Streptococcus bovis bacteremia and fetal death

BACKGROUND: Preterm premature rupture of membranes leading to intraamniotic infection and fetal death may be due to unusual bacterial species. CASE: A young multipara presented at 24 weeks and 6 days’ gestation with rupture of membranes of 2 days’ duration. She was febrile and hypotensive. No fetal heart activity was noted. Antibiotics, fluid resuscitation, and oxytocin were begun with delivery of a 798-g stillborn fetus. Maternal and fetal cultures demonstrated Streptococcus bovis as the infectious agent. CONCLUSION: Unusual bacteria such as S bovis are sometimes responsible for severe maternal and fetal infections. Aggressive fluid resuscitation, uterine evacuation, and triple antibiotic therapy until culture results are available are indicated.