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Streptococcal infection in pregnant women. Complications for pregnancy. Consequences and treatment of streptococcal infections after delivery

Streptococcus Group B (GBS) is a widespread type of bacteria that can cause infection. Usually, GBS does not pose a danger to adults, however, despite the fact that GBS is unlikely to hurt a pregnant woman, but he can be very dangerous for her baby. A woman can convey streptococcus her child during childbirth. Streptococcus carriers are approximately 25% of pregnant women.

Many people are carriers of streptococcal infection and do not know about it. GBS in adults usually does not have symptoms, but in some cases the bladder infections may cause or.

Paths of streptococcal infection

GBS bacteria live in the intestines, urinary and sex paths. They develop in the body naturally, which means that you cannot get infected through food, water and things that you touched. You can also not get infected from another person, and Streptococcus is not sexually transmitted.

Diagnostics Streptococca

To check if you have GBS, ask your doctor-gynecologist to make you an analysis on Streptococcus on the 35th 37th week of pregnancy. Conducting this analysis is simple and painless and lies in taking a smear from the vagina and the rectum. The obtained samples go to the laboratory, the results are usually available in 1 - 2 days.

Treatment of streptococcus in a pregnant woman

If the results of the analysis on Streptococcus will be positive, then you are afraid of childbirth (intravenous administration or dropper). Antibiotics treatment helps prevent your child from obtaining infection. As a rule, ideal time for the introduction of antibiotics is at least 4 hours before delivery.

The best antibiotic for the treatment of streptococcal infection is Penicillin. Also, doctors often use another antibiotic - ampicillin. Both of these medicines are safe for a woman and a child. However, some women (in 1 out of 25 women), treatment with penicillin causes minor allergic reactions, most often - rash. Therefore, if you know that you are allergic to Penicillin, be sure to warn your doctor about it!

If you have GBS, but you will give birth through the planned cesarean section (that is, if you do not wait for the fights, and you will not have spindle water), then you do not need antibiotics.

Effect of streptococcal for pregnancy

Without treatment, streptococcal infection during pregnancy can increase the risk:

  • premature breaking of the fetal shells;
  • premature births;
  • intrauterine death of a child (stilling).

GBS may also cause imp (urinary tract infections) during pregnancy. Imp can cause fever, pain and burning when urinating. Sometimes imp has no symptoms, but if you have imp, your doctor will definitely define it according to the results of the analysis of urine during one of your visits to women's consultation.

Signs of infection in a newborn baby

Signs of streptococcal infection in newborns are not always manifested immediately after birth. It depends on the type of infection that the child received.

There are two types of GBS infection:

1. Early start of infection - signs of this type of infection are fever, problems with breathing and constant drowsiness during the first 7 days of life (most often - on the first day). The early start of GBS can lead to pneumonia, sepsis and meningitis. About half of all GBS infections in newborns have an early start.

2. Later the beginning of infection - signs in this case are the following: cough, nasal congestion, food problems, fever, drowsiness or convulsions. The appearance of signs is celebrated - 3 months after birth. Very often, infection with late beginnings leads to meningitis and sepsis.

What problems can be streptococcus in newborns?

Infants infected with streptococcus may suffer from one or more concomitant diseases, among which are the most common:

  • meningitis (fluid infection and lining around the brain);
  • pneumonia (lung inflammation);
  • sepsis (blood infection).

All these diseases in newborns can be life-threatening. Most children treat GBS, recover. However, even after treatment, approximately 5% of children die, and most often dying premature children.

GBS infection can lead to health care problems and in his future life. For example, approximately 25% of children who have suffered with meningitis caused by streptococcal infection, the following problems may develop:

  • child cerebral palsy (a group of diseases that cause problems with the development of the brain; these problems affect the human ability to move and maintain balance and posture);
  • problems with hearing;
  • learning problems;
  • external deformities.

It is extremely important to try to prevent the transfer of infection with the newborn! If the child has become infected, then he should begin treatment as soon as possible by intravenous administration of antibiotics.

Postpartum complications from streptococcal infection

GBS may cause an intrauterine infection (uterus infection) both during and after pregnancy. The symptoms of the infection of the uterus are as follows:

  • high body temperature (fever);
  • abdominal pain;
  • an increase in heart rate (during pregnancy, the frequency of the fetal can also increase).

If you are confirmed by the uterine infection caused by the streptococcus group in, you will need treatment with antibiotics, and, as a rule, the infection takes place in a few days.

Website - Medical portal online consultation of children's and adult doctors of all specialties. You can ask a question on the topic "Streptococcus during pregnancy" And get free online advice of the doctor.

