Perinatal Infections Fetal Infection

Infections

Toxoplasmosis
Rubella
Varicella
Parvovirus
CMV
HIV
Syphilis

Introduction

3% of the perinatal mortalities are related to (fetal infection)
Fetus can

Red indicates the most vulnerable period of development. (Moore 143).

First Trimester
Organogenesis
Growth restriction
Second and Third Trimester
Neuological Impairment
Growth restriction

Think of fetal infection

I.U.G.R
Hepatic Calcification
Intracrainal Calcification
Hydrocephally, Microcephally
Ascits
Pericardial,Pleural Effusion
Non Immune Hydrops

Toxoplasmosis

- Toxoplasmon gondii (intracellular parasite)
Trans-placental affect the placenta fetus
Transmission Rate
- 10

Toxoplasmosis

Toxoplasmosis
- Incidence of congenital toxoplasmosis
- 0.07 – 0.5 : 1000 London
-

Risks to the Fetus

1st Trimester
- 55 – 85% will show

Toxoplasmonsis
Ultra Sound
- Intracranial, hepatic, calcification
- Ascitis
- Hepatosplenomegally
- Microcephally
- I.U.G.R
Diagnosis Fetal Blood

Toxoplasmosis

Treatment
- Reduce risk of transmission
Spiramycin
- If fetal infection documented
- Pyrimethamine
-

Pyron F, Wallonlion C, Goner P,
Cochrane Database Review
January 2005
Objective
To assess whether

Look, outcome of the children
3332 Papers identified

NO Trial fulfill the criteria

Conclusion
We do not know whether antibiotics Treatment reduces the congenital transmission

Toxoplasmosis

Prevention to Toxoplasmosis: Advice to Pregnant Women whose Serological Tests

Cont.. Prevention of Toxoplasmosis

Carefully wash hands after handling raw meat,

Rubella German Measles

Rubella
- 3rd Disease
RNA Virus
- Respiratory secretions
- 2 – 3

Rubella

- 0.5 – 2% Non Immune
- 0.2 – 0.5 Congenital Rubella

Rubella

Ultra Sound - I.U.G.R.
- Hepto-splenomegally
Congenital Rubella syndrome
- Eye

Rubella
Diagnosis
IgM

RUBELLA
Prevention
Active immunization by vaccination is the only efficient way

Varicella Zoster Virus DNA Herpes
- Chickenpox
- Herpes Zoster
- Incidence in pregnancy

Varicella

Neonatal Infection
Increase in Mortality
- 5 days before delivery – 48 hours

Diagnosis

Viral Culture
- PCR
Presence of infection does not predicate the severity of

VARICELLA
Prevention
Passive immunization is currently available
and should be

Varicella

Treatment
- Oral cyclovir to improve sysmatic I.V. to treat pneumonia
- Safe

Varicella
Screening
- Not Recommended

Parvovirus B.19 the fifth disease
Infectious period 5 – 10 days after

Intrauterine fetal infection

Fetal effect of B19 : - A symptomatic - IUGR -

Diagnosis

Parpovirus
- ELISA
-Western blot test
IGM Diagnosis of Primary Infection
Elect Microscopy
- Direct Visualization

Parvovirus

Fetal Diagnosis
PCR in A.F., Placenta & Blood
Ultra Sound
Hydropy Fetalis

Parvovirus

Prognosis and therapy
Survivor recovers normal
Fetal Therapy
Intravascualr Intrauterine Blood Transfusion

CMV
DNA Herpes Virus
Most common perinatal infection
0.2 – 2% of all

CMV

I.P 28 – 60 days
Viremia 2 – 3 weeks
Maternal effect –

Epidimulogical Facts
Primary Infection
-Risk of Transmission 30 – 40%
-10% Seguilie of the

Recurrent Infection
Transmission 0.1 – 2% Mostly a symptomatic most of the

Diagnosis

CMV
Diagnosis Culture or PCR
– blood, urine & salvia
IgG Serial Measurements

IGM is not reliable as it may be negative even in

Diagnosis

Fetal Diagnosis Ultra Sound System
- Intracrainal or hepatic calcification
- Echogenic bowel
-

CMV
Treatment
- Not available
- Neonatal therapy ganciclovir may decrease neonatal infections
Vaccine
- May

Human immunodeficiency virus (HIV) Infection

This is the major cause of

Mother ? child
in utero
at birth
breast milk
Organ/tissue donation
Semen
Kidneys
Skin, bone

TO SCREEN OR NOT TO SCREEN?

The best defense is a strong

PRE-TEST COUNSELING

Risks of transmission (including Mode)
Risks of perinatal transmission
Potential social and

Timing of Perinatal HIV Transmission

Cases documented intrauterine, intrapartum, and postpartum

Factors Influencing Perinatal Transmission

Maternal Factors
HIV-1 RNA levels (viral load)
Low CD4

Reducing HIV Transmission with Suboptimal Regimens

Partial ZDV regimens: ( New

Reducing Intrapartum HIV Transmission: Studies of Short Course Therapy

Oral

Treatment with zidovudine appears to be safe in pregnancy.
Elective

HIV
Chochrane Database 2002
Objective to assess what intervention will decrease the risk

AZT
4 trials decrease 1585 patients
Neviropine compared AZT 626 decrease transmission
C/S one

Conclusion
Zidoridine, Nevirpine
C/S decreases the transmission significantly.

Syphilis
- T.P.
- Increase HIV
Transmission all through

Manifestation
Ultra Sound
Thick Placenta
Hydrops fetalis
I.U.G.R
Hydroamnios – Hepato-splenomegaly ……
Risk of Transmission
90%

Diagnosis
Screening Non Specific
VDAL
RPR
Specific
TPHA
F.T.A. becomes …..
3 – 4

Treatment
- Penicillin
- Benzathin Penicillin 2.4 million unit
- Erythpromycine