Tetanus remains a leading cause of maternal and neonatal morbidity and mortality in
developing countries. It is caused by the release of two toxins produced by Clostridium tetani, a noninvasive gram-positive anaerobic bacillus. Tetanospasmin is taken up by the
neuronal end plates and prevents neurotransmitter release at the synaptic junction.
This leads to spasms and is irreversible. Recovery requires the formation of new neurons
and may take months. Generalized muscle spasm, respiratory compromise, and autonomic
dysfunction are all common clinical manifestations. Diagnosis is based mainly on history
and clinical examination. The management of the pregnant woman is similar to the nonpregnant
individual. The main objectives are prompt prevention of further toxin absorption,
wound debridement, antibiotic therapy, and aggressive supportive care. Primary and
secondary prevention protocols are important worldwide because tetanus is a preventable
disease. The tetanus toxoid vaccine can be given in pregnancy.
KEYWORDS
Tetanus - pregnancy -
Clostridium tetani
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Jeanne S SheffieldM.D.
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical
Center
5323 Harry Hines Boulevard, Dallas, TX 75390-9032