The role of chlamydial infection in pregnancy complications remains controversial. A few studies have reported a direct association between C trachomatis and miscarriage, whereas most show no correlation (Baud, 2011; Coste, 1991; Paukku, 1999). It is disputed whether untreated cervical infection increases the risk of preterm delivery, preterm ruptured membranes, low birthweight, or perinatal mortality (Andrews, 2000, 2006; BIas, 2007; Johnson, 2011; Moodley, 2017; Silva, 2011). Chlamydial infection has not been associated with a greater risk of chorioamnionitis or with peripartum pelvic infection (Berman, 1987; Gibbs, 1987). However, delayed postpartum uterine infection has been described by Hoyme and associates (1986). The syndrome, which develops 2 to 3 weeks postpartum, is distinct from early postpartum metritis. It is characterized by vaginal bleeding or discharge, low-grade fever, and uterine tenderness.
Infection poses a higher risk to the newborn than to the mother. Vertical transmission leads to infection in 8 to 44 percent of neonates delivered vaginally from afected women (Rosenman, 2003). Of neonatal infections, conjunctivitis is the most common (Chap. 32, p. 613). Perinatal transmission to newborns can also cause pneumonia.
Currently, the U.S. Preventive Services Task Force (LeFevre, 2014) as well as the American Academy of Pediatrics and American College of Obstetricians and Gynecologists (2017) recommend chlamydia screening for all women at the irst prenatal visit. he College further suggests testing in the third trimester for those treated in the irst trimester; all women aged ;25 years; and those aged �25 years with behavioral factors, which mirror those for women at risk for gonorrhea. In one review of repeat chlamydial infections among women, the reinfection rate was 14 percent, and most recurred within the first 8 to 10 months (Hosenfeld, 2009).
Diagnosis is made predominantly by culture or NAAT. Cultures are more expensive and less accurate than newer NAA T s (Greer, 2008). Of samples for NAAT, vaginal or cervical
TABLE 65-3. Oral Treatment of Chlamydia trachomatis Infections During Pregnancy
Erythromycin ethylsuccinate, 400 mg four times daily for 14 d
Data from Workowski, 2015.
samples are preferred, as urine collection may detect up to 10 infections (Papp,
Wiesenfeld, 2017).
Roberts and associates (2011) evaluated NAA T of urine speci mens compared with cervical secretions in more than 2000 pregnant women and found them to be equivalent. As with gonorrhea, the irst portion of the urine stream is collected.
Currently recommended treatment regimens for chlamydial infections are shown in Table 65-3. Azithromycin is irst-line treatment and is safe and efective in pregnancy. The luoroquinolones and doxycycline are usually avoided in pregnancy, and erythromycin estolate is contraindicated because of drug-related hepatotoxicity. Chlamydial testing is repeated 3 to 4 weeks after therapy completion and ,gain 3 months after treatment. In high-risk individuals, third-trimester rescreening is recommended (Workowski, 2015).