{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T14:18:07Z","timestamp":1789654687611,"version":"4.0.1"},"reference-count":38,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2011,12,1]],"date-time":"2011-12-01T00:00:00Z","timestamp":1322697600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of the Royal College of Physicians of Edinburgh"],"published-print":{"date-parts":[[2011,12]]},"abstract":"<jats:p>Despite global efforts to reduce maternal mortality, maternal deaths from bacterial sepsis have actually risen in the UK. The group A streptococcus, also known as Streptococcus pyogenes, is the leading cause of infection-related death in pregnancy and the puerperium. Many clinicians remain unaware of the risks posed to this particular group of otherwise fit, healthy patients despite the fact that S. pyogenes has been the leading infective cause of puerperal deaths since records began. S. pyogenes has a specific but unexplained predilection for the recently pregnant woman, and has an attributable mortality greater than many other invasive bacteria. Here, the epidemiology, aetiology, and management of severe peripartum sepsis are discussed, as are potential approaches to reduce risks. While fundamental changes in healthcare access can lead to dramatic reductions in maternal deaths in developing countries, an improvement in maternal sepsis deaths in the UK will require heightened awareness among both hospital and community-based clinical staff.<\/jats:p>","DOI":"10.4997\/jrcpe.2011.411","type":"journal-article","created":{"date-parts":[[2011,12,14]],"date-time":"2011-12-14T11:14:00Z","timestamp":1323861240000},"page":"339-346","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":56,"title":["Severe peripartum sepsis"],"prefix":"10.1177","volume":"41","author":[{"given":"S","family":"Sriskandan","sequence":"first","affiliation":[{"name":"Professor and Honorary Consultant in Infectious Diseases, National Centre for Infection Prevention and Management, Department of Infectious Diseases &Immunity, Imperial College London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2011,12,1]]},"reference":[{"key":"bibr1-JRCPE.2011.411","unstructured":"1United Nations. Millennium development goals [Internet]. New York: United Nations; 2010. Available from: http:\/\/www.un.org\/millenniumgoals"},{"key":"bibr2-JRCPE.2011.411","first-page":"1189","volume":"368","author":"Ronsmans C","year":"2006","journal-title":"Lancet maternal survival series steering group. Maternal mortality: who, when, where, and why"},{"key":"bibr3-JRCPE.2011.411","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2010.02847.x"},{"key":"bibr4-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"4 Van\u00a0Dillen J, Zwart J, Schutte J  Maternal sepsis: epidemiology, etiology and outcome. Curr Opin Infect Dis 2010; 23:249\u201354. http:\/\/dx.doi.org\/10.1097\/QCO.0b013e328339257c","DOI":"10.1097\/QCO.0b013e328339257c"},{"key":"bibr5-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"5 Kramer HM, Schutte JM, Zwart JJ  Maternal mortality and severe morbidity from sepsis in the Netherlands. Acta Obstet Gynecol Scand 2009; 88:647\u201353. http:\/\/dx.doi.org\/10.1080\/00016340902926734","DOI":"10.1080\/00016340902926734"},{"key":"bibr6-JRCPE.2011.411","doi-asserted-by":"publisher","DOI":"10.1177\/003591573302600911"},{"key":"bibr7-JRCPE.2011.411","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0897.2011.01083.x"},{"key":"bibr8-JRCPE.2011.411","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7827-1-122"},{"key":"bibr9-JRCPE.2011.411","first-page":"393","volume":"62","author":"Maharaj D.","year":"2007","journal-title":"Puerperal pyrexia: a review. Part I"},{"key":"bibr10-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"10 Gupta SD, Khanna A, Gupta R  Maternal mortality ratio and predictors