Infections during pregnancy

Infections during pregnancy are those diseases that women are most afraid of because of possible harm to them not only on the mother's body, but also the baby. Unfortunately, most diseases of pregnant women fall on different infections, which, depending on the type, may not affect the baby in any way or cause birth defects. It is the high risks of the birth of a sick child that should prompt not only the timely examination and treatment, but also the prevention of such infections.

[1], [2]

Epidemiology

The epidemiology of the problem of infections during pregnancy is very striking, as more than 85% of miscarriages in the first trimester are caused precisely by this factor. Among children with congenital malformations for the reasons of their development, the infection infectious diseases of women during pregnancy are in the first place. Speaking about the prevalence of such pathology, only 60% of infections are diagnosed on time, this is among those women who agreed to undergo the examination - diagnostics of more than 90%. The remaining 40% of undiagnosed infections in pregnancy are cases when women refused to conduct special examinations. This highlights the enormous relationship between the birth of a child with defects and the timely diagnosis of infections in a woman.

[3], [4], [5], [6], [7], [8], [9], [10], [11], [12]

Causes of the infections during pregnancy

The causes of the development of various infectious diseases during pregnancy are caused by a decrease in the immunity of a pregnant woman during this period. A child is an organism that is half foreign to the composition of its DNA. Therefore, in order to maintain its normal development, it is necessary that the woman's immune system does not take it as a foreign agent. This leads to the fact that normal depression of the immune status of a pregnant woman occurs - and this is a risk factor to quickly catch one or another infection. That's why, if even before pregnancy, a woman is not so often sick with even colds, then during pregnancy it happens much more often.

The causes of the development of infections depend on their mode of transmission, so several groups of diseases can be distinguished, which differ in the way of transmission and manifestations.

First of all, it is necessary to distinguish between viral and bacterial infections. Viral infections include: measles, rubella, chicken pox, cytomegalovirus, hepatitis, herpes, HIV. Bacterial infections include ureaplasmosis, syphilis, mycoplasmosis, chlamydia, toxoplasmosis, salmonellosis and many others. It should be noted that during pregnancy, a woman can be affected by any infection, but only those that can further influence the development of the fetus are taken into account.

It is necessary to distinguish that if a woman has any pathology before pregnancy, then all the measures aimed at preventing complications of the fetus are already taken when planning pregnancy. That is, the woman heals the disease, so that then do not take risks with possible consequences.

It often happens that some women get sick, while others do not. Why is this happening? Our immune system is unique, it preserves the memory of any infectious agents that have ever entered the body. If a woman was sick in childhood with many infectious childhood diseases, then she is to some extent already protected from them for life. This is because when a virus or bacteria gets into the body, antibodies are formed that persist for a lifetime, and then, if the virus re-enters, it simply kills it. But such a life-long immunity is not developed for all bacteria and viruses, because you can not always be calm at the same time. For example, there is a lifelong immunity to varicella, rubella, measles, hepatitis A viruses.

[13], [14]

Pathogenesis

The pathogenesis of the effects of infections on the fetus lies in the fact that these pathogens pass through the feto-placental barrier, and, depending on the trophicity, they affect one or another organ of the fetus. For example, cytomegalovirus is a representative of the herpes virus group. He gets into the body of a woman and can not even cause her any symptoms, while in the fetus he affects the brain with the formation of cysts there, affects the liver, visual analyzers and kidneys. This causes a violation of normal organogenesis, which can cause congenital malformations in the baby.

It is necessary to know one more feature - when a child is infected with any virus or bacterium in early pregnancy, in the first trimester, a huge number of congenital malformations are formed. And most often, due to this reasonable structure of human nature, a spontaneous miscarriage occurs. So the woman's body protects itself from the birth of such a child. Therefore, no matter how bad it may sound, it is not always necessary to save a miscarriage at this time. In any case, you must take care of yourself and avoid all risk factors for infection during pregnancy.

