Cases of death due to serious group A streptococcal toxic shock syndrome in pregnant females in Japan.

Abstract

Serious group A streptococcal (GAS) infections and its toxic shock syndrome (TSS) are associated with early onset and rapid progression, often resulting in death [1, 2]. The initial symptoms of a high fever and abdominal or chest pain are characteristics and are attributable to a common cold syndrome or viral infection [1]. The incidence rate is extremely low, with rates largely between 2 and 4 per 1,00,000 [3]. However, GAS-TSS is still one of the causes of maternal death. The perinatal and infant mortality rates in Japan are lowest worldwide (3:1,000). On the other hand, the maternal mortality rate is relatively high (4:1,00,000) [4]. Therefore, the Japan Association of Obstetricians and Gynecologists (JAOG) established a registration system for maternal death in 2010. If maternal death occurs, detailed reports are to be submitted to the JAOG. The individual data are analyzed by the Maternal Death Exploratory Committee (Chairman: Ikeda, T.). This committee consists of 15 obstetricians, four anesthesiologists, two pathologists, an emergency physician and some specialists who attend review sessions every month, in order to make recommendations for reducing the maternal mortality every year. The present study was performed as part of a series which analyzed maternal deaths in Japan by this committee. Report forms regarding the maternal death cases where a female patient died during pregnancy or within a year after delivery are submitted to this registration system. The 12 pages of the report form contain approximately 100 questions, and elicit detailed information about the clinical history of each death, the facility characteristics and which personnel participated in the patient’s care. All of the anonymized reports were analyzed for factors associated with the maternal mortality and the circumstances of death. A total of 155 reports of maternal death were completely analyzed by the Maternal Death Exploratory Committee between 2010 and 2012, while 128 cases of maternal death that occurred during pregnancy or within 42 days after delivery were reported by the Ministry of Health, Labour and Welfare, Japan [4]. Because GAS-TSS is still one of the causes of maternal death, though number of maternal death is decreasing in Japan, we thought it was necessary to clarify the clinical course and features of maternal death due to serious GAS infection in order to reduce the maternal mortality rate. In the analyzed reports of maternal deaths between 2010 and 2013, the clinical features in the pregnant patients who died due to serious GAS-TSS were reviewed in the present study. Cases were enrolled when the diagnosis of GASTSS based upon the previously published criteria [5] was made, and when culture findings were positive or the GAS toxin was detected. J. Hasegawa (&) A. Sekizawa Department of Obstetrics and Gynecology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo 142-8666, Japan e-mail: hasejun@oak.dti.ne.jp