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Questions and answers by: Streptococcus during pregnancy

2014-05-03 12:57:14

Tatyana asks:

Good day. Pregnancy 8 weeks. Streptococci Agalaxy 10 ^ 6, and an intestinal wand 10 ^ 7 found. Tell me please, is it possible to cure it during pregnancy? The doctor said that he would start to treat after 12 weeks. And how dangerous for the fetus? I lost my child for 26 weeks a year and a half ago, the reason did not say. Now diagnosed bacterial vaginosis. I am treated by Miramiksin. Thank you

2012-05-08 19:47:02

Asks Veronica:

Good day.
during pregnancy, the streptococcus viridans 10 * 6 degrees, ringed chlorophyllippt, decreased to 10 * 5.
i am very worried about this infection, because I have a small child.
how can I infect him? Is it dangerous ??

2016-10-12 16:58:44

Asks Natalia:

Hello. My husband and I are planning a pregnancy. Began to be examined by the gynecologist. With the first Bakpasev (end of July), they found streptococci. Treatment: Augmentin, Candles Clion D, Cape Boselk. The next Bakpasev (September 5) showed ureaplasm 10 to 2 degrees and streptococcus 10 to 6 degrees. Treatment: Sumamed, Supradin, Duflykan, Terezhin. The next Bakpasev (October 8) showed ureaplasm 10 to 2 degrees and streptococcus 10 to 5 degrees. I am worried about this streptococcus. What can I do with it? Why doesn't he pass after treatment?

Replies Julia Vasilyevna Biar:

2015-12-26 19:21:08

Asks Catherine:

Good evening!
Pregnancy 27 weeks.
05/07/15 passed the analysis by the PCR method for the presence of streptococcus group B, the answer came positive, after treatment, the result is positive again (the analysis passed on 07/01/15). After that, twice surrendered sowing on the microflora with the definition of sensitivity to antibiotics (08/12/15 and 12/22/15) and only in the second analysis found Enterococcus and Proteus Mirabilis 10 to 3 degrees. I now can't understand it is necessary to treat streptococci group B if they are not detected when sowing ???

Replies Medical consultant portal "Site":

Hello, Catherine! Microorganisms not detected in the crop do not have clinical significance and do not require treatment. Take care of health!

2015-10-04 15:35:27

Asks to wave:

Good day! I ask you to help! 2 months ago gave birth to a child, many nuances with the health of his chefalohematoma, congenital kidney vice, subclinical hypothyroidism, tightening jaundice so far. Bad chair from the second week of life. In the tank. Single was found to Klebseyella. According to the advice of the infectiousnessist, the smear from the zea and the nose itself was passed. Found evils. Staff-2 Art. In hemolytic streptococcal-2-3st. This is Zev. In the nose of two st. During pregnancy, nothing about such analyzes knew, ENT, when registered, wrote health, although he knew about the operation to remove GRAND.
Questions: How to be treated? I feed the breast. One doctor discharges antibiotics. The other advises chlorophyllipte and phages.
How dangerous I am dangerous for a child and other people? There was a paranoia of communication.
How strongly such results could affect the baby? Do our problems be related to this?
I ask you to answer. I worry that hurt the baby ...
Many thanks!

2014-11-04 13:32:50

Asks Maria:

Hello! Pregnancy 22 weeks. Passed
bakpasev in September in his consultation. According to
which is detected streptococci agalact and
yeast fungi genus Candida - moderate growth.
Treatment did not conduct. Relocated in a month (end
october) Bakposev in private honey. Center. By
the results of which were found in CERV. Vag.
leukocytes 5-10, epithelium 5-10, discovered only
gram-positive wands, in uretra. Prost leukocytes
0-1, epithelium 2-5, found: G + Cockki, GR + sticks,
lact Bacillies in t. C. With a culture study
streptococcus SPP 10 to 3 degrees found. Tell me
please raise treatment in the form of application
vaginal hexicon candles (1 time per day for 9
days), and the reception of Vagilak for 1 month for
normolization of normophlor? I read about Hexicon,
reviews are not inspirational, is it worth it to apply it?

Replies Julia Vasilyevna Biar:

Hello Maria! I do not know what you read about Hexicon, but in some way it cannot harm or be effective. Treatment is appointed adequately, so do not worry.

2014-06-28 11:43:22

Lyudmila asks:

Hello! I'm 25. Pregnancies, miscarriages, there was no abortion. I plan a pregnancy. March 1, 2014 was an extension operation (ectopic pregnancy).
Analysis on hidden infections, bargaining infections are handed over, nothing has been revealed. Blood on hormones - everything is normal.
I have a small erosion. Husband with me trembled infections, passed the spermogram and blood at bargaining infection - everything is normal. Help, please decipher the tank. After the vagina and should be treated what is found in it.

Total number of m / o\u003e 8 with a value of 6-8
Lactobacilli 8 at a meaning\u003e 5
Enterobacteria 6 with staphylococci values \u200b\u200b0
Streptococci 0.
Enterococci 6 with the value of the non-enzyme m / o 0
Corinbacteria 0.
Nassenia 0.
Mushrooms 0.
Marak microscopy - epithelium flat surface and intermediate layers. Slime. Leukocytes - 10-25 in p / sp. Microflora - lactomorphotypes in moderate count. Grams (+) Cockki in a scant number.

