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


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.



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.


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Infections of the male and female reproductive tract and their consequences:

What are RTIs?

Why STI/RTIs are important?

What can be done about RTIs?

The role of clinical services in reducing the burden of STI/RTI

Preventing STIs/RTIs and their complications

How to prevent STI

How to prevent iatrogenic infections

How to prevent endogenous infections

Detecting STI/RTI

Detecting STI/RTI


Vaginal infections

Cervical infections

Pelvic inflammatory disease

HIV counselling and testing

STI/RTI education and counselling

Key points

Privacy and confidentiality

General skills for STI/RTI education and counselling

Health education


Promoting prevention of STI/RTI and use of services

Key points

Reducing barriers to use of services

Raising awareness and promoting services

Reaching groups that do not typically use reproductive health services

STI/RTI Assessment during Routine Family Planning Visits

Key points

Integrating STI/RTI assessment into routine FP services

Family planning methods and STIs/RTIs

STI/RTI Assessment in pregnancy, childbirth and the postpartum period

Key points

Management of symptomatic STIs/RTIs

Syndromic management of STI/RTI

Management of common syndromes

STI case management and prevention of new infections

STI/RTI complications related to pregnancy, miscarriage, induced abortion, and the postpartum period

Key points

Infection in early pregnancy

Infection in lated pregnancy

Infection following childbirth

Vaginal discharge in pregnancy and the postpartum period

Sexual violence

Key points

Medical and other care for survivors of sexual assault

Annex 1. Clinical skills needed for STI/RTI


Common STI/RTI symptoms

Examining patients

Annex 2. Disinfection and universal precautions

Preventing infection in clinical settings

High-level disinfection: three steps

Universal precautions

Annex 3. Laboratory tests for RTI

Interpreting syphilis test results

Clinical criteria for bacterial vaginosis (BV)

Wet mount microscopy

Gram stain microscopy of vaginal smears

Use of Gram stain for diagnosis of cervical infection

Annex 4. Medications

Medications in pregnancy

Antibiotic treatments for gonorrhoa

Annex 5.

STI/RTI reference table


Additionnal resources


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