MEDICAL PRACTICE Group A Streptococcal Sepsis and Ovarian Vein Thrombosis After an Uncomplicated Vaginal Delivery

Background: Group A streptococcal puerperal sepsis is an uncommon peripartum infection that can quickly progress to a fulminant, multisystemic infection and life-threatening toxin-mediated shock. This infection can be asymptomatic during a short hospital stay after a routine delivery. Early treatment with antibiotics might not alter the course of tissue destruction caused by the exotoxin A. Methods: Literature searches were performed using the key words “puerperal infections,” “streptococcal infections,” “septic sacroiliitis,” “postpartum septic arthritis,” and “postpartum ovarian vein thrombosis.” After patient consent was obtained, a report was prepared documenting the disease course, diagnosis, and treatment of a case of puerperal sepsis with multiple serious complications. Results and Conclusion: Puerperal sepsis occurs when streptococci colonizing the genital tract or acquired nosocomially invade the endometrium, adjacent structures, lymphatics, and bloodstream. A lack of symptoms early in the course of infection is common; later, minor somatic complaints can quickly progress to septic shock as effects of the exotoxin A are manifest. Women who complain of fever, pelvic pain, or unexplained systemic symptoms in the early postpartum period should have a detailed history and physical examination. All sites of suspected infection should be cultured. If sepsis is suspected, diagnostic imaging includes chest radiographs, contrast-enhanced computed tomographic scans, or magnetic resonance imaging to rule out ovarian vein thrombosis, pelvic abscess, or sacroiliac septic arthritis. Broad-spectrum antibiotic coverage must be initiated immediately after collection of cultures. Clindamycin plus a -lactam antibiotic is preferred for streptococcal toxic shock syndrome.(J Am Board Fam Pract 2001;14:375–80.)