Conditional pathogenic m / o
1. Escherichia coli 10 ^ 6 KoE / TamP
2. Enteroccocus Sp. 10 ^ 6 KoE / TamP

Sensitivity to Nitrofurantoin, Fosfomycin

Replies Wild hope Ivanovna:

Lyudmila, does not contradict himself. Ectopic pregnancy is a pregnancy that ended with operational treatment. With infections, the same is not all good. Intestinal wand and enterococcus is a conditional pathogenic microflora in the vagina, which should not be there. I recommend checking the kidneys: ultrasound, tank. After urine. Survey the thyroid gland and pride the infection. Neshka is not needed, and not everything is good - do not rush, and go through treatment. In addition, your plans are not pregnancy planning. Contact your family planning office, where you will provide information about family planning and will help you to prepare and undergo treatment.

2014-04-02 07:18:08

Asks Stanislav:

Good day!
No complaints, but turned to a urologist for preventing prostatitis and pregnancy planning. Increased copper content in prostate juice. Ciprofloxacin appointed. I doubt the effectiveness, I don't want to waste the body and whether it is necessary ... when tangling PJ-in a certain place, tangible pain. Question: How to get rid of streptococci in the prostate gland and should the wife follow a similar course of treatment?

Replies Vladychenko Konstantin Anatolyevich:

Hello. You probably conducted a tank. Sowing a prostate juice? If you have as a result of these microbes less than 10 * 4 and there is no clinic (symptoms) that are worried, the treatment is not required. The presence of microorganisms in this case is interpreted as contamination, and not as an infectious process. When planning a family, the most important analysis is a spermogram.

2013-11-10 13:50:31

Asks Eve:

Hello! About 3 months ago, the loan was sick, it became more common to go to the toilet, at night 1 time began to get up. It was painful on the right side. As a slope forward, the pain intensified. At the analyzes of OAM 2 times, the weight: 1016 protein otr. Lake Unit, Eritz Uz., On nichiporenko protein Otr, leukocytes100, ERIT200, passed 2 times the ultrasound. For the first time, the cups were sluggish, there were no lag in Such, I revealed the urine to the urine revealed Streptococci Agalactiae 10 * 4. I drink Kanefron. Ceffid pillars 4 and a half days later, allergy was canceled by Pila Furadonin 7 days. Now everything is exactly the loin hurts not so much, quickly marzen, pace. 36.9. Very much like the second child during the first pregnancy with the kidneys, everything was fine, whether they were treated correctly? What else to do to exclude diseases?

The content of the article:

Streptococcus during pregnancy and during childbirth can negatively affect both the state of the mother's health and fetus. Streptococci is a group of bacteria of spherical shape, which inhabit the human body. Most of them are not dangerous, however, some species provoke heavy diseases: food poisoning, purulent-inflammatory processes and the development of post-stock-flow autoimmune reactions (rheumatism, glomerulonephritis), intrauterine infection of the fetus can occur, and in a newborn, they can cause sepsis and meningitis.

Streptococci in pregnant women

The immune system of pregnant women weakened, and therefore they are more susceptible to infectious diseases, whose pathogens, including streptococci. Streptococcal infection can provoke premature genera, placenta breaks, fetal development disturbances or its death. In this article, we will talk about streptococcus during pregnancy and childbirth, about their types, diagnosis and methods of treating streptococcal infection.

Basic Information about Streptococcus

Streptococcus is a family of microorganisms that have a spheroid form, do not form a dispute. They belong to the gram-positive rock creme of the StreptococcaEae family of the family. Bacteria has no flagellas, they cannot move independently, but they are able to survive in a medium where there is no oxygen.

If you try to consider streptococci through a microscope, then you will see that bacteria are located in pairs or entire groups that resemble chains. These are common microorganisms that dwell in the ground, on plants, in the body of animals and people. Streptococci are easily experiencing temperature differences, they are able to multiply, even by several years in the soil. But they are easy to destroy them with the help of antibacterial drugs of the penicillin group, also use macrolides, sulfonamides for this.

Microorganisms begin to actively multiply in the nutrient medium: serum, sweet solution or blood. Bacteria are investigated in laboratories, they are settled on Wednesday with favorable conditions and are observed for their livelihoods: reproduction, carbohydrate fermentation, acid excretion and toxic substances.

Classification Streptococcov

Types of streptococci:

- β-hemolytic streptococci:

Group A is the most dangerous strain of bacteria that lives on the skin and mucous membranes. Microorganisms penetrate wounds, cracks and provoke purulent inflammation. When bacteria fall into the human body, then there is a risk of eliminating tissues or infectious-toxic shock. Some types of streptococci groups A have similarities with myocardial tissues, which leads to the fact that the body begins to destroy their own "good" heart cells.

