Perinatal Infections part 1

1. PERINATAL INFECTIONS
PART 1

2.  Togavirus (RNA )
 Incubation period 7-12 days
 Infectious 7 days before and 7 days after the rash
 Screening is a common practise in early pregnancy for immunity to rubella
(Rubella IGg)
 Aim of screening: postpartum vaccination of non-immune
 Vaccination: Contraindicated during pregnancy (live attenuated vaccine )
 If any woman vaccinated; advice her to delay pregnancy for 1 month
RUBELLA
‫االلمانيه‬ ‫الحصبه‬

3. Maternal Presentation
Asymptomatic in 20–50%
of cases.
Febrile rash
Fetal Presentation
CRS can include
sensorineural deafness,
congenital cataracts,
blindness, cardiac defects
(PDA) and diabetes
RUBELLA

4. The risk of congenital rubella infection reduces with gestation
Congenital infection in the first 12 weeks of pregnancy among
mothers with symptoms is over 80% and reduces to 25% at
the end of the second trimester.
RUBELLA
Before
conception no
documented
risk of fetal
defects
First 11 weeks
of gestation risk
of fetal defects
is 100%
Between 16-
20 weeks
minimal risk
of deafness
After 20 weeks
no documented
risk of fetal
defects

5. 12 weeks and below : the risk is 80-100 % ….. Offer
termination of pregnancy
From 13-16 weeks : offer termination if foetal PCR is positive
Above 16 observe and follow up
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MANAGEMENT OF PREGNANCIES WITH
RUBELLA

6.  DNA virus
 Droplet transmission
 Fever and pruritic rash
 More sever in pregnancy than childhood
 Can lead maternal pneumonia, encephalitis and myocarditis
 Incubation period : 7-21 days
 Infectious 2 days before the rash until vesicles crust over (5
days )
 Remains dormant in the dorsal root ganglia
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VARICELLA ZOSTER
‫الجدري‬ CHICKENPOX

7.  Possible miscarriage in the first trimester
 Fetal varicella syndrome from 3-28 weeks (1-2% risk)
 More if after the first trimester and before 28 weeks
 Leads to : microcephaly , hydrocephaly , limb deformity , rash
, IUGR , soft tissue calcifications, microphthalmia ,
chorioretinitis , cataract
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FETAL INFECTION

8. If the women is exposed : check her immunity
 If she has varicella IGg +ve …. Do nothing, not at risk
 If she has varicella IGg negative …… wait for symptoms
 If she has no symptoms … vaccine postpartum (safe in
breastfeeding )
 Note that varicella vaccine is live attenuated and
contraindicated in pregnancy. In whome took it should delay
pregnancy for 1-3 months
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MANAGEMENT
EXPOSED PATIENT

9.  Before the rash : IVIG can be given within 10 days of exposure
before the rash
 After the rash : oral acyclovir is needed or IV in sever,
complicated or high risk cases
 Fetal ultrasound is needed after 5 weeks of the exposure and
PCR amniocentesis can be also done if no ultrasound findings
 No intrauterine treatment
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MANAGEMENT OF INFECTED MOTHER

10.  DNA virus from herpes virus family
 Transmission occur to one third of the fetuses (30-40%)
 Mostly asymptomatic but can present as IMN like
 Fetal effect :
 the most common cause of fetal sensorineural hearing loss and
learning disability
 Microcephaly, fetal hydrops , ventriculomegaly, intracranial
calcification
 Miscarriage and intrauterine fetal death
 No vaccination
 No effective fetal therapy 10
CYTOMEGALOVIRUS

11.  Protozoal infestation
 First trimester it may lead to miscarriage
 Infection increases with increasing gestational age but
severity declines
 Women are usually asymptomatic
 Fetal effect : chorioretinitis, hydrocephaly , internal organ
calcification , jaundice , hepatomegaly
 Treatment by pyrimethamine + sulfadiazine
 Spiramycin for fetal infection
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TOXOPLASMOSIS

12.  DNA virus
 Erythema infectiosum or fifth disease
(slapped cheek)
 Maternal infection is usually
asymptomatic
 Not teratogenic but can lead to fetal
hydrops (3-10% risk of hydrops with 50
%fetal demise if hydrops occurs)
 Attack bone marrow (erythropoiesis,
anemia) and cardiac cells
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PARVOVIRUS B 19

13.  Risk of transmission increases with increased gestational age
reaching 70% toward term
 30% of hydrops resolves spontaneously
 Follow up of fetal anemia by MCA peak systolic velocity and
ultrasound
 May need intrauterine blood transfusion once
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14. 14
SYPHILIS

15. 15
TREPONEMAL TESTS

16.  After 14 weeks , increasing with increasing gestational age
with 70 % risk at term
 Hydrops , stillbirth , miscarriage , preterm labor , bone
deformity , neurological impairment , deafenss , abnormal
teeth (Hutchinson teeth ) and nose
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EFFECT ON THE FETUS

17.  Hepatomegaly is the most accurate diagnostic feature of
congenital syphilis on ultrasound
 Treatment is by penicillin
 Even after treatment, 15 % still have fetal death or congenital
syphilis .
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