Infectious diseases that occur during pregnancy and the puerperium pose special risks to the mother, fetus, and infant. Furthermore, preventive and therapeutic measures often must be modified because of the potential for adverse events that may occur during these normally healthy periods to mother and developing child.

With the premise that the efficacy of any diagnostic, prophylactic, or therapeutic intervention must be individually weighted against possible side effects, this chapter discusses problems that are common or severe.

URINARY TRACT INFECTIONS

Asymptomatic bacteriuria and symptomatic infection of the upper and lower urinary tract are associated with significant risks to the mother and the fetus. A positive urine culture in an asymptomatic person makes a diagnosis of asymptomatic bacteriuria. For pregnant women it is recommended to routine culture a properly collected urine specimen at the first prenatal visit. Treatment should be provided if the urine culture is positive. Screening for recurrent or persistent bacteriuria should be done following therapy.

Suppressive therapy until delivery is recommended for women who have persistent bacteriuria after two or more courses of therapy. Short courses (3 days) of antimicrobial therapy are usually effective in eradicating asymptomatic bacteriuria in pregnancy. In general, penicillins and cephalosphorins are considered safe in pregnancy. Only drugs to which the microorganism is susceptible should be used.