Group B is the conditionally pathogenic microorganisms, the most famous S. Agalactiae. Streptococci Group C may be present in the nasopharynk, gastrointestinal tract and vagina. If a person is healthy, then the bacteria do not exhibit themselves, but with a decrease in immunity, they begin to multiply, as a result, hazardous diseases arise. Streptococcal groups in during pregnancy can pass through the placenta, infect an embryo or provoke miscarriage, with infection during childbirth, meningitis can develop. Remove streptococcus during pregnancy in bapposev is quite easy, the main thing is to pass on time. Acute or chronic pharyngitis, angina, bronchitis also arise due to the reproduction of this bacterium.

Group C.

Group G.

- α-hemolytic streptococci:

Pneumococci (S. pneumoniae) lead to pneumonia.

Bacterial endocarditis (Streptococcus Viridans).

For pregnant women most dangerous streptococci groups in, as they are located in the vagina. Streptococcus during pregnancy in a smear can be revealed as a result of laboratory studies. After that, the woman should consult with a gynecologist, which will prescribe preparations for treatment, usually use penicillin-row antibiotics for this.

Diagnosis of streptococcal infection in pregnant women

Most often to identify streptococcal infection is quite difficult. And sometimes the disease has pronounced symptoms (for example, with scarletin or face inflammation). Although in most cases it is necessary to carry out a bacteriological study to reveal the streptococci in the smear.

In order for the treatment to be effective, the doctor takes smears from epidemic foci:

To identify the causative agent of tonsillitis or pharyngitis, the mucus is removed from the throat and the eye;

It is possible to determine the streptococcal endocervicitis by smear from the vagina, and for the detection of urethritis, the mucus from the urethra can be removed;

In suspected streptococcal pyoderma or rye - purulent liquid collected with a cotton swab;

To identify the causative agent of nephritis after a general urine study;

To identify the cause of inflammation of bronchi or pneumonia, the sputum is examined.

To clarify the nature of the infectious disease, the doctor prescribes a blood test (PCR) to streptococcus, screening tests are based on the definition of AG SGV with the help of latex agglutination, coaggglutination and ELFA, as well as ECG (electrocardiography).

Pool streptococcus, which dwells on the mucous membrane, when weakening immunity is actively developing, penetrates the intestines and organs of the urogenital system. The first symptoms are manifested 3 days after infection.

Ideally, it is necessary to conduct an antibioticogram - this is a test on the sensitivity of infectious diseases to antibacterial drugs. The minus is that this procedure takes several days, and the bacteria at this moment are actively multiplied.
In most cases, the doctor when choosing a drug is based on personal experience and data on streptococci, which prevail in their region.

The infection is present in the body of each healthy person, simply does not manifest. The rate of streptococcus during pregnancy in the smear is no more than 104 CFU / ml.
As previously mentioned, the streptococcal infection can be revealed by symptoms.

Symptoms of streptococcal infection during pregnancy

Symptoms when infection of respiratory tract

In the reproduction of pathogens of microbes in the throat, the following features arise:

The temperature rises to 39-40 °;
acute pain when swallowing;
The lymph nodes are increasing on the neck;
severe weakness appears;
Glands swell and covered with white raids;
the patient is thrown into the heat, then znobit;
Muscles of the nape move with difficulty.

The disease quickly progresses, complications may occur: otitis, sinusitis, inflammation of the lungs.

Symptoms of the skin manifestation of streptococcus

Streptococcus provokes skin diseases, for example, a face, impetigo. Symptoms of skin infection:

On the damaged area, the skin blushes;
There is a clear boundary between the patient and damaged skin;
When touched, severe pain arises;
Skin cover on the damaged area is inflated, swells, gloss;
Frequently rises temperature.

Foreign inflammation most often amazes the lower and upper limbs, face.
Another kind of streptococcal infection on the skin is streptodermia. Characteristic symptoms are bubbles filled with purulent liquid, which over time burst and covered with a crust. Because of the bubbles there is a strong itching, the patient is combing them, and the infection applies further. For streptodermia in pregnancy, read on our website.

Streptococcal symptoms depend on the place of reproduction of infection

Under osteomyelitis, the bone substance dies, an ulcer is formed on it, the contents of which are poured over time;

In rheumatism, bacteria destroy the connecting tissues of different organs (joints, small vessels of the brain, kidney, liver, etc.);

With a furunculesis, the hair follicles are inflamed, a purulent rod is formed, which matches it, breaks through and worshiped;

For sepsis, the formation of glasses on light, liver, kidneys or brain, after their breakthrough, pathogenic microbes penetrate the bloodstream, because of which the patient may die.