The cause of infections is often domestic animals, because they can be carriers of pathogens of many infectious diseases. Therefore, one of the risk factors for infections during pregnancy can be called contact with animals. Therefore, for the period of pregnancy and even in the first year of life of a child, it is better to give pets for a while to live with relatives.

Among other causes of infections are those that can be a factor in the transmission of infections. These include low-quality water, stale food, and do not forget about the simple contact with infected people or carriers of infection. Sometimes, for a disease, you can simply kiss a person to pass on staphylococcus, or to transmit hepatitis B - contact must be sexual. Therefore, do not neglect a thorough research before pregnancy on dangerous infections, because they often may not have manifestations.

[15], [16], [17], [18], [19], [20], [21], [22]

Symptoms of the infections during pregnancy

Speaking about the clinical picture of various infections during pregnancy, it is necessary to identify those that pose a danger to the normal development of the child. Therefore, it is necessary to classify all infections into subgroups. First of all, it is necessary to distinguish viral and bacterial infections, which is important for the approach to their treatment. The main types of infections are: dangerous infections; hidden; sexually transmitted infections; viral and intestinal infections. All of them in one way or another are dangerous for the life of the woman and the health of the future baby. 

Dangerous infections during pregnancy are those diseases that must first of all be diagnosed because of their harm to the future child. These infections include the so-called group TORCH. These are diseases that include toxoplasmosis, rubella, cytomegalovirus and herpes viruses, as well as some others.

Toxoplasmosis is a disease caused by the simplest - toxoplasm of gondii. The disease is dangerous for the child only if the woman has already contracted during pregnancy. The causative agent is transmitted through cats that are its carriers, or through poorly roasted meat. Symptoms of toxoplasmosis in a pregnant woman are dangerous because they do not allow diagnosing the disease. The first signs of infection are often manifested by malaise, headache, pain in the muscles, an ache in the whole body. This increases body temperature and can be a sore throat, discharge from the nose and catarrhal phenomena. Sometimes there may be a rash in the body in the form of an allergic. That is, the clinical picture of toxoplasmosis resembles an acute respiratory disease. Therefore, it is difficult to diagnose toxoplasmosis in pregnancy, and treatment is dangerous for the fetus.

Rubella is an acute viral disease that is transmitted by airborne droplets and carries a potential threat to the fetus due to many congenital malformations. Symptoms of this disease are also manifested by fever, intoxication, and also small-scale rash on the body. Also, the posterior and occipital lymph nodes increase. When the virus enters the placenta, and then into the fetus, in the first trimester of pregnancy, rubella causes the child to have the typical developmental malformations of the hearing, vision and heart. More often children with congenital rubella have congenital deafness, cataract and heart disease. This teratogenic effect of the virus is proved, therefore in Ukraine the disease of a pregnant woman with rubella is a medical indication for abortion.

Cytomegalovirus is a disease that can be transmitted by airborne, sexual and contact. In a woman, the symptoms of the disease may not appear at all, or there may be mild catarrhal symptoms with an increase in temperature. The virus has a tropism to the brain of the child and liver, so when exposed to the fetus, this infection causes severe brain damage in the form of ischemic lesions and cysts, as well as an enlarged liver and severe jaundice with bilirubin encephalopathy.

Herpes is a virus that has a tropism for the nervous system. There are two main types - herpes labial, which is transmitted by airborne and by contact, as well as genital herpes, sexually transmitted. Symptoms of the disease in a pregnant woman are manifested by vesicular rashes on the lips or on the genitals, which causes itching, burning and unpleasant sensations. If the virus enters the fetus, then it initiates serious brain damage. When a woman is infected with genital herpes before the birth, then a decision is made about a cesarean section, because if the virus has not managed to penetrate the placenta, the child can be infected contact when passing through the birth canal.

Infections from the TORCH group are dangerous, since the probability of formation of congenital malformations in the fetus when infected with these pathogens is very high. Symptoms can be very different when different organs are affected: abnormality of the skull in the form of microcephaly or hydrocephalus, heart and muscle defects, deafness, emotional disorders and various forms of intellectual disability, cataracts, chorioretinitis, liver disease and lesions.

