Poster Presentation Lancefield International Symposium for Streptococci and Streptococcal Diseases 2025

Severe GAS infections in pregnancy and the peripartum period in South Auckland, New Zealand, 2023.  (#50)

Rachel Webb 1 2 3 , Genevieve Walls 4 , Susan Morpeth 4 , Katherine Given 4 , Kate Wong-she 5 , Andrew Fox-Lewis 6
  1. Kidz First Hospital, Counties Manukau District Health Board, Auckland
  2. Department of Paediatrics, University of Auckland,
  3. Paediatric Infectious Diseases, Starship Children's Hospital, Auckland District Health Board, Auckland
  4. Department of Infectious Diseases, Middlemore Hospital, Auckland , New Zealand
  5. Aotearoa Clinical Trials, Auckland, New Zealand
  6. Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

Background aims

Puerperal sepsis due to group A streptococcus (GAS) is an important global cause of maternal mortality. Despite high GAS incidence in NZ, there is limited data on contemporary incidence of GAS in pregnancy and the peripartum period. Peripartum infections may not be captured by passive laboratory-based surveillance, particularly if non-sterile-site genital tract isolates are not included. We sought to describe GAS infections in pregnancy and the peripartum period (between the onset of rupture of membranes and 28 days postpartum) in South Auckland, NZ. We aimed to describe maternal disease and looked for secondary cases in infants.  

Methods

Prospective laboratory-based surveillance Jan 1st– Dec 31st 2023. All GAS isolates (sterile and non-sterile) were notified to the research team. Clinical records of pregnant and peripartum women and exposed infants <4 weeks were reviewed.  

Results

There were five serious infections in pregnancy including bacteraemia (2), pleural empyema (1), peritonsillar abscess (1) and severe cellulitis (1). All five women delivered healthy infants.

There were nine serious peripartum infections. Two had bacteraemia and seven had positive genital tract cultures with clinical endometritis /sepsis. Intrapartum sepsis occurred in three cases. Six had postpartum onset (median onset day two). Eight infants were healthy. One infant was born at 32 weeks gestation with GAS bacteraemia and sepsis, to a mother with intrapartum bacteraemia. There were no infant deaths.  

 Conclusions

The majority of peripartum cases had a positive genital tract culture but not a positive blood culture, highlighting the importance of active notification by clinicians.