Symptoms in pregnant women when infection with streptococcus a genitourinary system

Pregnant women can develop chorioamnionitis, infection of the urinary system, infection of the fetus, which can lead to miscarriage or stillbirth.

After the delivery, especially with the cesarean section, the likelihood of endometritis is great. Symptoms will be nonspecifier, such as: an increase in body temperature, weakness, pain at the bottom of the abdomen, the painfulness of the uterus during palpation.

After birth, the newborn in the first hours of life can develop sepsis or after 10 days of life - meningitis.

If the urinary system is suspected, the analysis will help reveal streptococcus during pregnancy in the urine and smear from the vagina.

Treatment and features of childbirth during streptococcus

If the result of the analysis for streptococcal infection turned out to be positive, then it is necessary to start therapy. Most often, the future mothers are striking streptococci groups in: Piogenies and Agalakik. Treatment of streptococcus during pregnancy is carried out using antibacterial drugs, which are administered intravenously or through a dropper. Only with the help of antibiotics can be protected newborn from infection. Treatment starts with 35 weeks of pregnancy, as well as at the time of birth. In rare cases, it is possible to receive antibiotics after 12 weeks of pregnancy.

The best antibacterial drugs for the treatment of streptococcal infection are antibiotics of a penicillin row: ampicillin, benzylpenicillin, sometimes prescribed macrolides. These medicines are most safe for mother and fetus. However, in some cases allergy arises in the form of a rash. This is possible with individual intolerance to Penicillin.

Also for the treatment of infection in pregnant women use bacteriophage streptococcal - this is an immunobiological preparation, which is effective in relation to streptococci.

Complications in newborns

The consequences of streptococcus during pregnancy can be deplorable, especially infection is dangerous for newborns. Due to infection, the baby suffers from the following diseases:

Meningitis (inflammation of the shells of the head and spinal cord);
pneumonia;
Blood infection (sepsis).

According to statistics, 5% of children with such diseases die. But there are cases when the child is not infected with Streptococcus during childbirth from the infected mother.

Streptococcal infection can further provoke the development of the following problems:

Cerebral palsy (cerebral paralysis) - the disease in which the CNS is affected is disturbed by the development of the brain, motor and other disorders arise;

Hearing disorders;

Mental retardation;

Loge in physical development.

About the features of streptococcus children read in the article on our website.

To avoid such diseases, it is necessary to protect the newborn from streptococci for this use preventive doses of antibiotics.

Streptococcus during pregnancy is very dangerous for the future mother and fetus. According to doctors, the disease is easier to prevent, how to treat, for this use vitamins, correctly manifest, lead a healthy lifestyle.

Sepsis newborns

Synonyms

Streptococcal into infection.
Code of the ICD-10
A40 Streptococcal septicemia.
A40.1 Septicemia caused by Streptococcus Group B (SGV).
B95.1 HCG as causative agents of diseases classified in other categories.

EPIDEMIOLOGY

The first description of the streptococcal infection with an early start of the disease appeared in 1939. By this time, the classification of streptococci was already developed on the structure of their polysaccharide ag (Lancefield R., 1935), and Streptococcus Agalactiae was attributed to the group B.

In the 60s of the last century, the first reports appeared that these microorganisms could cause severe diseases in newborns. The infection caused by the SGV, the newborn is acute, sometimes lightning, mortality reaches 60%. Up to 50% of surviving children suffer from the diseases of the CNS. Infection occurs in childbirth from the mother, the generic paths of which colonized the SGV.

For SGV, a asymptomatic stay on the mucous membranes (colonization) is characterized. It is assumed that in adults people the main way to spread the SGV - sexual contact, although this is not recognized by all researchers. Due to the increasing prevalence of STIs and with the wide use of oral contraceptives that violate the natural balance of sex hormones and support the increased sensitivity of the vaginal epithelium to the adhesion of the SGV, there is a significant increase in the colonization of the vagina with these microorganisms.

The main reservoir of streptococcal infection in humans is a gastrointestinal tract, and women still have a vagina and a urethra. In the US, the percentage of colonization of the CGI of the Vagina and the rectum in women is equal to 20-40%, in Brazil - 26%, in India - 6%, in Italy - 7%, in Austria - 12%, in Israel - 2-3%.

The maximum sampling of the vagina of the SGV in pregnant women is observed in a period of 35-37 weeks. The risk factors for the transfer of microorganism to the fetus and the child are: the presence of the SGV in the urine, childbirth until the 37th week of pregnancy, anhydrous interval of more than 18 hours, fever from the mother above 38 ° C. Therefore, CDC (Center for Diseases Control) recommends examining pregnant women to identify the colonization of the SGV in terms of 35-37 weeks of pregnancy, as well as in the presence of the risk factors listed above at any other period of pregnancy.

