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Infectious diseases in pregnancy

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Infectious diseases in pregnancy

  1. 1. Infectious diseases in pregnancy Khalid Sait Professor Faculty Of Medicine King Abdulaziz University
  2. 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. 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. 4. HIV in pregnancy •  Intrapartum management: Avoid scalp PH , Internal scalp electrode and ARM. May be there is benefit from C.S.
  5. 5. HIV in pregnancy •  Post partum: No breast feeding Encourage contraception
  6. 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. 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. 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. 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. 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. 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. 12. Listeria infection and pregnancy •  High risk of preterm labor and Choriamnioties •  Treatment: Iv ampicillin and gentamycin
  13. 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. 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

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