maternal sepsis and that suspicion of sepsis should trigger urgent referral for assessment and treatment. Clinical signs of infection include:
Sepsis following Group A Strep in women still occurs within UK hospitals and can strike women who were otherwise very healthy and I represent a number of women who have suffered serious injuries as a result of delayed diagnosis and treatment. Many hospitals run sepsis awareness programmes and the charity The UK Sepsis Trust also campaigns for public awareness of the condition; they highlight that sepsis is the biggest direct cause of death in UK pregnancies.
Hopefully with improved vigilance of care, the incidence of woman who suffer a delay in diagnosis of sepsis during or after pregnancy will greatly improve.