Viral infection during pregnancy is considered more dangerous than bacterial, since viruses have a great tendency to induce different mutations and better penetrate the placenta. Other viral etiology diseases that are of high risk include measles, chicken pox, hepatitis B and C, HIV.

Hepatitis B and C virus are diseases that are transmitted sexually, and to the child the disease can be transmitted vertically through the placenta, at birth or with milk while breastfeeding. In case of intrauterine infection, the child is affected by the liver, and then the brain. Severe liver damage leads to the fact that after birth the child can not live long due to the severity of his condition. If the infection occurred during passage through the birth canal or with milk, the child develops chronic hepatitis, which also has a poor prognosis for survival.

HIV is a virus that affects the immune cells of the body, which in time causes a complete suppression of immunity and reduces the ability to fight any infections. The danger of the virus is that for a very long time it can be asymptomatic in the body, but only after tens of years, causing the disease. A person can also not be sick, but simply be a carrier of the virus and pass it on to others, which is even more dangerous. Symptoms of the disease that causes HIV are characterized by a set of symptoms - weight loss of more than 10% of body weight, sweating, swollen lymph nodes and causeless diarrhea. This may lead to the idea of the possibility of AIDS. In a pregnant woman, if the virus is determined before or during pregnancy, special therapy is carried out throughout pregnancy, as well as treatment of the child in the first days after pregnancy - this avoids the development of the disease in the child.

Sex infections during pregnancy often endanger the baby due to possible repeated miscarriages. Such diseases include ureaplasmosis, gonorrhea, syphilis.

Ureaplasmosis and gonorrhea are intracellular microorganisms, which are located in the cells of the uterine epithelium can cause miscarriage. 

Syphilis is a sexually transmitted disease that carries a potential threat to the fetus due to the birth of a child with congenital syphilis. In this case, the child may have heart disease, dental abnormalities and other abnormalities.

Intestinal infections during pregnancy can be a threat to the mother, since a large number of toxins have a bad effect on the mother's body, and can also affect the baby. Symptoms of intestinal infections are similar - it is a headache, repeated vomiting and diarrhea, headache and abdominal pain, and also dehydration. Salmonellosis and listeriosis are the most frequent and dangerous infections in pregnancy. They are transmitted with food or water. If the pathogen gets to the fetus - lungs, liver, brain, and stillbirth may be affected.

Hidden infections during pregnancy are those that are asymptomatic, which carries an even greater threat due to the inability to detect them.

Thus, the symptoms of different infections can have a different manifestation, but the potential danger is that they may not have manifestations, but at the same time initiate congenital malformations in the child. This proves the need for timely diagnosis of such infections.

[23], [24], [25]

Complications and consequences

The consequences of infections during pregnancy are very serious, and it is primarily about the life of the child. Complications that can cause infectious diseases are limited not only by congenital malformations, but there may still be health problems in the future in the form of chronic forms of infections and disorders of the intellect.

[26], [27], [28], [29], [30], [31],

Diagnostics of the infections during pregnancy

Timely diagnosis of any infection during pregnancy is a guarantee of health not only to the mother, but also to the child. It is very important to diagnose the disease before pregnancy, therefore the planning of any pregnancy with careful examination comes to the fore. If the symptoms of the disease are manifested during pregnancy, the main goal is to diagnose the type of infection.

If a woman has the symptoms of an acute respiratory infection, this does not mean that this is a simple flu. It is necessary to examine the woman, clarify the anamnesis, the presence of pets, and only then talk about a particular diagnosis.

Analyzes that need to be collected can be divided into mandatory and special. Among the mandatory tests - a general blood test, urinalysis, blood sugar level, as well as biochemical analysis if necessary. Changes that can be in such analyzes can be taken as the basis for determining a viral or bacterial infection. Viral infection is characterized by an increase in lymphocytes, but for bacterial infection - leukocytosis with a shift of the formula to the left and an increase in the young forms of leukocytes. The analysis of urine allows to exclude disease of urinary ways in case of rise in temperature at the woman. Biochemical blood test is necessary when a woman develops jaundice to determine the level of bilirubin. This suggests that hepatitis virus or another cause of such jaundice is affected.