of maternal deaths in selected desert districts in Rajasthan: a community-based survey and case control study. Womens Health Issues 2010; 20:80\u201385. http:\/\/dx.doi.org\/10.1016\/j.whi.2009.10.003","DOI":"10.1016\/j.whi.2009.10.003"},{"key":"bibr11-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"11 Kongnyuy EJ, Mlava G, van den Broek N. Facility-based maternal death review in three districts in the central region of Malawi: an analysis of causes and characteristics of maternal deaths. Womens Health Issues 2009; 19:14\u201320. http:\/\/dx.doi.org\/10.1016\/j.whi.2008.09.008","DOI":"10.1016\/j.whi.2008.09.008"},{"key":"bibr12-JRCPE.2011.411","unstructured":"12UK Obstetrics Surveillance System (UKOSS). Severe maternal sepsis [Internet]. Oxford: UKOSS [cited 2011 Sept 9]. Available from: https:\/\/www.npeu.ox.ac.uk\/ukoss\/current-surveillance\/ss"},{"key":"bibr13-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"13 Kankuri E, Kurki T, Carlson P  Incidence, treatment and outcome of peripartum sepsis. Acta Obstet Gynecol Scand 2003; 82:730\u201335. http:\/\/dx.doi.org\/10.1034\/j.1600-0412.2003.00265.x","DOI":"10.1034\/j.1600-0412.2003.00265.x"},{"key":"bibr14-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"14 Boggess KA, Watts DH, Hillier SL  Bacteremia shortly after placental separation during cesarean delivery. Obstet Gynecol 1996; 87:779\u201384. http:\/\/dx.doi.org\/10.1016\/0029-7844(96)00037-3","DOI":"10.1016\/0029-7844(96)00037-3"},{"key":"bibr15-JRCPE.2011.411","first-page":"173","volume":"43","author":"Barnham MR","year":"2001","journal-title":"Bacteraemic Streptococcus pyogenes infection in the peri-partum period: now a rare disease and prior carriage by the patient may be important"},{"key":"bibr16-JRCPE.2011.411","first-page":"217","volume":"8","author":"Mead PB","year":"2000","journal-title":"Vaginal-rectal colonization with group A Streptococci in late pregnancy"},{"key":"bibr17-JRCPE.2011.411","unstructured":"17Colebrook, D. The source of infection in puerperal fever due to haemolytic streptococci. Report for the Medical Research Council. HMSO; 1935."},{"key":"bibr18-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"18 Dellinger RP, Levy MM, Carlet JM  Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Crit Care Med 2008; 36:296\u2013327. http:\/\/dx.doi.org\/10.1097\/01.CCM.0000298158.12101.41","DOI":"10.1097\/01.CCM.0000298158.12101.41"},{"key":"bibr19-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"19 Chuang I, Van\u00a0Beneden C, Beall B  Population-based surveillance for postpartum invasive group A streptococcus infections, 1995\u20132000. Clin Infect Dis 2002; 35:665\u201370. http:\/\/dx.doi.org\/10.1086\/342062","DOI":"10.1086\/342062"},{"key":"bibr20-JRCPE.2011.411","unstructured":"20 Lamagni T, Efstratiou A, Sriskandan S  Excess maternal risk of severe group A streptococcal infection. Abstract 23. XVIIIth Lancefield International Symposium on Streptococci and Streptococcal Diseases (LISSSD); 2011 Sept; Palermo, Italy."},{"key":"bibr21-JRCPE.2011.411","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir325"},{"key":"bibr22-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"22 Lamagni TL, Darenberg J, Luca-Harari  Epidemiology of severe Streptococcus pyogenes disease in Europe. Clin Microbiol Infect 2008; 14:1002\u20139. http:\/\/dx.doi.org\/10.1111\/j.1469-0691.2008.02076.x","DOI":"10.1111\/j.1469-0691.2008.02076.x"},{"key":"bibr23-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"23 Stevens DL, Gibbons AE, Bergstrom R  The eagle effect revisited: efficacy of clindamycin, erythromycin, and penicillin in the treatment of streptococcal myositis. J Infect Dis 1988; 158:23\u201328. http:\/\/dx.doi.org\/10.1093\/infdis\/158.1.23","DOI":"10.1093\/infdis\/158.1.23"},{"key":"bibr24-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"24 