The main source of infection of the newborn are genital paths of the mother. When passing through the generic paths, as well as with the ascending infection of the SGV, the fetal skin is seized. With aspiration, microorganisms fall into the respiratory tract, light. The lack of protective mechanisms against infection in the fetus can cause a generalized disease and the death of a newborn.

Etiology (reasons) streptococcal infection

The causative agent of infection caused by the SGV is the gram-positive diplococcus Streptococcus Agalactiae. He is the only species in this group of streptococcal and more often forms chains than other strains.

Most strains of this species are B-hemolytic. SGV contains two polysaccharide ags: a group-liquid C-AG and a type-specific S-AG, on the basis of the last SGV strain is divided into types 1A, 1B, 1C, 1A / C, 2, 3, 4, 5, and 6. Typical specifications are contained in the capsule and are important factors of virulence.

1C serotype contains protein ag. Serotypes 3, 2 and 1C most often cause a disease with early beginnings, at the same time serotype 3 dominates among the diseases with late beginnings.

PATHOGENESIS

SGV is a conditional pathogenic microorganism. Currently, the possibility of manifestation of the pathogenic action of microorganism under certain conditions is being studied. The presence of virulence genes in some strains, more often causing the development of intrauterine SGV infection.

Pathogenesis of complications of gestation

Fetal infection occurs when it passes through the generic paths of the mother. SGV can penetrate the uterus in both PRPOs and intracanalicularly through intact fetal shells and thereby affect the fetus. In such cases, they may be the cause of early and late miscarriage, premature genera, stillbirths.

With the defeat of the endometrium, the process of placentating and development of the lane is disturbed, which contributes to secondary placental insufficiency. SGV may affect the placenta (placentate) and the fetal shells (chorioamnionit), which in turn leads to the SIR, as well as to the premature initiation of generic activities. Often there are late extermination of OS, the anomalies of the generic activity (rapid births). In the postpartum period, the parameter is possible, due to the distribution of infection with lymphogenic by the postpartum wound or infected uterus, as well as when the cervix of the uterus and the upper third of the vagina.

In the pathogenesis of the development of the SGV infection, the fetus and the newborn matters the massiveness of the colonization of Streptococcus Agalactiae. When colonizing more than five sections of the skin and mucous membranes, the newborn in the first days of life is possible the development of SGV Sepsis.

In the study of protein factors for the pathogenicity of the SGV, such as B-, A-AG and C5A peptidase, it has been established that these factors, with all its significance in the formation of the virulent phenotype of the microbe, are not determining.

Clinical picture (symptoms) streptococcal infection in pregnant women

In adults, the SGV most often causes inflammatory diseases of the urinary bodies, especially with the anomalies of their development and SD. Currently, the SGV is considered as one of the main causative agents of the infection of the genitourinary system. Pneumonia, endocarditis, osteomyelitis in adults are also described.

The pregnant woman may have chorioamnionitis, infection of urinary organs, and after childbirth - endometritis. The frequency of these complications in the United States is calculated for endometritis 12 per 1000 genera, bacteriuria - 8 per 1000 genera. The risk of developing endometritis and bacteremia is higher in the delivery by the operation of the COP. Symptoms of the occurrence of SGV infection are nonspecific: fever, poor well-being, chills, pain at the bottom of the abdomen, the painfulness of the uterus during palpation. When infecting the fetus, stilling is possible. Symptoms indicating the disease of the fetus, slightly, and they are nonspecific (violation of heartbeat, metabolic acidosis, low pH of the arterial blood cord).

In an neonatal period, one of the two forms of streptococcal infection can develop - sepsis with an early start of the disease in the first hours and day of life of the child and the second form for which the beginning is characteristic of the beginning, most often after the tenth day of life. The disease with late beginnings clinically most often flows as meningitis.

Neonatal disease with early beginnings is characterized by the emergence of signs of the disease during the first 7 days, while in 90% of cases the signs of the disease appear in the first 24 hours of life. The lesions of the respiratory organs are detected in 54%, sepsis without a certain focus - in 27%, meningit is 12%.

Complications of gestation

Colonization of the urinary tract of the SGV pregnant women does not significantly affect the course of pregnancy.

The exception is asymptomatic bacteriuria or pyelonephritis of pregnant women caused by the SGV. In newborns, it is possible to identify intrauterine infection, especially when colonizing more than 5 sections of skin and mucous membranes.

Diagnosis in streptococcal infection during pregnancy

Founded solely on the results of laboratory studies.

ANAMNESIS

It is important to have a history of long-term colonization of the urinary tract of the SGV, as well as pyelonephritis or bacteriuria.

Physical research

Signs of inflammatory diseases of the genitourinary system detect.

LABORATORY RESEARCH

To diagnose the colonization of the SGV, women are seeding the material taken from the vagina and from the anorectal region, on a liquid or dense nutritional selective medium.

