Bacterial Infections in Pregnancy

Abstract

All pregnant women should be screened on the first prenatal visit for chlamydia infection and gonorrhea. High-risk patients should be rescreened in the third trimester. Patients with symptomatic bacterial vaginosis should be treated with metronidazole to prevent complications such as preterm delivery, chorioamnionitis, and puerperal endometritis. All patients should be screened for GBS infection at 35 to 37 weeks and treated intrapartum with prophylactic antibiotics if they test positive. Prompt diagnosis and treatment of chorioamnionitis are essential to prevent neonatal and maternal complications. The treatment of choice intrapartum is ampicillin plus gentamicin. Patients who require cesarean delivery should also receive either clindamycin or metronidazole postpartum to strengthen coverage against anaerobes. Two highly effective treatment regimens for puerperal endometritis are clindamycin plus gentamicin or metronidazole plus ampicillin plus gentamicin. This review contains 5 figures, 7 tables and 43 references. Key Words: bacterial vaginosis, chorioamnionitis, lower genital tract infection, puerperal infection, urinary tract infection