Infectious Diseases in pregnancyThis is a featured page

Infectious diseases in pregnancy Infectious diseases are recognized because of maternal and neonatal morbidity.
Viral infections
AIDS – Acquired Immunodeficiency Syndrome
Infection with the HIV ( Human Immunodeficiency Virus ) results in the development of AIDS HIV has been isolated in blood, serum, vaginal secretions, urine, saliva, tears, CSF, amniotic fluid, breast milk. HIV is a RNA retrovirus. Virus infected cells are major source of infection of HIV Individuals who are at high risk of AIDS include: - Homosexuals - Haemophilic patients - Patients who receive blood transfusion - Prostitutes - Intravenous drug abusers - Children delivered from HIV positive mothers The average interval from initial infection to the onset of AIDS in an adult is 10 years Typically the patient develops asymptomatic lymphadenopathy followed by onset of constitutional symptoms
  • Anorexia
  • Fever
  • Weight loss
  • Diarrhoea
  • Nausea
  • Vomiting
Opportunistic infections are:
  • Pneumonia
  • Tuberculosis
  • Meningitis
  • Nephritis
  • Severe herpes
Secondary cancers include:
  • Kaposis sarcoma
  • Non – Hodgkin’s lymphoma
Neurological diseases are:
  • Dementia
  • Neuropathy
In children the disease progresses more rapidly. Of infants with HIV, half develops AIDS in the 1st year of life and 35% develops AIDS by the age of 3 years. Children have extremely poor prognosis and average survival time from diagnosis is 3 years. Pregnancy does not appear to accelerate the course of HIV infection. But pregnant woman may be at increased risk for developing of infectious complications during pregnancy Infectious complications during pregnancy:
  • Opportunistic infections
  • Postpartum infections
  • Antepartum urinary tract infections
  • Sexually transmitted diseases
Studies to date have not shown an increased risk of growth retardation, preterm labour or premature rupture of membranes. The risk of vertical transmission of HIV from an infected mother to her infant is between 20% - 30%. Such transmissions account for 99% of cases of HIV infections in children. Vertical transmissions may occur:
  • In utero transplacental
  • Intrapartum
  • Postpartum
More than 50% transmission occurs just before the time of labour or during labour There is no confirmed evidence that foetal HIV infections can result in structural anomalies. It appears that women with advanced disease, recent HIV infection or preterm delivery have an increased risk of vertical transmission to their infants. And as HIV has been isolated in breast milk transmission may occur with breast feeding and increases the risk of transmission by 10% – 20%.
Infectious Diseases in pregnancy - Dr.Rufus' Medical Website
Cytomegalovirus
( no clinical symptoms ) It is a DNA virus, transmitted by:

  • Blood transfusion
  • Sexual contact
  • Urine
  • Saliva
  • Transplacentally
  • During delivery by direct contact
Placental infection may occur without foetal infection and when the mother does not exhibit symptoms. The risk of transmission is constant across trimesters with 40% - 50% maternal – infant transmission rate. Problems associated with congenital cytomegalovirus infection:
  • Non – immune hydrops
  • Symmetrical intrauterine growth retardation
  • Chorioretinitis
  • Microcephaly
  • Cerebral calcification
  • Hepatosplenomegaly
  • Hydrocephaly
80 – 90% are asymptomatic at birth and later exhibit the symptoms.
  • Mental retardation
  • Visual impairment
  • Progressive hearing loss
  • Delayed psychomotor development
Both mother and baby should be treated with a special vaccine

Rubella – German measles
It results from infection with a single stranded RNA toga virus. Rubella has the greatest impact on foetal risk. Foetal infection may result in: · A normal baby · Spontaneous abortion · The congenital rubella syndrome Components of congenital rubella syndrome are:

  • Symmetrical intrauterine growth retardation
  • Congenital deafness; detected after 1 year
  • Cardiac malformations; Potent ductus arteriosus,
Pulmonary aretery hypoplasia
  • Eye lesions; Cataracts,
Retinopathy, Microphthalmia
  • Hepatosplenomegaly; hepatitis
  • CNS involvement; Microcephaly,
Panencephalitis, Brain calcifications, Psychomotor retardation
  • Thrombocytopoenic purpura
Infection in the 1st trimester carries 25% risk development of the congenital rubella syndrome, 50% in the 1st 4 weeks. Abortion recommended due to risk of congenital anomalies.
Infectious Diseases in pregnancy - Dr.Rufus' Medical Website


Hepatitis B
The hepatitis B virus is a DNA virus. It is transmitted via:

  • Blood
  • Saliva
  • Vaginal secretions
  • Semen
  • Breast milk
  • Across placenta
The baby has greatest risk of getting the disease if the mother has acute hepatitis in 3rd trimester. So the risk for baby is not so high. Usually the pregnancy can be saved. The course of acute hepatitis is unrelated to pregnancy. Foetal infection may occur if maternal infection appears in 3rd trimester. ( Chronic hepatitis is associated with increased risk of prematurity, low birth weight, neonatal period )

