Fever in pregnancy (listeriosis, pyelonephritis, chorioamnionitis, malaria)
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Fever (≥ 38 °C) without obvious cause: tests the same day
Samples before any antibiotic, the same day
- Blood cultures (state "pregnant woman, test for Listeria")
- Urine microscopy and culture
- FBC
- CRP
- Blood film and thick film (or rapid test combined with the blood film) urgently, if stay in a malaria-endemic areaif neededReturn from a malaria-endemic area: combine a sensitive technique (thick film or rapid molecular testing) with a thin film; pregnancy excludes outpatient management of a malaria attack [2].
- Obstetric opinion the same day (maternity unit); do not delay antibiotic therapy once blood cultures have been taken.
Do not order
- Listeria serology: poor sensitivity and specificity, not recommended for diagnosis [3].
- Stool culture for Listeria: not evaluated, not recommended; intermittent faecal carriage is common (about 5%) and does not indicate infection [3].
- Vaginal swab to look for Listeria: usually negative, placental infection being haematogenous [1].
Sources (15)
- Charlier C, Disson O, Lecuit M. Maternal-neonatal listeriosis. Virulence. 2020;11(1):391-397.
- SPILF, comité des référentiels. Prise en charge et prévention du paludisme d'importation, mise à jour 2017 des recommandations françaises (diaporama du groupe recommandations). Publication : Bouchaud O, Bruneel F, Caumes E, et al. Med Mal Infect. 2020;50(2):161-193.
- Centers for Disease Control and Prevention. Clinical care of listeriosis: management of people at risk for invasive listeriosis (page professionnels de santé), revue le 12 août 2024.
- Charlier C, Perrodeau É, Leclercq A, et al.; MONALISA study group. Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study. Lancet Infect Dis. 2017;17(5):510-519.
- American College of Obstetricians and Gynecologists. Committee Opinion No. 614: Management of pregnant women with presumptive exposure to Listeria monocytogenes. Obstet Gynecol. 2014;124(6):1241-1244.
- Charlier C, Goffinet F, Azria E, Leclercq A, Lecuit M. Inadequate management of pregnancy-associated listeriosis: lessons from four case reports. Clin Microbiol Infect. 2014;20(3):246-249.
- Charlier-Woerther C, Lecuit M. Listériose et grossesse. Presse Med. 2014;43(6 Pt 1):676-82.
- Charlier C, Sellier Y, Bille E, Driessen M, Kermorvant E, Lecuit M. Listériose et grossesse. Protocole de prise en charge au sein de l'hôpital Necker-Enfants malades. Rev Sage-Femme. 2019;18(4):199-203.
- Société de pathologie infectieuse de langue française (SPILF). Diagnostic et antibiothérapie des infections urinaires bactériennes communautaires de l'adulte. Actualisation au 11 décembre 2015, chapitre VIII « Infections urinaires au cours de la grossesse ».
- Schmitz T, Sentilhes L, Lorthe E, et al. Preterm premature rupture of the membranes: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2019;236:1-6.
- National Institute for Health and Care Excellence (NICE). Suspected sepsis in pregnant or recently pregnant people: recognition, diagnosis and early management. NICE guideline NG255, 19 novembre 2025 (recommandations 1.6.1, 1.7.2 et 1.11.2).
- Society for Maternal-Fetal Medicine; Shields AD, Plante LA, Pacheco LD, Louis JM. Society for Maternal-Fetal Medicine Consult Series #67: Maternal sepsis. Am J Obstet Gynecol. 2023;229(3):B2-B19.
- Rijksinstituut voor Volksgezondheid en Milieu (RIVM), Landelijke Coördinatie Infectieziektebestrijding. Listeriose : LCI-richtlijn, publiée le 27 mai 2025.
- Robert Koch-Institut. RKI-Ratgeber Listeriose, état du 24 novembre 2023.
- National Institute for Health and Care Excellence (NICE). Preterm labour and birth. NICE guideline NG25, 20 novembre 2015, mise à jour le 10 juin 2022 (recommandations 1.5.1 et 1.5.2).