Among the special tests are those that allow you to accurately establish this or that infection. To do this, a serological study of the blood with the definition of antibodies to these or other infections. The level of antibodies of the class of immunoglobulins G and M is determined. Special reagents are used, which allow to determine the level of these antibodies to a special infection. If there is an increase in the level of immunoglobulins G for example, to cytomegalovirus, then we can say that the woman is infected before delivery and now this virus does not represent a danger to the child. But if immunoglobulins M are found, then this indicates an acute infection, that is, a woman is sick and the fetus is also at risk. Among special tests for suspected sexual infections, a smear from the vagina is also performed. Due to this, it is possible to establish the type of pathogen and its sensitivity to drugs. In the case of intestinal infections, it is necessary to conduct a study of stool, which will also help determine the infectious agent.

Instrumental diagnosis of infections during pregnancy is aimed at examining the condition of the fetus and its organs, in order to determine how an infection affected the child. Therefore, the ultrasound of the fetus is performed, which can determine the structure of the heart, bones, and some soft tissues - which allows us to identify certain congenital malformations in the first trimester. If there are any problems, then at this time the woman can still have an abortion. Further in the second and third trimester, the chances of detecting congenital malformations with ultrasound are higher, and then it is possible to interrupt pregnancy on medical grounds in the event of problems. Occasionally, invasive procedures, such as amniotic fluid puncture with further identification of the infectious agent, are required.

[32], [33]

Differential diagnosis

Differential diagnosis of infections during pregnancy should be carried out between acute respiratory infections and viral and bacterial pathologies dangerous to the fetus, because the symptoms can be very similar. Here, the main and more accurate method can be considered a serological study, which allows you to accurately determine this or that pathogen.

In Ukraine, before pregnancy and already during pregnancy, a test for the TORCH group is not necessary, but it is always recommended by the doctor and the woman herself decides whether to conduct it or not, as this is a very expensive examination. But taking into account possible risks, it is necessary to emphasize the high importance of this study for timely diagnosis and treatment, which will not harm the baby.

Treatment of the infections during pregnancy

Treatment of infections in pregnancy, given the teratogenicity of drugs, can be very dangerous, but also by comparing risk and benefit - treatment is necessary to avoid serious damage to the fetus. Each disease has its own drug for treatment, which is most effective in this case.

1. Treatment of toxoplasmosis in pregnant women is performed with a drug that is most effective for this pathogen and is least harmful for the child.

Spiramycin is an antibiotic from the macrolide group, which is the drug of choice for the treatment of toxoplasmosis in pregnant women. It has the highest activity against toxoplasma, inhibiting the synthesis of its wall proteins, but it has no teratogenic effect. Dosage of the drug is 6-9 million IU per day, that is, it is one tablet two or three times a day. Side effects of spiramycin - paresthesia, violations of skin sensitivity, numbness of hands and feet, tremor, violation of outflow of bile, as well as dyspepsia. Precautions - do not use for cholestasis or cholelithiasis.

1. Cytomegalovirus and herpes virus - do not have specific treatment, since these viral infections are not very sensitive to drugs. But with a high degree of activity in a pregnant woman, interferon preparations can be used.

Viferon is an antiviral drug that contains recombinant human interferon, is active against most viruses from the herpes group. It acts on cytomegalovirus, hepatitis virus, as well as some bacterial infections, also has an immunomodulatory effect. The drug is available in the form of ointments, gels, suppositories. For the treatment of pregnant women, the method of application is recommended in the form of rectal suppositories. Dosage of the drug - from 300 000 IU for acute disease, the course of treatment begins with applying one tablet, and then on a special scheme. Side effects are possible: thrombocytopenia, itching at the injection site, redness, and also allergies. Precautions - it is not recommended to apply before 14 weeks of pregnancy.

