Premium
How could we suspect life‐threatening perinatal group A streptococcal infection?
Author(s) -
Arai Tomohiro,
Takai Yasushi,
Samejima Kouki,
Matsunaga Shigetaka,
Ono Yoshihisa,
Seki Hiroyuki
Publication year - 2020
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.14497
Subject(s) - medicine , odds ratio , confidence interval , sore throat , sepsis , group b , univariate analysis , neonatal infection , neonatal sepsis , pregnancy , pediatrics , obstetrics , multivariate analysis , surgery , biology , genetics
Aim Perinatal group A streptococcal infection is a rare but life‐threatening condition. Few reports have focused on its clinical characteristics and how to prevent deterioration. We report our experience with two antenatal fatal cases and reviewed 96 cases in the literature to assess the clinical characteristics of group A streptococcal infection. Methods English‐language clinical reports of antenatal and postnatal group A streptococcal infection in 1974–2019 were retrieved and examined. Relationships between clinical characteristics and maternal outcomes were assessed. Results Univariate analysis revealed that antenatal group A streptococcal infection was significantly associated with an age of ≤19 or ≥ 35 years, cesarean section, sore throat as an initial symptom, positive throat culture, maternal death and fetal death. Multivariate analysis revealed that antenatal onset (odds ratio = 7.922, 95% confidence interval = 1.297–48.374; P = 0.025) and a quick sepsis‐related organ‐failure assessment score (qSOFA; low blood pressure, high respiratory rate or altered mental status) of ≥2 (odds ratio = 6.166, 95% confidence interval = 1.066–35.670; P = 0.042) were significantly related to maternal death. Conclusion Per our findings, antenatal group A streptococcal infection was significantly associated with maternal and fetal death. Further, the antenatal infection was revealed as a more critical risk factor. We suggest that the presence of any sign related to the qSOFA is a potential clue suspecting perinatal group A streptococcal infection in primary obstetric facilities.