Management of Enteritis in Pregnancy
For pregnant women with enteritis, immediate assessment of hydration status is essential, with hospitalization for intravenous fluid replacement recommended for those with severe dehydration. 1
Initial Assessment and Diagnosis
- Stool cultures should be obtained for enteroinvasive bacterial infections and Clostridioides difficile testing in pregnant women with gastroenteritis 1
- Travel and contact history should be carefully reviewed, with appropriate testing for amoebic or Shigella dysentery in patients with relevant travel history 1
- Clinical evaluation can provide important clues to aid in establishing a correct diagnosis in most patients with infectious enteritis 2
Management Approach
Hydration and Supportive Care
- Pregnant women with severe dehydration require hospitalization for intravenous fluid replacement and close monitoring 1
- Correction of electrolyte disturbances is essential, particularly monitoring for hyponatremia and hypokalaemia 3
- Thiamine (vitamin B1) supplementation should be provided to prevent Wernicke's encephalopathy, especially in cases of prolonged vomiting 4
Antimicrobial Therapy
- For pregnant women with Salmonella gastroenteritis, treatment is recommended to prevent extraintestinal spread of the pathogen 1
- Appropriate antibiotic choices include ampicillin, cefotaxime, ceftriaxone, or TMP-SMZ; fluoroquinolones should be avoided during pregnancy 1
- For perianal sepsis requiring antibiotic therapy, metronidazole and/or ciprofloxacin may be used 5
Thromboprophylaxis
- Pregnant women hospitalized for gastroenteritis should receive anticoagulant thromboprophylaxis during hospitalization 1
- Outpatients with active inflammatory disease should receive VTE prophylaxis during the third trimester, unless contraindicated 1
Symptom Management
- Antiperistaltic drugs are not recommended for pregnant women with diarrhea 1
- For constipation, which may occur during recovery, bulk-forming agents and stool softeners are considered safe in pregnancy 6
- Osmotic and stimulant laxatives should be used only in the short term or occasionally to avoid dehydration or electrolyte imbalances 6
Nutritional Support
- Following resolution of acute symptoms, cautious introduction of fluids and low-fat solids is recommended 7
- When oral feeding is not tolerated, enteral nutrition combined with antiemetic therapy may be considered 7
- Iron tablets should not be used in those with active inflammatory disease as systemic inflammation inhibits absorption 1
Special Considerations for Inflammatory Bowel Disease
- For pregnant women with IBD who develop enteritis:
- 5-ASA therapy should be continued throughout pregnancy if already on maintenance therapy 5
- Thiopurine maintenance therapy should be continued throughout pregnancy 5
- Anti-TNF therapy should be continued in pregnant women on maintenance therapy 5
- For disease flares, systemic corticosteroids or anti-TNF therapy is recommended to induce symptomatic remission 5
Imaging Considerations
- Limit radiologic investigations to ultrasound and MRI where possible 5
- Avoid gadolinium as part of MR imaging during pregnancy 1
- Flexible sigmoidoscopy or colonoscopy may be used if the results will affect antenatal management 5
Follow-up and Prevention
- Household contacts of pregnant women with salmonellosis or shigellosis should be evaluated for asymptomatic carriage to prevent recurrent transmission 1
- Mental health screening should be performed with appropriate referral to support services 1
- Do not delay urgent surgery to manage complications solely due to pregnancy 1
Common Pitfalls and Caveats
- Fluoroquinolones should be avoided during pregnancy due to potential risks to the fetus 1
- Osmotic and stimulant laxatives should only be used short-term to avoid dehydration or electrolyte imbalances 6
- Most cases of infectious enteritis are self-limiting, but some pathogens can cause serious disease requiring accurate diagnosis and suitable antibiotic therapy 2
- Appropriate precautions are mandatory to prevent the spread of infectious diarrhea in the hospital environment 2