1. To treat intestinal infections, the most safe and at the same time sensitive are preparations from the group of cephalosporins of 3 or 4 generations.

Tsefpyrom is an antibacterial agent of the 4th generation of the group of cephalosporins. The drug has a bactericidal effect on most bacteria, causative agents of intestinal infections. The drug has no teratogenic effect, so it can be used to treat intestinal infections in pregnant women at any time. Dosage of the drug - 200 milligrams twice a day, at least ten days. Side effects are possible with the influence on the stomach - develops colitis or dysbiosis, which manifests itself by bloating, a violation of the stool. Precautions - do not use the drug for allergies to antibiotics-penicillins, as well as for congenital fermentopathies.

1. Such infections during pregnancy like trichomoniasis, ureaplasmosis, gonorrhea, chlamydia belong to intracellular parasites, so the most effective antibiotics against them are macrolides. Azithromycin is an antibacterial agent from the macrolide group, which is active against most intracellular parasites, including sexually transmitted infections. The drug penetrates inside the cell and blocks the work of the microbial wall, thus neutralizing the bacterium itself. Dosage of the drug - one tablet twice a day. The course of treatment is selected individually, depending on the pathogen. Side effects are possible in the form of stomach pain, dizziness, depression of pressure. Precautions - do not take in case of Wilson-Konovalov's illness. Often for the full treatment of sexually transmitted infections, it is necessary to use in parallel and local treatment in the form of combined candles.
2. Meratin-combi is a combined remedy that contains two antibacterial drugs (neomycin and ornidazole), an antifungal (nystatin) and a hormonal drug (prednisolone). He thanks to this composition has a wide range of actions and due to local action it allows to get rid of acute infections. The drug is released in tableted pharmacological form and the dosage is one tablet per night for ten days. The way of using the drug - one vaginal tablet should be inserted into the applicator and inserted into the vagina at night using the applicator. After this, it takes some time to lie down in a horizontal position for the best effect of the drug. Side effects occur rarely due to the local topical action of the drug, but there may be dizziness and headache, as well as local burning and itching in the vaginal area.

Thus, the main principle of treating infections during pregnancy is that the benefit of treatment is higher than its absence at all.

Physiotherapeutic treatment of infections in time is not used in the acute period, but with chronic infections and the appearance of complications (eg, adhesive process), thermal procedures and electrophoresis can be used.

Vitamins in infections are very useful, because against the background of a decrease in immunity and the possibility of damaging the child's internal organs, additional sources of vitamins and antioxidants are needed. It is necessary to take folic acid.

Alternative treatment of infections in pregnancy

Alternative therapies certainly have their preference, but only with complex treatment. The main effect of different drugs and medicinal plants is aimed at normalizing blood circulation in the placenta, which can suffer from the effects of infections.

1. Very useful for the treatment of sexual infections are compresses using Kalanchoe, since this plant contains many vitamins and antibacterial agents that act on bacteria and fungi. For the compress, you can use the Kalanchoe juice and add a few drops of olive oil. From this solution, you need to make a tampon and enter for two hours into the vagina.
2. To treat intestinal infections during pregnancy helps infusion of honey and celery grass. To do this, the celery leaves need to be washed in water, pour boiling water and insist, and after that add a spoonful of honey and drink three times a day. After the symptoms of diarrhea disappear, you need to drink kefir, which will restore the microflora.
3. High efficiency in the treatment of infections that are chronic, show therapeutic herbs. For herbal compresses, you need chamomile leaves, oak bark and anise cortex. All ingredients must be filled with water and boiled. Marl needs to be moistened in this solution and insert a tampon for twenty minutes. It's also good to hold an evening toilet in this solution.

Herbal treatment of infections is also effective, in addition, such herbal teas normalize blood pressure and improve circulation in the placenta.

