Mohamed Tahir Abdi ( BSc, Mph nutrition)

1. Assignment presentation on
Effect of maternal infection
during pregnancy on birth
outcome
Presented and prepared by:-
Mohamed Dahir Abdi

2. Outline presentation
Introduction
Infection in pregnancy with general principle
Fetus and infection
Bacterial infection
Viral disease
Conclusion with recommendation

3. Introduction
• Maternal infections during pregnancy can have a direct impact on the
developing fetus and in some infections can result in fetal demise.
• It is extremely important to screen women for infections when it is
available and practical and to treat when necessary.
• Thus, it is critically important that efforts continue to prioritize the
development of immunizations and treatments plans for all viruses
that can result in congenital fetal infection in an attempt to minimize
the substantial long-term morbidities that result.

4. Infection in pregnancy
General principle
Pregnancy does not alter resistance to infection
Sever infection have greater effect on the fetus
Maternal antibodies cross the placenta and give passive immunity to
the fetus
Fetus become immunologically competent from the 14th week

5. Fetus and infection
• Indirect effect -oxygen transport nutrient exchange
• Direct effect-invasion of placenta and infection of fetus
• Viruses more than bacteria
• Rarely effect fetus unless maternal infection is severe

6. Continue….
Infection during pregnancy can cause:-
Miscarriage
Fetal hydrops
Preterm delivery
Congenital anomalies
Fetal death
Preterm rapture of the membrane

7. Bacterial infection
 Bacteruria
 Vaginal infection
 Group B streptococci
 Gonorrhea
 Chlamydia
 Toxoplasmosis
 Listeria

8. Bacteruria
• Asymptomatic
• 5-8% of all pregnancy
• Urinary stasis, tract dilatation
• Subsequent care( prophylaxis

9. Group B streptococci
• 25% women are carrier
• 50% of babies born will be colonized
• 1-2% will have group B strep infection
• Pneumonia ( early) meningitis (Late)
• Screening v/s risk factor prophylaxis

10. Gonorrhea
• Neisseria gonorrhea
• Pre-term labor , chorioamnionitis , endomotitis
• 80% asymptomatic
• Screening needed
• Cephtraxone IM start

11. chlamydia
• 5-7% reproductive population
• Conjunctivitis (18-50%) pneumonia (18%)
• Most are asymptomatic
• Screening needed
• Azithromycin 1 gram start

12. syphilis
• Can infect trans placentation from 15th week
• second stage by birth if not treated
• Treatment ( High dose of pencillin)

13. Toxoplasmosis
• Toxoplasmosis Gondi ( Protozoa)
• Cat feces raw/under cooked meat
• TORCH syndrome
• Encephalitis , neonatal jaundice
• Treatment ( sulfonamides + pyrimathamine )

14. Intra-amniotic infection
• 1-2% all deliveries
• Clinical diagnosis -fever , uterine tenderness, leukocytosis
• Ascending infection , rarely haemotogenous
• Treatment -antibiotics and delivery

15. Viral Disease
• Rubella
• Cytomegalovirus
• Herpes
• HIV
• Parvovirus
• Varicella zoster
• Hepatitis

16. Rubella
• Toga virus (RNA virus)
• Incubation -14 to 21 days
• Respiratory droplets inoculation
 Only modestly contagious
 Fever , rash ( 3days) cough arthralgia's ,post auricular & suboccipital
lymphadenopathy .
 usually mild ,overt clinical symptom 50-75% of cases
 Encephalitis , bleeding, diathesis and arthritis are rare complication .

17. Parvovirus
• Human parvovirus B19(DNA virus)
• Erythema infection in childhood
• Chronic arthropathy
• Chronic bone marrow failure (Immunodefic)
• Aplastic crisis (sickle disease)
• Incubation 4-14 days
• Respiratory droplet spread
• High fever, slapped check syndrome
• No specific rash, no symptom

18. Parvovirus and fetus
• Hydrops ( Anemia , myocarditis )
• Adult 60% sero-positive
• 1/3 fetus affected in acute infection
• Fetal loss rare with appropriate treatment
• Asses serology 1gG/gm paired serology
• Serial ultrasound , intra uterine transfusion

19. Varicella
• Varicella zoster virus (DNA)
• Incubation 10-20 days
• Respiratory droplet inoculation
• Fever, malaise , pruritic , rash ( Maculopapular with vesicles )
• Pneumonia , encephalitis , myocarditis , pericarditis and adrenal ,
insuffiency especially adult.

20. Cytomegalovirus (CMV) congenital infection
• Hepatomegaly
• Splenomegaly
• jaundice
• Thrombocytopenia
• Microcephaly
• Intrauterine growth retardation

21. Cytomegalovirus (CMV )congenital infection (
Late)
• Venticulomegaly
• Cerebral atrophy
• Mental retardation
• Psychomotor delay
• seizure
• Learning difficulty and language delay
• Intracranial calcification
• Pneumonia

22. HIV
• Infection rate variable
• Risk of vertical transmission 20-40% mostly peri-partum
• Screening and treatment can almost completely reduce risk of
transmission
• C-section reduce risk of transmission
• Viral count < 1000 negligible risk to fetus

23. Conclusion with recommendation
• Many of the maternal infections that previously resulted in significant
impact and poor outcomes on the developing fetus have improved as
treatments and vaccines have been introduced and refined.
• Other infections are continuing to increase, with the true impact on
society, yet to be determined. Thus, it is imperative that we monitor
any infections in a pregnant woman, and complete a thorough
examination and evaluation of each infant born with the hopes of
identifying any abnormalities quickly and improving the outcomes of
each infant to the best of our ability.

24. The end !
THANK YOU FOR YOURATTENTION!!