Department of Reproductive Health and Research (RHR), World Health Organization
Sexually transmitted and other reproductive tract infections
A guide to essential practice
Management of STIs/RTIs
Infection in late pregnancy
After the first trimester, infection of the vagina, cervix, and fetal membranes or amniotic fluid (chorioamnionitis) is a common cause of spontaneous abortion, rupture of membranes, preterm labour and stillbirth. The same vaginal, cervical and exogenous organisms (gonococci, chlamydia, bacteria associated with bacterial vaginosis, trichomonas, group B streptococci) may be involved in postabortion infection, chorioamnionitis, and postpartum and neonatal infections. Some of these infections often follow vaginal examination or other procedures, which should be avoided in late pregnancy unless necessary. Prevention of these complications also includes detection and treatment of STIs/RTIs during antenatal visits where possible (Chapter 3).
Infection and rupture of membranes
Infection may cause rupture of membranes (ROM) or follow it. All women—whether at term or preterm—with ROM and any signs of infection (fever, increased white blood cells, increased C-reactive protein or foul-smelling discharge) should be given antibiotics intravenously or intramuscularly (Flowchart 7) and urgently referred for care.
When membranes rupture at term, labour usually begins within 24 hours. Women without signs of infection can be observed. If labour does not begin within 24 hours, the woman should be referred to a facility where labour can be safely induced. To further reduce the risk of infection:
When membranes rupture before term, complications—preterm delivery, low birth weight, and perinatal morbidity and mortality—are more common. When ROM occurs before onset of labour, management should take into account the health of the mother, gestational age and viability of the fetus, and available options for intervention. Flowchart 7 summarizes the management of women with prelabour rupture of membranes.
In choosing the antibiotics to treat infection in a woman with a viable pregnancy, the risks and benefits should be carefully weighed. Antibiotics that may be harmful to the fetus should be avoided where possible (see Annex 4). If infection is severe, however, the priority should be to give effective antibiotic treatment.
Prevention of infection in late pregnancy and preterm delivery should include interventions throughout the pregnancy to prevent and detect STI/RTI. Where feasible, screening for common STIs/RTIs implicated in prelabour ROM and other adverse pregnancy outcomes is recommended at the first antenatal visit, and again later in pregnancy for women at high risk of preterm labour (see Chapter 3). The importance of primary prevention of STI/RTI to a healthy pregnancy should be emphasized to women and their partners.
Infections of the male and female reproductive tract and their consequences:
Preventing STIs/RTIs and their complications
STI/RTI education and counselling
Promoting prevention of STI/RTI and use of services
STI/RTI Assessment during Routine Family Planning Visits
STI/RTI Assessment in pregnancy, childbirth and the postpartum period
Management of symptomatic STIs/RTIs
STI/RTI complications related to pregnancy, miscarriage, induced abortion, and the postpartum period
Annex 1. Clinical skills needed for STI/RTI
Annex 2. Disinfection and universal precautions
Annex 3. Laboratory tests for RTI
Annex 4. Medications