Group A Streptococcal Infection in Pregnancy and the Puerperium.

There has been an increasing incidence worldwide of invasive group A streptococcal disease in pregnancy and the puerperal period over the past 30 years. Group A Streptococcus (GAS) was identified as the major cause of maternal morbidity and mortality from sepsis before the identification that hand washing techniques could prevent the transmission of the bacteria. Hand washing remains the cornerstone of prevention as transmission can occur directly from an asymptomatic colonized healthcare provider, other patients, or a community-acquired source. Pregnancy and the puerperal period are associated with significant maternal physiologic changes that must be identified and clarified to identify signs and symptoms of GAS so that treatment can be initiated at the earliest moment. Treatment of group A streptococcal sepsis follows the guidelines developed under the Surviving Sepsis Campaign model. Maternal outcomes are improved by identifying risk factors and working with the perinatal team to implement rapid intervention. Even with prompt treatment of invasive group A Streptococcus, it remains the most common cause of infection that results in severe maternal morbidity and death in the world.

Streptococcal A infection: reemerging and virulent.

Streptococcal A infections are reemerging as a dangerous clinical problem. This particular infection is usually a problem for the postpartum mother and not usually associated with fetal or neonatal infections. Maternal morbidity and mortality are overwhelming when compared with other maternal infections. Historically, group A streptococcus was the cause of epidemic postpartum sepsis prior to the advent of proper hand-washing techniques. Currently, transmission can occur directly from a colonized healthcare provider, other patients, or a community-acquired source. The Joint Commission and the International Surviving Sepsis Campaign have placed patient safety and early recognition and treatment of sepsis as major initiatives to improving patient outcomes.

The pregnant trauma patient in the intensive care unit: collaborative care to ensure safety and prevent injury.

The pregnant woman who has experienced trauma will need to be transferred to an appropriate setting once she is stabilized. Nursing has evolved into many specialty areas with specific sets of skills developed to care for women in these areas. The trauma team and the intensive care unit team will most likely be uncomfortable with the pregnant woman. The perinatal team may be uncomfortable with the injuries or illness that brought the woman to the trauma unit. Together the combined knowledge of all teams can provide for safe care of the woman and fetus and prevent injury occurring to them. Collaborative care is part of the overall plan of care, which follows a formal plan already established by the leadership teams of the 2 units. The purpose of this article is to review collaborative care in the intensive care unit and to provide an overview of the nursing skill sets necessary to care for the pregnant trauma woman.

Alloimmune thrombocytopenia in the fetus: current management theories.

Fetal alloimmune thrombocytopenia (AIT) affects only a small number of fetuses but the consequences may be devastating. Outcomes range from mild thrombocytopenia without signs or symptoms to intracranial hemorrhage (ICH) and fetal or neonatal death. Antenatal screening is available but not used routinely in the United States. The most frequent method of AIT identification is its diagnosis in the neonatal period (index neonate). AIT may be diagnosed antenatally if an ICH is noted on routine obstetric ultrasound. There are accurate predictors of AIT, as well as antenatal therapies, to prevent the occurrence of severe disease and ICH.

Use of antidiabetes agents in pregnancy: current practice and controversy.

Prior to the discovery of insulin, the combination of diabetes and pregnancy was considered potentially lethal. Advances in the care of diabetes, combined with advances in antepartum fetal testing, have reduced maternal and perinatal mortality outcomes to levels expected in nondiabetic pregnancies. As new oral antidiabetes medications are introduced, the safety and efficacy of using them during pregnancy are under investigation. This article describes the oral medications currently available to treat diabetes, reviews the body of research available on these agents, and discusses current recommendations and controversies.