Since the penetration of the microorganism from the lower departments of the digestive tract occurs periodically, the take of sowing sowing simultaneously from the anorectal region and from the vagina provides an increase in SGV by 5-15% higher than the sowing of samples only from the vagina. It should also be noted that the nutrient selective medium (for example, with the addition of the overwhelming growth of the accompanying microflora of antibiotics) increase the selection of the SGV by 50%.

For the etiological diagnosis of SGV infection, newborns use sterile blood, spinal fluid, urine, endobronchial aspirate. It is important to know that in a large percentage of SGV cases in newborns allocate from urine. It is necessary to remember that sepsis with early beginnings is associated with relatively fast increasing neutropenia, determined by frequent blood test. It is advisable to carry out a complete blood test, including the definition of indicators such as C-jet protein, fibronectin, C3D complement fraction.

SCREENING

Since the colonization of the urinary tract of pregnant SGV is associated with the high risk of premature births, premature fracturing, the colonization of the Fruit and the risk of the development of a systemic infection in a newborn, the question of choosing a test for screening SGV infection in pregnant women.

The chemoprophylaxis strategy requires the establishment of colonization of the SGV in women using tests with high sensitivity and specificity of the allocation and identification of streptococcus culture.

The disadvantage is the result of the result not earlier than 18-24 hours, which is not always convenient. However, to date, sowing and the allocation of the Culture of the SGV, with the subsequent conduct of the species and typical identification of the microorganism, remains a gold standard of diagnosis of streptococcal colonization and infection.

Screening tests are based on the definition of AG HCG with the help of latex agglutination, coagglutination, as well as ELISA. Latex agglutination is based on sorption on small standardized latex particles AT to AG SGV. The reaction put on the glass by mixing the drops of the test sample and the test system drop. A positive result is taken into account by the formation of flakes.

In the coaggglutination reaction, the AT is sorbed on the surface of the staphylococcal cells, which has protein A. AT to the SGV attachment to the protein and due to the FC fragment, and the Fab fragment is free to connect to the AG SGM, if the AG is contained in the material under study. It should be noted here that polysaccharide hypers are involved in the reaction, therefore it is extracted from the test material with acid extraction with boiling.

More specific and sensitive ELISA to determine the HBV antigen, however, the reagents are not always available for it. Fast tests - coagglutination and latex agglutination are little sensitive with premature power and premature birth due to dilution of material by water and blood. Therefore, the culture method for identifying the SGV remains the most reliable.

Molecular biological methods of diagnostics (PCR) are also used to detect the SGV. At the same time, there was an opportunity in the study of virulence genes from SGV. Streptococci with the presence of virulence genes can cause the most severe defeats in newborns.

Differential diagnosis

Conduct with similar inflammatory diseases of other etiology (vulvovaginitis, pyelonephritis, bacteriuria).

Indications for consultation of other specialists

If there is a pyelonephritis - the consultation of the nephrologist. It is possible to consult other specialists in the development of complications of infection.

Treatment Streptococcal B infections during pregnancy

For the prevention of fetal infection, medication is carried out, starting from the 35th week of pregnancy, and in childbirth. If necessary (the presence of the threat of non-pregnancy, pregnancy development, pregnant or bacteriuria, is possible the appointment of therapy in earlier pregnancy (after 12 weeks).

Treats of treatment

Treatment should be directed to the elimination of the SGV, to preserve pregnancy and prevent the transfer of infection to the fetus.

Medicia treatment

Conducted according to the sensitivity of the SGV to antibacterial drugs. Ampicillin, benzylpenicillin, in some cases, macrolides are most often prescribed.

Evaluation of the effectiveness of treatment

An assessment of the effectiveness of treatment is carried out in the absence of colonization of the newborn CGI.

Indications for hospitalization

Independent hospitalization disease does not require.

Prevention of streptococcal infection during pregnancy

Conduct antibiotic proclaiming of the transfer of the SGV newborns. For this, a pregnant, colonized SGV, a benzylpenicillin in a dose of 5 million units is prescribed 35-37 weeks of pregnancy, then 2.5 million meals every 4 hours are also intravenously or ampicillin in a dose of 2 g intravenously, then 1 g every 4 hours for 5 days. In this case, there is a temporary suppression of the reproduction of the SGV, after the abolition of antibiotics, the colonization can be recovered.

Information for the patient

· SGV may be present in the vagina as part of a normal microbiocenosis.
· The transfer of the fetus occurs only in 37% when colonizing the SGV of the genital pathways.
· Treatment is carried out, starting from 35-37 weeks of pregnancy. If necessary, the attending physician may assign treatment in earlier time, but not earlier than 12 weeks.
· Newborn are not always born infected.

The StreptococcaEaE family includes several genera of morphologically similar gram-positive Cockkops, which are optional anaerobes. Based on carbohydrate antigens localized in the cell wall, the serological groups of streptococci A, B, C, D, E, F, G and N. in the appearance of the colonies and the nature of hemolysis on the blood agar of these pathogens are divided into hemolytic, green and non-magliatic species. .

