Maternal infection and the risk to the baby

What is it?

Group B strep is a bacteria that lives harmlessly in many adults. It is not a sexually transmitted infection and carrying it is not a health problem for the person carrying it. It matters only because a baby can be exposed during birth and can develop serious infection. ²

chorioamnionitis, also called intraamniotic infection, means bacteria have reached the membranes and fluid around the baby. It typically presents with maternal fever, a fast maternal heart rate, a fast fetal heart rate and uterine tenderness. It affects both mother and baby, and it is named in guidance as a contributor to newborn brain injury. ¹

Urinary tract infection is more common in pregnancy, and untreated infection can ascend to the kidneys and is associated with preterm labor.

Two ways infection injures a baby

Directly. Bacteria reach the baby and cause neonatal sepsis or meningitis. ²

Through inflammation. The inflammatory response itself can injure developing brain tissue, particularly white matter, without the baby being infected at all. This is why maternal infection appears in guidance as a contributor to brain injury separately from oxygen deprivation. ^{1 4}

Infection is also one of the recognized causes of preterm labor, so it can injure through that route as well. ³

What does standard care look like?

GBS screening in late pregnancy, with guidance setting out the recommended timing and method. ²

Antibiotics through a vein during labor for those who screen positive, for those with risk factors, and for those whose status is unknown with risk factors present. Risk factors include preterm labor, prolonged rupture of membranes, fever in labor, and a previous baby with GBS disease. ²

Appropriate antibiotic choice, including in people with a penicillin allergy, where guidance addresses testing and alternatives. ²

Recognition and treatment of chorioamnionitis, including antibiotics and informing the newborn team. ¹

Treatment of urinary infection in pregnancy, including asymptomatic bacteriuria.

Prophylactic antibiotics before cesarean. ⁵

Newborn evaluation where the mother had fever or infection in labor. ²

Placental pathology where infection is suspected, which can confirm it. ¹

What can go wrong?

GBS screening not done, or done outside the recommended window. ²

A positive result not acted on in labor.

Antibiotics given too late, or not at all, or the wrong choice used in someone with a penicillin allergy. ²

Risk factors not acted on in someone with unknown GBS status. ²

Fever in labor not treated, and the newborn team not informed, which changes how the baby is evaluated. ²

chorioamnionitis not recognized, where the combination of fever, fast heart rates and uterine tenderness was present. ¹

Urinary infection not treated.

The placenta not sent to pathology, so the evidence of infection was lost. ¹

The newborn not evaluated or not treated despite maternal infection. ²

Whether any of this amounts to a departure from the standard takes a physician expert reading the whole record.

Which injuries can follow?

For the baby

• Neonatal sepsis. ²
• Neonatal meningitis, with its risks of hearing loss and hydrocephalus. ^{6 7}
• Neonatal encephalopathy and HIE, where infection contributes. ¹
• Periventricular leukomalacia and white matter injury, through inflammation. ⁴
• Cerebral palsy. ¹
• Preterm birth and everything that follows. ³
• Neonatal seizures. ⁸

For the mother, see infection in pregnancy and after birth. ⁹

What does this look like in the records?

From the prenatal record

• The GBS screening result and the date it was taken. ²
• Urine culture results and any treatment.
• Any documented infection during the pregnancy.

From the labor record, which is where the answers are

• Every temperature reading with its time.
• Maternal and fetal heart rates over time. ¹⁰
• The time of rupture of membranes, and how long before delivery.
• Which antibiotic was given, at what time, and how many doses. This is the single most important entry. ²
• Whether chorioamnionitis was diagnosed and documented. ¹
• Whether the newborn team was informed.

From the newborn record

• The infection evaluation: blood cultures, blood count, and whether a lumbar puncture was done. ⁴
• Antibiotics given and the duration.

Afterward

• The placental pathology report, which can confirm infection of the membranes. Ask for it separately. ¹

What can you do this week?

1. Request the complete labor and delivery record for you and your baby. The records request builder writes the letters for you.
2. Write down what you remember while it is fresh, using the delivery timeline builder.
3. Read how to read your labor and delivery records before the records arrive.
4. Check the deadline to file in your state with the statute of limitations lookup.