Varicella Zoster virus or chicken pox virus
Chicken pox is caused by Varicella Zoster or DNA herpes virus Potential maternal complications include:

  • Preterm labour
  • Encephalitis
  • Vaicella pneumonia
The risk of foetal syndrome is 2 – 24%. It depends on the week of pregnancy, If maternal infection occurs before delivery the infant is at greater risk of developing infection. In the presence of foetal infection the ultrasonogram may reveal:
  • Hydrops
  • Organ calcification
  • Limb deformities
  • Microcephaly
  • Growth retardation
Clinical findings in new born include:
  • Limb hypoplasia
  • Cunaneous scars
  • Cataracts
  • Cortical atrophy
  • Microcephaly
  • Symmetrical intrauterine growth retardation

Rubeola measles
It is caused by Paramyxovirus There is no difference in the course of disease during pregnancy. Maternal infection has been associated with:

  • High risk of spontaneous abortions
  • Preterm labour
  • Low birth weight
  • The foetus can become infected by transplacentally transmitted virus
  • There is no increased risk of congenital anomalies
Neonatal infection due to congenital measles may be mild or rapidly fatal with a morbidity of 56% in preterm infants and 20% in term foetus. This is in contrast to postnatal acquired measles where the disease course is usually mild. Herpes simplex It is member of DNA herpes virus family. It is an STD which is highly contagious. This virus establishes its latency in the sensory ganglia Maternal infection has been associated with an increased risk of obstetric and neonatal complications.
  • Spontaneous abortions
  • Intrauterine growth retardation
  • Preterm labour
Neonatal herpes: The infant via passage through an infected birth canal or via an ascending infection in 90% of cases, transplacental infection and close contact with infected lesions. 60% of infants who are infected die in neonatal period and 50% of survivors have significant sequel including:
  • Microcephaly
  • Mental retardation
  • Seizures
  • Microphthalmus
Patients with active lesions wither recurrent or primary at the time of labour should delivered by caesarian section. If we cannot find any active lesions on genital tract then we can allow normal delivery through birth canal

Parasitic infections
Toxoplasmosis
It is caused by protozoa Toxoplasma Gondii. The organism is acquired by:

  • Ingesting undercooked meat
  • Unpasteurized goats milk
  • By exposure to faeces of an infected cat
The classic triad of symptoms is:
  1. Hydrocephaly
  2. Intracranial calcifications
  3. Choreoretinitis ( rarely seen )
Approximately 75% of infected infants are asymptomatic at birth. 25 – 50% manifestations of congenital toxoplasmosis infections are:
  • Hydrocephaly – choreoretinitis
  • Microcephaly – microphthalmy
  • Hepatosplenomegaly – cerebral calcifications
  • Adenopathy – convulsions
  • Delayed mental development
Toxoplasmosis presents as a mononeuclosis like syndrome but most infections are subclinical
Infectious Diseases in pregnancy - Dr.Rufus' Medical Website
Bacterial infections Group B Streptococci
It may be transferred from a colonized mother to her infant via vertical transmission at delivery. Risk factors include:

  • Preterm labour
  • Preterm rupture of membranes
  • Low birth weight
  • Intrapartum fever
  • History of previously delivering in infected infant
  • Puerpural infection, endomyometritis
  • Bacteruria in pregnancy
Streptococci sepsis is the most common cause of neonatal sepsis. The infant presents with respiratory distress and pneumonia meningitis. The overall infant mortality rate from early onset of disease is 50%

Listeriosis
It is caused by infection with Listeria Monocytogenes which can be traced in unpasteurized milk or milk products High carriage rate are found in pigs and in chicken. Maternal infection may result in:

  • Chroniamnionitis
  • Preterm labour
  • Spontaneous abortion
Foetal infections occur primarily by:
  • Transplacental passage
  • Intrapartum via passage through colonized genital tract
  • By ascending infection
  • May result from cross contamination in nursery. Neonatal infection

Tuberculosis
TB is very rare, with low incidence of 1% The baby is infected through blood, passed to foetus by haematogenous route across the placenta as a result of the foetus swallowing infected amniotic fluid. An infected infant exhibits:

  • Low birth weight
  • Fever
  • Respiratory distress
  • Adenopathy
  • Hepatosplenomegaly

Syphilis
Maternal infection can result in transplacental transmission to the foetus at any gestational age. Transmission rate is between 50 – 80% Components of early congenital syphilitic infection include:

  • Non – immune hydrops
  • Hepatosplenomegaly
  • Profound anaemia and thrombocytopenia
  • Skin lesions and rashes
  • Ostitis and periostitis
  • Pneumonia
  • Hepatitis
The prenatal mortality rate form congenital syphilis is roughly 50% Late congenital syphilis is a multisystem disease characterized by dental anomalies, saber shini, keratitis etc If mother is infected with gonorrhoea and chlamidia the condition should be treated. But if the foetus is infected spontaneous abortion should be done.


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