Introduction
Gram-positive beta-haemolytic group A Streptococcus (GAS)
bacteria, cause infections responsible for a wide range of diseases in
humans. (1-3). GAS-associated endometritis is a potentially
life-threatening event during pregnancy and postpartum (2, 4, 5). GAS
infections have re-emerged since the 1980s (6) after a period of
continuous decline in infection rates associated with infection control
measures and penicillin use. They now account for more than 75,000
yearly deaths worldwide (2). The attack rate of invasive GAS infection
is 20-fold higher for pregnant and postpartum women compared to
non-pregnant women (6). Approximately 85–93% of infections occur
postpartum among patients with pregnancy-related GAS infection (7, 8).
Risk factors for intrapartum and postpartum GAS infection include upper
respiratory tract infection prior to delivery, contact with carriers of
GAS infection during pregnancy (9), and risk factors attributed to the
delivery itself, such as preterm premature rupture of membranes (PPROM)
(1), mucosal damage, and emergency caesarean deliveries (10).
A rate of maternal morbidity and even mortality was reportedly as high
as 60% when streptococcal toxic shock syndrome (STSS) develops (11).
The severity of maternal infection in cases of pregnancy-associated GAS
infection can be difficult to predict, and there is a lack of studies on
predictions of pregnancy-associated GAS disease severity. It is
plausible to assume that late recognition of pregnancy-associated GAS is
related to substantial morbidities, such as STSS, intensive care (ICU)
admissions, septic shock, surgical intervention, and emergency
hysterectomy.
This study aimed to determine the risk factors associated with GAS
disease severity, such as maternal STSS and rates of admission to the
ICU. The specific objective was to assess the impact of a delay in
recognition of the infection or pathogen subtype and the provision of
appropriate treatment on maternal instability and clinical
deterioration.