Infections affecting the fetus in the prenatal period

A lot of infections, mainly viral infections, can affect the fetus. In English scientific terminology they are united under the abbreviation "TORCH-infection: T-toxoplasmosis, O-other (for example, AIDS, syphilis), R rubella, C-cytomegalia, H herpes (and hepatitis). Infection of the fetus with the first five diseases occurs antenatal, herpes and hepatitis - usually postnatal. Antenatal infection with measles.

Rubella. Poor immunity is present in 70% of pregnant women. With the routine vaccination of all children, no pregnant woman will be susceptible to rubella. Routine antenatal screening identifies those who need to be vaccinated in the postpartum period (after that they avoid pregnancy for 3 months because the vaccine is alive). Rubella symptoms are absent in 50% of mothers. The fetus is most vulnerable in the first 16 weeks of pregnancy. Almost 33% of the fetuses aged less than 4 weeks will be infected with rubella if the mother is infected with it; 25% - at the age of 5-8 weeks; 9% - at the age of 9-12 weeks. Cataract will develop in the fetus in the event that he will suffer rubella at the term of 8-9 weeks, deafness - for a period of 5-7 weeks, heart damage - for a period of 5-10 weeks. Other symptoms of rubella are rash, jaundice, hepatosplenomegaly, thrombocytopenia, cerebral palsy, microcephaly, mental retardation, cerebral calcification, microphthalmia, retinitis, cataracts, growth disorders. Possible miscarriage or childbirth of a dead fetus. If you suspect a rubella in a pregnant woman, you need to compare the dynamics of antibodies in the blood taken with a 10-day interval, determine IgM antibodies at 4-5 weeks from the start of the incubation period. You should also consult an infectious disease doctor.

Syphilis. Screening of mothers for syphilis is carried out as part of a routine examination; when an active process is detected, the mother is treated with a novocaine salt of benzylpenicillin, for example intramuscularly injected '/ ampoules containing 1.8 g of bicillin daily for 10 days. Signs of syphilis in newborns: rhinitis, obstructed nasal breathing (due to syphilitic rhinitis), rash, hepatosplenomegaly, lymphadenopathy, anemia, jaundice, ascites, dropsy, nephrotic syndrome, meningitis. Nasal discharge is examined for the presence of spirochaetes: in case of X-ray examination, perichondritis can be detected; in the blood the content of monocytes and protein is increased, serological reactions are positive. In such cases, the novocaine salt of benzylpenicillin is administered at a dose of 37 mg / kg per day, intramuscularly for 3 weeks.

AIDS (human immunodeficiency virus, HIV). In 86% of children with AIDS, the mother is a high-risk group for this disease. Therefore, such women should give recommendations in advance and educate them about the consequences of HIV infection for themselves and their children, as well as offer them to undergo diagnostic tests for HIV. Up to 15% of children born to seropositive mothers are infected in utero, but the diagnosis in the puerperium can be difficult, since most children under the age of 18 months will carry the maternal antibodies to HIV. Clinically, AIDS can manifest itself to a 6-month age of developmental delay, recurrent fever and persistent diarrhea. In addition, generalized lymphadenopathy, pathology of the lungs and upper respiratory tract, common candidiasis, opportunistic infections and dermatitis are possible. Death can come quickly enough.

Cytomegal. In the UK, cytomegaly is a more frequent cause of congenital fetal growth retardation than rubella. The infection course in the mother is erased or asymptomatic. The fetus is most vulnerable in the early stages of pregnancy. Up to 5: 1000 live-born infants are infected, and 5% of them develop early physical disabilities and develop diseases caused by the cytomegalovirus (with nonspecific manifestations resembling rubella plus choroiditis). At 5% those or other physical defects develop in a later period. Effective methods for preventing them do not exist.

Toxoplasmosis. Toxoplasma infection in the mother and fetus resembles cytomegalovirus, but is less common. Serologic testing of pregnant women and spiramycin treatment are possible, but there is no consensus on the permissible intensity of treatment. Prevention can be more effective: gloves and hygiene products should be used for gardening and cat care, as well as for subsequent cooking and eating. Infected children (diagnosed serologically) should receive 0.25 mg / kg of chloride every 21 hours within 6 days, 50 mg / kg of sulfazine every 12 hours, and folic acid (since chloridine is a folate antagonist).