Sriskandan S, McKee A, Hall L  Comparative effects of clindamycin and ampicillin on superantigenic activity of Streptococcus pyogenes. J Antimicrob Chemother 1997; 40:275\u201377. http:\/\/dx.doi.org\/10.1093\/jac\/40.2.275","DOI":"10.1093\/jac\/40.2.275"},{"key":"bibr25-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"25[No authors listed]. IV immunoglobulin therapy for infectious diseases. Drug Ther Bull 2010; 48:57\u201360. http:\/\/dx.doi.org\/10.1136\/dtb.2009.07.0032","DOI":"10.1136\/dtb.2009.07.0032"},{"key":"bibr26-JRCPE.2011.411","unstructured":"26 Kearney J. Guidelines for prevention and control of group A Streptococcal infection in acute healthcare and maternity settings in the UK. J Infect. Forthcoming 2011."},{"key":"bibr27-JRCPE.2011.411","doi-asserted-by":"publisher","DOI":"10.2807\/ese.14.05.19110-en"},{"key":"bibr28-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"28 Luca-Harari B, Darenberg J, Neal S  Clinical and microbiological characteristics of severe Streptococcus pyogenes disease in Europe. J Clin Microbiol 2009; 47:1155\u201365. http:\/\/dx.doi.org\/10.1128\/JCM.02155-08","DOI":"10.1128\/JCM.02155-08"},{"key":"bibr29-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"29 Zhang S, Green NM, Sitkiewicz I  Identification and characterization of an antigen I\/II family protein produced by group A Streptococcus. Infect Immun 2006; 74:4200\u201313. http:\/\/dx.doi.org\/10.1128\/IAI.00493-06","DOI":"10.1128\/IAI.00493-06"},{"key":"bibr30-JRCPE.2011.411","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.0020005"},{"key":"bibr31-JRCPE.2011.411","first-page":"216","volume":"315","author":"Taha TE","year":"1997","journal-title":"Effect of cleansing the birth canal with antiseptic solution on maternal and newborn morbidity and mortality in Malawi: clinical trial"},{"key":"bibr32-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"32 Rouse DJ, Cliver S, Lincoln TL  Clinical trial of chlorhexidine vaginal irrigation to prevent peripartal infection in nulliparous women. Am J Obstet Gynecol 2003; 189:166\u201370. http:\/\/dx.doi.org\/10.1067\/mob.2003.322","DOI":"10.1067\/mob.2003.322"},{"key":"bibr33-JRCPE.2011.411","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007482.pub2"},{"key":"bibr34-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"34 Steer AC, Law I, Matatolu L  Global emm type distribution of group A streptococci: systematic review and implications for vaccine development. Lancet Infect Dis 2009; 9:611\u201316. http:\/\/dx.doi.org\/10.1016\/S1473-3099(09)70178-1","DOI":"10.1016\/S1473-3099(09)70178-1"},{"key":"bibr35-JRCPE.2011.411","first-page":"218","volume":"340","author":"Bronze MS","year":"2010","journal-title":"Progress in the development of effective vaccines to prevent selected gram-positive bacterial infections"},{"key":"bibr36-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"36 McNeil SA, Halperin SA, Langley JM  Safety and immunogenicity of 26-valent group A streptococcus vaccine in healthy adult volunteers. Clin Infect Dis 2005; 41:1114\u201322. http:\/\/dx.doi.org\/10.1086\/444458","DOI":"10.1086\/444458"},{"key":"bibr37-JRCPE.2011.411","doi-asserted-by":"crossref","unstructured":"37 Colebrook L, Kenny M. Treatment with prontosil of puerperal infections due to haemolytic streptococci. Lancet 1936; 2:1319\u201322. http:\/\/dx.doi.org\/10.1016\/S0140-6736(00)48180-8","DOI":"10.1016\/S0140-6736(00)48180-8"},{"key":"bibr38-JRCPE.2011.411","unstructured":"38 Lewis G, editor. The confidential enquiry into maternal and child health (CEMACH) saving mothers\u2019 lives: reviewing maternal deaths to make motherhood safer: 2003\u20132005. The seventh report on confidential enquiries into maternal deaths in the United Kingdom. London: CEMACH; 2007. 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