Management of Enteritis in Pregnancy

Initial Assessment and Diagnosis

• The American College of Gastroenterology recommends that 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

Management Approach

Hydration and Supportive Care

• Pregnant women with severe dehydration require hospitalization for intravenous fluid replacement and close monitoring 1
• For pregnant women with Salmonella gastroenteritis, treatment is recommended to prevent extraintestinal spread of the pathogen 1

Antimicrobial Therapy

• 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 2

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 2
• Thiopurine maintenance therapy should be continued throughout pregnancy 2
• Anti-TNF therapy should be continued in pregnant women on maintenance therapy 2

Imaging Considerations

• Limit radiologic investigations to ultrasound and MRI where possible 2
• Avoid gadolinium as part of MR imaging during pregnancy 1
• Flexible sigmoidoscopy or colonoscopy may be used if the results will affect antenatal management 2

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