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A group of 1031 parturient women at high risk for intraamniotic infection were studied. Women in whom group B streptococci grew from cultures of the amniotic fluid did not differ in clinical risk factors when compared with similar parturient women without group B streptococcal colonization of amniotic fluid. Patients who had perinatal group B streptococcal disease (maternal or neonatal bacteremia) did not differ from those without disease, by maternal or neonatal acute antibody levels or antibody response, inoculum size, or serotype of the colonizing strain.

Bacteriuria in pregnancy was prospectively studied in 569 women, with specific reference to group B streptococcal infection. Forty-six patients (8%) had bacteriuria, including 14 with group B streptococcal infection; group B streptococci (GBS) were exceeded in frequency only by Escherichia coli. Two thirds of the bacteriuric patients remained asymptomatic. The outcome of pregnancy was studied in 41/46 bacteriuric patients, including all those with group B streptococcal infection. Two pregnancies ended in intrauterine fetal death, and one neonate developed group B streptococcal sepsis; all three complications occurred in the 14 women with group B streptococcal bacteriuria. Diabetes mellitus appeared to increase the risk of group B streptococcal bacteriuria. This study revealed that group B streptococcal bacteriuria is more common in pregnancy than was previously suspected and suggests that culture methods to detect GBS should be used in bacteriuria screening programs done in pregnancy. In terms of perinatal infection risk, screening for group B streptococcal bacteriuria at or near the time of delivery may be more meaningful than other group B streptococcal surveillance culture studies.

Twenty-one patients were seen with puerperal sepsis owing to group B streptococci (GBS), resulting in an attack rate of 2/1,000 deliveries. Most were young primiparous black women from a population with a known high incidence of GBS carriage. The asscciation among abdominal delivery, endometritis, and puerperal sepsis was striking. Cultures of the birth canal or lochia were commonly positive for the same serotype recovered from the blood. Forty-seven patients with nonbacteremic GBS infections were seen; 27 had endometritis or amnionitis. Twenty patients had GBS urinary tract infection: Eight infections occurred prenatally, seven at delivery, and five post partum. Seven neonates developed serious GBS infections; intrauterine exposure occurred in at least four cases. Fetal exposure to GBS also occurred in three of four cases in which parturients with GBS bacteremia were delivered of their infants by cesarean section. Because of the high incidence of puerperal and perinatal GBS infections in this population, antibiotic prophylaxis regimens may be beneficial.

Type-specific antibodies against group B streptococcal and pneumococcal capsular antigens were measured in 68 amniotic fluid samples from healthy women between 16 and 20 weeks of pregnancy. Mean antibody levels ranged from 0.13 to 0.61 microgram/ml, with few samples having greater than 1 microgram/ml against any antigen. The role of antibodies in protection against intrauterine infection is discussed.