CAPSULE

Women presenting with recurrent pregnancy losses and positive genital tract cultures for Group B Streptococcus infection were successfully managed with pre and post-conceptional antibiotic therapy.  An infectious etiology of these miscarriages is suggested.

ABSTRACT

OBJECTIVE: To offer antibiotics as a valued treatment option for patients with group B streptococcus colonization and recurring first trimester pregnancy losses.

DESIGN: Case reports.

SETTING: Private infertility clinic with New York State licensed microbiology laboratory.

PATIENTS: Six couples who visited The MacLeod Laboratory for the evaluation of recurring first trimester miscarriages during an eighteen months period.

INTERVENTION: All couples underwent routine fertility evaluation and detailed bacteria testing of seminal fluid, cervix and endometrial samples. Based on culture results, all couples received antibiotics as the only fertility therapy. After the next pregnancy was achieved all the wives were retreated with intravenous Ampicillin.

RESULTS: All six women revealed positive post - conceptional cervical culture for group B streptococcus. Following a post conceptional IV Ampicillin therapy only two patients remained culture positive during the second trimester and were treated with additional oral Penicillin for the remainder of pregnancy. All six women experienced term deliveries.

CONCLUSIONS: It appears that in addition to causing infectious complications and pregnancy loss during the second and third trimester, group B streptococcus is also associated with first trimester pregnancy losses. We also suggest revising the recommended dose of antibiotics in this group of patients.

INTRODUCTION

Group B streptococcus is readily recovered from human sources, both in symptomatic and asymptomatic conditions, most notably from the vaginal canal in postpartum women suffering from endometritis (1,2).  The bacterium is known to be one of the chief causes of neonatal sepsis and meningitis (3) Recently group B streptococcus infection has been reported in association with preterm delivery (4), suspected as one of the major causes of still birth (5) and as the key pathogen in asymptomatic intrauterine infections associated with spontaneous mid-trimester abortions (6).  During the past few years, we observed certain patients with histories of multiple first trimester miscarriages and heavy cervical and endometrial colonization with group B streptococcus.  Since some patients, in addition, have experienced adverse pregnancy outcomes identical to those associated with group B streptococcus, without finding any other cause for the pregnancy losses, we elected to use antibiotics as the single therapeutic regimen in this group of patients.

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