Management of STIs/RTIs
Chapter 9. STI/RTI complications related to pregnancy, miscarriage, induced abortion, and the postpartum period

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Key points

• Infection in pregnancy, following miscarriage, induced abortion or in the postpartum period, can be life-threatening and must be managed aggressively and without delay.
• Patients with infectious complications of induced abortion (safe or unsafe) should be treated with intravenous fluids and antibiotics, and referred immediately if emergency management cannot be provided on-site.
• Infection in pregnancy can provoke preterm labour and serious complications for mother and fetus. Prevention and early management are key to reducing morbidity and mortality.
• Patients with postpartum infection should be treated with intravenous fluids and antibiotics, and referred immediately if emergency management cannot be provided on-site.
• Vaginal discharge in pregnancy may mask signs of abortion complications, rupture of membranes or postpartum infection. If there is no evidence of blood or amniotic fluid, treatment should be given to cover yeast infection, trichomoniasis and bacterial vaginosis.
• Activities to prevent postpartum infection include prevention and detection of STI/RTI during pregnancy (Chapter 2 and Chapter 3) and good delivery practice.

 

Chapter 7 discussed STIs/RTIs in the context of routine care of women during pregnancy, childbirth and the postpartum period. This chapter looks at some important STI/RTI-related problems that can occur during or following pregnancy, and addresses the management of infectious complications that can occur in such situations. Management of miscarriage, complicated induced abortion (endometritis, septic abortion), and postpartum infection (endometritis, puerperal sepsis) is emphasized because these are among the most serious conditions that affect women�s health during their reproductive years, and are largely preventable.

While this chapter focuses on STI/RTI management, infection may not be the woman�s chief concern or reason for her visit to the clinic. Women with abortion complications or postpartum infection often present with bleeding and pain, and may be in shock. Other WHO guidelines¹ provide guidance on comprehensive management including assessing and stabilizing patients, and starting intravenous fluids and antibiotics. Once stabilized, the patient should be referred to a centre that can provide appropriate emergency services.

Advice on preventing infection when performing medical and obstetrical procedures is given in Chapter 2.

 

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¹ Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice. Geneva, World Health Organization, 2003, and

Managing complications in pregnancy and childbirth: a guide for midwives and doctors. Geneva, World Health Organization, 2000.