1. To prepare medicinal tea, you need to take 50 grams of thyme, 50 grams of licorice and the same number of leaves of alder, it should be cooked over low heat for five to ten minutes and then filtered. To drink such a tea you need three times a day for half a cup, after which you need to lie down a bit, because there may be dizziness due to a decrease in pressure. This is not a side effect, but on the contrary, the complex action of plants contributes to increased blood flow in the placenta.
2. You need to take 100 grams of althei grass, saber, mother-and-stepmother and dog rose, make tea from a liter of water and drink in small sips throughout the day. The course of treatment is four weeks.
3. The root of the aura, the root of the peony and the fruits of the mountain ash should be poured in a lump and cook for fifteen minutes. Then you need to let the tea cool and after half an hour you can drink this tea up to five times a day. It is especially effective against cytomegalovirus infection.
4. Especially effective in the treatment of infections from the group of bacterial sex infections infusion of dill, hops and leaves of chamomile. To make medicinal tea you need to take ten grams of herbs, pour water in the volume of a half liter, and then after it tinges for twenty minutes, strain and drink. Dosage - about a liter of tea you need to drink a day, controlling another fluid in the presence of edema.

Treatment with homeopathic remedies is also widely used because of the possibility of prolonged therapy, which does not affect the fetus.

1. Lapis Album is a complex homeopathic medicine that acts bactericidal and immunomodulating. Issued in the form of drops and used in the dosage of eight drops at a time. Method of application - the solution should be dripped into 100 milliliters of boiled water and drunk half an hour before meals. The course of treatment is not less than three months. Precautions - do not use for allergies to jasmine color. Side effects are rare, allergic skin reactions are possible.
2. Veratrum viridum is a homeopathic remedy that has the composition of organic substances and promotes the activation of the body's natural defenses, including in the fight against viral agents. The drug is used in the pharmacological form of homeopathic drops and dosed four drops twice a day for half an hour before meals at the same time. The course of treatment is three months. Side effects can be in the form of drawing pains in the lower abdomen.
3. Glononium is a homeopathic medicine that is used in diagnosed infections, especially for the prevention of chronic infection in the case of hepatitis virus infection. Issued in the form of drops and used in the dosage of eight drops at a time. Method of application - the solution should be dripped into 100 milliliters of boiled water and drunk half an hour before meals. The course of treatment can begin before pregnancy, if a woman is sick with hepatitis, with a dose of three drops, and then throughout the pregnancy take eight drops. Precautions - it is not recommended to use the drug in women with hypertension or gestosis. Side effects are rare, allergic skin reactions are possible.
4. Aurum muriatikum is an inorganic homeopathic preparation. Used to treat intestinal infections with severe nausea and vomiting. The way of using the drug depends on the form. Dosage in case of taking drops - one drop per year of life, and with capsules - two capsules three times a day. Side effects are possible in the form of hyperemia of the skin of hands and feet, as well as sensation of heat. Precautions - do not use in combination with sorbents.

Operative treatment of infections during pregnancy can be used only if proven congenital malformations of the child are proven, then it is possible to interrupt pregnancy on medical grounds. If a woman has become infected in the third trimester of pregnancy, premature births by caesarean section are possible before the infection of the baby occurs.

[34], [35], [36]

Prevention

Preventive maintenance of infections during pregnancy first of all should be nonspecific - each woman at approach of pregnancy should protect herself and avoid contact with infectious patients.

[37], [38], [39]

Forecast

It is necessary to be investigated for a group of TORCH-diseases, and if the woman was not sick, then a specific immunization should be carried out. Then the prognosis of a good development of pregnancy will be favorable, but in case of defeat during pregnancy a dangerous infection - the risk of the birth of an unhealthy child is very high.

Infections during pregnancy - this is what you should be afraid of most, because any infection is a potential threat to the development of complications in the child. Therefore, it is so important to prepare for the birth of a child, carefully examine both mum and dad, and only then think about how to preserve this desired pregnancy. If you pass all the recommended examinations according to the terms of pregnancy, then the chances of having a healthy baby are very high.

[40], [41]