Listeriosis. The mother is ill, as a rule, in a mild form, without specific manifestations. Transplacental transmission of the disease in 5% of pregnant women causes miscarriages or premature births and induces a multi-organ pathology in newborns with the formation of granulomas of the skin and pharynx. Treatment: ampicillin and gentamicin intravenously. Listeria can be isolated from blood or amniotic fluid (this is a gram-positive cocci bacterium). Listeria is prevalent everywhere. Prevention of infection is simple: do not use softened cheese, pâté and food subjected to inadequate re-heating; as well as cold food.

Hepatitis B. Although previously chronic carrier of hepatitis B virus in the UK was rare, with the increase in drug use and the expansion of the population of empowered ego problems became more acute and some experts even suggest conducting an appropriate virologic examination of all mothers. If a mother develops acute hepatitis B in the second or third trimester of pregnancy, then the risk of perinatal infection is high. Infection is most likely to occur at the time of delivery, so infants born to mothers who have already established the fact of infection or carry of the hepatitis B virus should be given antiviral immunoglobulin (0.5 ml intramuscularly for 12 hours after birth) and a hepatitis B vaccine (0.5 ml for 7 days after birth, and also at the age of 1 and 6 months).

Herpes of a person. About 80% of cases of infection or carriage are due to Type II virus. Almost 50% of children are infected at birth, if the mother had obvious damage (changes) in the cervix. From the cervical canal of pregnant women who have a history of herpes infection, weekly (starting from the 36th week) take swabs for the cultivation of the virus. When a virus is detected, the question arises about the delivery of a cesarean section. With spontaneous discharge of amniotic fluid, the cesarean section is sought to be performed within the next 4 hours. The development of neonatal infection usually occurs in the first 5-21 days with the appearance of vesicle-pustular elements, often on the foreground parts of the body or places of slight traumatization (for example, the electrodes on the head ). There may be periocular lesions involving conjunctiva. In a generalized form, encephalitis (including individual paroxysms and neurological signs), jaundice, hepatosplenomegaly, collapse and DIC syndrome may develop. Infected newborns should be isolated and treated with acyclovir. If necessary, they resort to the help of specialists.

Conjunctival neonates. This lesion, characterized by purulent discharge from the eyes of newborns under the age of 21 days. In the first place, the infection of Neisseria gonorrhoe should be excluded , but in many cases the causative agent is Chlamydiae, herpes virus, staphylococcus, streptococcus and pneumococcus, E. Coli and other gram-negative organisms. Babies with gluing eyelids take smears to determine bacterial and viral flora, microscopy (examined for intracellular gonococci) and Chlamydia identification (eg, immunofluorescence).

Gonococcal conjunctivitis. Infection usually develops in the first 4 days after birth. Purulent discharge is usually accompanied by edema of the eyelids. There may be opacity of the cornea, there is a risk of perforation of the cornea and the development of panophthalmitis. Children born from mothers with established gonorrhea should be given intramuscular injection of penicillin G at an initial dose of 30 mg / kg within 1 hour after birth, and drops containing 0.5% chloramphenicol (levomycetin) solution should be injected into the eyes. If there are signs of active infection for 7 days intramuscularly administered penicillin G at a dose of 15 mg / kg every 12 hours and every 3 hours, instilled a 0.5% solution of levomycetin. The baby is isolated.

Chlamydia (Chlamydia trachomatis). Approximately 30-40% of infected mothers will have children infected. Conjunctivitis develops 5-14 days after birth and can manifest as minimal inflammation or purulent discharge. The cornea is usually unaffected. Chlamydial pneumonia can also be attached. Diagnosis is carried out by immunofluorescence or culture. Treatment is carried out with 1% tetracycline ophthalmic ointment or drops - every 6 hours for 3 weeks. It should also be given erythromycin 10 mg / kg every 8 hours inside, to eliminate the pathogen from the respiratory tract. Both parents should be treated with tetracycline or erythromycin.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]