WHO Recommendations for Prevention and Treatment of Maternal Peripartum Infections

These infections also contribute to severe morbidity and long-term disabilities, such as chronic pelvic pain, fallopian tube blockage, and secondary infertility, affecting many women. Maternal infections before or during childbirth are associated with an estimated 1 million newborn deaths annually. Several factors have been linked to an increased risk of maternal peripartum infections, including pre-existing maternal conditions, such as malnutrition, diabetes, obesity, severe anaemia, and bacterial vaginosis, as well as spontaneous or provider-initiated conditions during labour and childbirth, such as prolonged rupture of membranes, multiple vaginal examinations, manual removal of the placenta, and caesarean section. Strategies to reduce maternal peripartum infections and their complications have focused on preventive measures where such risk factors exist. The World Health Organization (WHO) has prioritized evidence-based interventions for the prevention and treatment of genital tract infections during labour, childbirth, and the puerperium. The most common intervention for preventing morbidity and mortality related to maternal peripartum infection is the use of antibiotics for prophylaxis and treatment. However, antibiotic misuse for obstetric conditions or procedures that are thought to carry a risk of infection is common in clinical practice, which has implications for global efforts to contain the emergence of antibiotic-resistant bacteria. Standard infection prevention and control measures are a cornerstone of peripartum infection prevention, including hand hygiene and the use of clean equipment. WHO recommendations for the prevention and treatment of maternal peripartum infections include both recommended and non-recommended interventions during labour, childbirth, and the postpartum period. Clinical monitoring, early detection, and prompt treatment of peripartum infection with an appropriate antibiotic regimen are essential for reducing death and morbidity in affected women. The WHO recommends judicious use of antibiotics to control antimicrobial resistance, including identifying and correcting predisposing factors to infection, promoting hand hygiene and the use of clean products and equipment, maintaining a clean hospital environment, and developing and implementing local protocols on infection prevention and control practices. The organization also recommends intrapartum antibiotic administration to women with group B Streptococcus (GBS) colonization for the prevention of early neonatal GBS infection. In addition, the WHO has made several recommendations for the prevention and treatment of maternal peripartum infections, including routine perineal/pubic shaving prior to giving vaginal birth, digital vaginal examination at intervals of four hours for routine assessment of active first stage of labour in low-risk women, and routine vaginal cleansing with chlorhexidine during labour for the purpose of preventing infectious morbidities. However, the organization does not recommend routine vaginal cleansing with chlorhexidine during labour in women with GBS colonization or routine antibiotic prophylaxis during the second or third trimester for all women with the aim of reducing infectious morbidity. The WHO also recommends against routine antibiotic administration for women in preterm labour with intact amniotic membranes, but recommends antibiotic administration for women with preterm prelabour rupture of membranes. Furthermore, the organization does not recommend routine antibiotic administration for women with prelabour rupture of membranes at or near term. These recommendations aim to balance health benefits for the mother and newborn with safety concerns and the public health imperative to control antibiotic resistance.