This document discusses various infectious diseases that can affect pregnancy, including their risks, screening recommendations, and treatment/management approaches. For HIV in pregnancy, screening and treatment can reduce transmission risk to the baby to 7.2%. Hepatitis B screening and immunoglobulin treatment within 12 hours of birth can reduce neonatal infection rates. Several infections including parvovirus, rubella, toxoplasmosis, varicella, CMV and listeria can cause fetal complications if acquired during pregnancy. Group B streptococcus is a leading cause of neonatal sepsis, and prenatal screening and intrapartum antibiotics can help prevent transmission.

1. Infectious diseases in pregnancy
Dr Khalid Sait

2. HIV in pregnancy
• USA 1-5% Canada 1/5000
• Risk to the baby 25 %
• Risk increase in HIV patient with low CD4
count and high viral load.

3. HIV in pregnancy
• Prenatal care:
Counseling
CD4 count in first and second trimester
Torch and STD screen in first and third
trimester
Pap smear twice eight week apart Watch
for IUGR Zidovudine ( ZDV)
during pregnancy and labor and to the infant
reduce the risk to 7.2 %

4. HIV in pregnancy
• Intrapartum management:
Avoid scalp PH , Internal scalp electrode
and ARM.
May be there is benefit from C.S.

5. HIV in pregnancy
• Post partum:
No breast feeding Encourage
contraception

6. Hepatitis in pregnancy
• Exposed pregnant women should be immunize with
immunoglobulin 0.02 ml/kg IM
Neonatal infection in HBsAg positive mother:
Maternal status Neonatal infection rate
HBeAg positive 90 %
HBe Ag negative 10-20 %
Anti Hbe positive 0-10 %
Acute HBV in ist trimester 10-20 %
Acute HBVin third trimester
or with in 1 month of
delivery
80-90 %
Infant required HBIG and HBV with in 12 hours of delivery

7. Parvovirus in pregnancy
• Fifth disease , childhood exanthum
( slapped cheeks)
• Can cause intrauterine infection and lead to
fetal hemolysis and fetal anemia and then
non immune hydrops
• IgG immune
• IgM acute infection(watch the baby )

8. Rubella in pregnancy
• Rubella specific IgM that present for four
weeks or rise fourfold in IgG
• Congenital rubella syndrome
1st
month 50 % risk
Second month 25 % risk
Third m 10 % risk
Second trimester 1 % risk

9. Toxoplasmosis in pregnancy
• Four fold rise in IgG
• IgM be present for many years
• Non pregnant infected women should delay
pregnancy for 6 months
• Congenital infection can occur but often is a
symptomatic
• 90 % of symptomatic neonate will be
neurologically impaired
• Treatment with 3 g spiramycin daily apparently
reduced the severity of congenital toxoplasmosis

10. Varicella in pregnancy
• Pneumonia associated with 10 % mortality
• Fetal risk 2-5 % (rare in second half pf pregnancy)
• Neonatal risk:
mild if maternal infection was 5-20 days before
delivery
30 % risk of neonatal disseminated VZV if
maternal infection was less than 5 days before
delivery or 2 days post partum they need VZIG
• Maternal exposure:
Check for immunity if not immune give VZIG 125
iu/10 kg with in 96 hours of exposure

11. CMV and pregnancy
• Four fold rise in CMV titer considered
evidence of acute infection
• Fetal risk of congenital CMV:
40 % in first trimester
30 % in second trimester
25 % of children have squeal
Third trimester infection is
usually with out squeal

12. Listeria infection and pregnancy
• High risk of preterm labor and
Choriamnioties
• Treatment:
Iv ampicillin and gentamycin

13. Group B streptococcal infection
and pregnancy
• Most common cause of neonatal sepsis in USA
• Vaginal colonization in 5-40 % of pregnant women
• Only 1-2 % of neonate develop sepsis
• Early onset infection ( first 2 days of life) mortality up to
37 % majority in preterm infant
• Late onset infection
Onset 6-90 days after delivery
mortality up to 25 %
Frequently cause endomytrities
A symtomatic bacturia is cause of pyelonephritis and
preterm labor

14. Group B streptococcal infection
and pregnancy
• Prevention:
1- Intrapartum antibiotic prophylaxsis to
all women with positive culture
2- If no culture is available we should treat
risk factors:
1- preterm labor
2- ROM > 18 H
3- previous baby with GBS
disease 4- Maternal fever