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.