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18 - Infectious diseases in pregnancy

from Section 5 - Other disorders

Published online by Cambridge University Press:  19 October 2009

By
Gabriela Rocha Lauretti  and
Robert S. F. McKay
Edited by
David R. Gambling ,
M. Joanne Douglas  and
Robert S. F. McKay
Gabriela Rocha Lauretti
Affiliation:
Professora Associada (Anestesiologista) Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Av. Bandeirantes Ribeirão Preto-SP, Brasil
Robert S. F. McKay
Affiliation:
Clinical Professor and Chair, Department of Anesthesiology, University of Kansas, School of Medicine – Wichita, Wichita, KS, USA
David R. Gambling
Affiliation:
University of California, San Diego
M. Joanne Douglas
Affiliation:
University of British Columbia, Vancouver
Robert S. F. McKay
Affiliation:
University of Kansas
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Summary

Bacterial infections

Clinical features: fever and asymptomatic patient

Fever during pregnancy can result from a variety of infections, tissue trauma, malignancy, epidural analgesia, drug administration, and endocrine or immunologic disorders. Infection is the most common cause, reflecting the effect of pyrogens on the hypothalamus. Bacterial infections of the skin, periodontal tissues, respiratory and genitourinary tracts can lead to pregnancy-related complications such as preterm labor, premature rupture of membranes, abortion following pelvic inflammatory disease, chorioamnionitis, neonatal infections, cervicitis, urethritis, ectopic pregnancy, low birthweight, stillbirth, pneumonia, septicemia, and both maternal and neonatal death. Urinary tract bacterial infections usually arise from preexisting covert bacteriuria and experts recommend screening and eradication of these silent infections as routine prenatal practice. Antibiotic treatment during pregnancy is beneficial in reducing neonatal and maternal morbidity/mortality, and most bacterial infections are preventable and treatable. Clindamycin in early pregnancy can reduce the risk of preterm birth by 40–60%. Vaginal bacterial diseases are often asymptomatic and have little impact on management by the obstetric anesthesiologist. The more common bacterial infections and related complications are listed in Table 18.1.

Maternal and fetal implications

The incidence of maternal infection during labor has been estimated to be about 3%. Severe sepsis is less common, however, and presents as the primary problem in < 1% of patients. However, sepsis remains a significant cause of maternal death in underdeveloped countries. In pregnancy, there are decreases in immunoglobulin G levels, lymphocyte count, and impaired lymphocyte activity.

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Obstetric Anesthesia and Uncommon Disorders , pp. 321 - 342
Publisher: Cambridge University Press
Print publication year: 2008

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  • Infectious diseases in pregnancy
    • By Gabriela Rocha Lauretti, Professora Associada (Anestesiologista) Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Av. Bandeirantes Ribeirão Preto-SP, Brasil, Robert S. F. McKay, Clinical Professor and Chair, Department of Anesthesiology, University of Kansas, School of Medicine – Wichita, Wichita, KS, USA
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.019
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  • Infectious diseases in pregnancy
    • By Gabriela Rocha Lauretti, Professora Associada (Anestesiologista) Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Av. Bandeirantes Ribeirão Preto-SP, Brasil, Robert S. F. McKay, Clinical Professor and Chair, Department of Anesthesiology, University of Kansas, School of Medicine – Wichita, Wichita, KS, USA
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.019
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  • Infectious diseases in pregnancy
    • By Gabriela Rocha Lauretti, Professora Associada (Anestesiologista) Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Av. Bandeirantes Ribeirão Preto-SP, Brasil, Robert S. F. McKay, Clinical Professor and Chair, Department of Anesthesiology, University of Kansas, School of Medicine – Wichita, Wichita, KS, USA
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.019
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