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Infections in pregnancy

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An overview of infections in pregnancy

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Infections in pregnancy

  1. 1. Infections In Pregnancy Dhammike Silva
  2. 2. Bacterial Infections in Pregnancy  Bacterial infections can affect pregnant women from implantation of the fertilized ovum through the time of delivery and peripartum period.  They may also affect the fetus and newborn. Many women with these infections are asymptomatic, necessitating both a high degree of clinical awareness and adequate screening.
  3. 3. 1. Group B Streptococcus • GBS; Streptococcus agalactiae is the most common cause of life-threatening infections in newborns and can also affect the mother. • Found as part of normal vaginal, rectal, and oral flora • Intrapartum transmission occurs via ascending spread or at the time of delivery
  4. 4. Urinary tract infections • Asymptomatic bacteriuria develops in 10-15% of pregnant women. • Lead to complications such as pyelonephritis and premature labor. • All pregnant women should undergo screening with urine culture at least once during early pregnancy • Significant bacteriuria is defined as >100,000 colony-forming units (CFU) of a single organism in a clean-catch specimen.
  5. 5. causative organisms • Escherichia coli • Klebsiella species • Enterobacter species • Enterococcus species • Group B Streptococcus (GBS) • Staphylococcus saprophyticus • Proteus mirabilis
  6. 6. Listeriosis • One third of all reported cases of listeriosis occur during pregnancy, typically during the third trimester • Mode of transmission- • ingestion of contaminated food, • contact with infected animals and • nosocomial transmission • Clinical presentation – • with listeriosis is bacteremia, often asymptomatic; CNS Listeria infections are rare • Symptomatic pregnant patients - fever, muscle aches, and, occasionally, nausea or diarrhea during the bacteremic phase of the disease • Maternal complications- • amnionitis • spontaneous septic abortion • premature labor with delivery of an infected baby • stillbirth • Fetal complications- • septicemia, meningoencephalitis, or disseminated granulomatous lesions with microabscesses
  7. 7. disseminated granulomatous lesions with microabscesses
  8. 8. Syphilis • Untreated primary or secondary syphilis in pregnancy leads to a fetal infection rate of almost 100% • Maternal Signs & symptoms – In primary syphilis- a hard, painless red ulcer typically forms on the vulva, cervix, or vagina – Secondary syphilis -predominantly manifests as a nonpruritic rash that may involve the palms and soles; fever, lymphadenopathy, and joint pain – The latent stage causes no symptoms and is still transmissible to the fetus – Tertiary syphilis can result in cardiovascular or gummatous disease – Neurosyphilis can occur at any stage, resulting in CNS or ophthalmic presentations • Complications – – Stillbirth – late abortion – neonatal death – latent infection
  9. 9. Congenital syphilis
  10. 10. Chlamydia • Approximately 75% of women with C trachomatis infection are asymptomatic • The usual mode of transmission to the fetus is vertical during the second stage of labor • Maternal complications – – Endometritis – Cervicitis – acute PID, and acute urethral syndrome – Chorioamnionitis – postpartum endometritis – gestational bleeding in pregnant women • In neonates- commonly causes conjunctivitis (ophthalmia neonatorum) and pneumonia
  11. 11. Gonorrhea • Gonococcal infections are second only to chlamydial infections in the number of cases of bacterial STDs • Gonococcal infections cause no symptoms in approximately 50% of patients • Pregnancy is a predisposing factor to the development of disseminated gonococcal infection • presents as an arthritis-dermatitis syndrome • Newborns exposed to gonorrhea during vaginal delivery can develop an acute conjunctivitis (ophthalmia neonatorum), sepsis, arthritis, and meningitis
  12. 12. ophthalmia neonatorum
  13. 13. viral Infections in Pregnancy • RUBELLA: ( German Measles). – Risk of fetal transmission: • 50-60% of fetuses are affected if maternal primary infection is in the first month of gestation. • 22% in the second month, • 6-10% in the third to fourth month.
  14. 14. congenital rubella syndrome includes • -Neuropathic changes: • 1.microcephaly. • 2.mental& motor retardation. • 3.meningoencephalitis • 4.cerebral palsy. • 5.cerebral calcification • -Cardiovascular lesions: • 1.persistent ducats arteiosis • 2.pulmonary artery stenosis • 3.atrioventricular septal defects • -Ocular defects: • 1.cataract • 2.microphthalmia • 3.retinal changes, retinitis • 4.blindness
  15. 15. Congenital rubella with hemorrhagic lesions in the skin CYTOMEGALOVIRUS (CMV)
  16. 16. CYTOMEGALOVIRUS (CMV) • Transmission: – direct: person to person contact ( saliva, milk, urine, semen, tears, stools, blood, cervical and vag. Secretion.). – indirect: contaminated fomites. • in primary CMV infection – – 30-40% of fetuses will be infected, – 2-4% of them will develop severe malformations at birth.
  17. 17. Complications of fetal CMV infection include: • 1. micro & hydrocephaly • 2. chorioretinitis • 3. cerebral calcification • 4. mental retardation • 5. heart block • 6. petechiae
  18. 18. chorioretinitis
  19. 19. Varicella Zoster • If infection occurs in first trimester 4.9% risk of congenital varicella . • Congenital Syndrome – Limb hypoplasia - – Ocular abnormalities – CNS abnormalities ( convulsive disorders ) – Dermatomal scarring
  20. 20. Varicella-Zoster Infections Figure 3. Congenital varicella with short-limb syndrome and scarring of the skin. The mother had varicella during the first trimester of pregnancy.
  21. 21. Herpes Simplex virus • Primary – Fetal loss – Congenital Syndrome • Recurrent – Mucocutaneous lesions – Disseminated disease – Encephalitis • Transmission occurs at time of delivery in 90-95% of cases( vaginal delivery). • Prevention:If lesions present at time of delivery, recommend caesarean section.
  22. 22. VIRAL HIBATITIS • Most common cause of jaundice during pregnancy. • HepatitisB transmitted by contaminated blood ,saliva, breast milk, semen . • Hepatitis B - pregnant women who are infected transmit the virus transplacentally to the fetus and at birth.
  23. 23. TOXOPLASMOSIS • Causative agent: by protozoan toxoplasma gondi. • Risk of fetal infection: – First Trimester - 15 % ( less incidence of fetal infection but serious disease is most common ). – Second Trimester - 25 % . – Third Trimester - 65 % ( but almost 90% of newborns are without clinical signs of disease ). • 40% of fetuses are affected if the mother has the illness. • the earlier in pregnancy the more damage. • Maternal symptoms: usually asymptomatic, fever, rash & eosinophelia If symptomatic ( the CNS prognosis is poor

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