In the vagina, healthy women may be present streptococci related to three groups - streptococci groups of Viridans (green streptococci), streptococci serological group B and streptococci serological group D (enterococci). The detection frequency and the number of streptococci belonging to these groups varies significantly and is normal at no more than 104 CFU / ml. In perinatology, two pathogen - Streptococcus Pyogenes (β-hemolytic streptococcus of the serological group A, which caused most cases of postpartum sepsis in the past) and Streptococcus Agalactiae (Streptococcus Serological Group, which has recently become the most common cause of infections as in newborns, especially premature and their mothers).

Infections caused by streptococci group a

    Pathogen- Streptococcus Pyogenes (β-hemolytic).

    Risk of pregnant women- 20% of pregnant women are bacteria carriers (nasopharynk, vagina and perianal area).

    Clinic in pregnant woman- Tonnsillitis, pharyngitis, pyodermia, colonization of the vagina and the perianal region, urinary infection, chorionnionitis, endometritis, postpartum sepsis.

    Diagnostics- Cultural method (on the blood agar aerobo and anaerobo).

    Influence on the fruit- intranatal transmission of infection, the risk of neonatal sepsis increases with a long anhydrous interval.

    Prevention- Identification of risk factors, compliance with the rules of asepsis in childbirth, antibiotic therapy according to the results of gynecological sowing.

    Treatment- Penicillins, cephalosporins at least 10 days.

Clinic.Streptococci Group A determine the infections of the respiratory tract (pharyngitis, scarlet nature), skin and wound infections, sepsis, sharp wound fever, glomerulonephritis.

At the heart of the diseases that are complications of infections caused by these streptococci, there are autoimmune mechanisms, healthy carrier is possible.

From the point of view of perinatal infections, it is necessary to take into account the possibility of vertical transmission of streptococcal infection from the mother to the newborn, the source of the infection can be the intestines and the vagina of the woman. Despite the use of antiseptics and antibiotics, recently reports to increase the number of the most severe infections caused by streptococci groups A, including a severe sepsis of newborns.

Diagnosticsstreptococcal infections include the cultivation of the material under study on the blood agar, both in aerobic and anaerobic conditions.

Treatment.When the group's streptococci is detected, the pregnant women need penicillinotherapy for 10 days, the use of cephalosporins and macrolides. In the postpartum sepsis, high doses of benzylpenicillin or ampicillin parenterally are prescribed. The newborn in streptococcal infection is also prescribed high doses of benzylpenicillin, ampicillin or cephalosporins.

Prevention.Streptococcus Pyogenes is transmitted by contact path. Prevention consists in compliance with the aseptic rules in childbirth.

Infections caused by streptococci groups in

    Pathogen- Streptococcus Agalactiae.

    Risk of pregnant women- It is included in the microflora of the vagina in 20% of pregnant women.

    Prevalence- The frequency of sepsis of newborns caused by the streptococcus group in the USA - 2 per 1000 live births.

    Clinic in pregnant woman- asymptomatic bacterial colonization of the vagina and the perianal region, the infection of the urinary tract, chorioninionitis, endometritis.

    Diagnostics- Cultural method.

    Influence on the fruit- in 80% - by infection (infection in childbirth) - sepsis; In 20% - late infection - meningitis, severe neurological complications.

    Prevention- identification of risk factors, antibiotic therapy according to the results of gynecological sowing.

    Treatment- Penicillins, cephalosporins, macrolides.

Streptococcus Agalactiae.it is able to cause severe diseases of respiratory organs, meningitis, septicemia, often leading to death. At the same time, this streptococcus is part of the normal marginal microflora in 5-25% of pregnant women and can be isolated in 10-20% of cases from the intestinal tract of newborns.

In the US, neonatal mortality associated with streptococci Group B exceeds 10%. The range of infections caused by these streptococcis in the perinatal period is very wide. It varies from septic miscarriage to transient bacteremia. Often the premature children are amazed, perhaps because the chorionnion is caused by streptococci Group B leads to premature birth.

The initial reservoir for streptococci groups in the normal intestinal microflora of a woman. There is a close relationship between the colonization of the organism of the mother and her child. The more intense the infection of the mother, the more often the child is infected. When a rapid transaction through natural generics, the frequency of intranatal infection is 50-60%. The risk of a disease of a dancer child-1-2%, premature - 15-20%, under a term of less than 28 weeks - 100%.

Clinic.Traditionally, two forms of infections of newborns caused by streptococci groups in: "Early attack" - an early form due to the vertical transmission of the pathogen, and the "late attack", developing after 1-6 weeks after birth, due to the horizontal infection.

In immature children, the infection often occurs in the form of sepsis, in the docking newborns - in the form of pneumonia. In severe cases, the disease begins immediately after birth and quickly progresses.