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Perinatal Infectious Diseases Dr. Hazem Al-Mandeel.

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Presentation on theme: "Perinatal Infectious Diseases Dr. Hazem Al-Mandeel."— Presentation transcript:

1 Perinatal Infectious Diseases Dr. Hazem Al-Mandeel

2 Perinatal Infections Accounts for 2-3% of birth defects Few infectious organisms are cost-effective to screen for prenatally (Rubella, Cytomegalovirus, Syphilis, HBV ± HCV, ?HIV) Important perinatal infections include: Toxoplasmosis, Rubella infection, CMV infection, genital herpes infection, Syphilis, HBV infection, HIV infection, group B streptococcus infection

3 Toxoplasmosis Parasitic infection cause by Toxoplasma gondii One of the common infections worldwide (0.1%) Infection leads to lifelong immunity (10-40% +ve) Risk of fetal infection depends on trimester Consequences: classic triad hydrocephalus, intracranial calcifications, and chorioretinitis 25% of infected fetuses are symptomatic (mental retardation, seizure, CNS, & hepatosplenomegally

4 Toxoplasmosis Dx: rarely made clinically Maternal infection cause mononucleosis-like syndrome (check Ab’s IgM & IgG) Fetal testing by either blood or placenta culture Treatment: pyrimethamine + sulfadiazine + folinic acid Route of Delivery: vaginal Prevention: avoiding cat litter/feces, wearing gloves when gardening, and avoid ingestion of unpasturized milk or raw meat

5 Rubella (German Measles) Viral infection caused by RNA virus and causes lifelong immunity Disease of childhood and transmitted by respiratory route (highly contagious) The period of infectivity is 7 days before the rash to 5 days after the rash appears 85% of the general population is seropositive 75% of infected patients become clinically ill

6 Rubella (German Measles) Risk of fetal infection affected by GA Consequences: 1. Spontaneous abortion2. IUGR 3. Congenital heart disease 4.CNS (deafness, cataracts, retinopathy, microcephaly, calcifications, mental retardation) 5. Hepatosplenomegally 6.Thrombocytopenic purpura

7 Rubella (German Measles) Dx: maternal testing (IgM & IgG) and fetal testing (IgM in umbilical blood or IgG in infant’s blood after 5 months) Treatment: none; mother can deliver vaginally Prevention: screen all pregnant women in 1 st visit; avoid exposure during pregnancy; vaccination of seronegative women in postpartum period and contraception for 3 months

8 Cytomegalovirus (CMV) Caused by DNA herpes virus One of the most common congenital viral syndrome Transmitted via exposure to infected blood, other body fluid, or organ transplantation 50% of pregnant women are seropositive

9 Cytomegalovirus (CMV) Risk of fetal infection: 50% in all trimesters with 1ry infection and < 1% with recurrent one Dx: a) Symptomatic infection appears as a mononucleosis-like syndrome with hepatitis (rarely seen) b) Asymptomatic infection is more common

10 Cytomegalovirus (CMV) Dx: viral culture of amniotic fluid, urine, or other body fluid. Maternal and fetal Ab’s testing Treatment: if active  ganciclovir Route of delivery: vaginal Prevention: counseling the mother to avoid blood transfusion in pregnancy and in using universal protection measures at work

11 Herpes Simplex Virus (HSV) HSV-II causes 90%, HSV-I causes 10% (protect) Most contagious STD and most common cause genital ulcer HSV-II accounts for 70% & HSV-I for 30% 50% of pregnant women are seropositive Types of genital herpes infections: - Primary - Recurrent

12 Herpes Simplex Virus (HSV) Dx: culture from ulcer or smear or ELISA Significance: - 1ry infection: spontaneous abortion, IUGR, IUFD, & preterm labour. No malformation syndrome. Neonatal attack rate 50%, mortality 50%, and permanent sequelae 50% - Recurrent infection: no intrauterine risks. Neonatal attack rate 4% by passing vaginally

13 Herpes Simplex Virus (HSV) Treatment: antiviral agents, symptomatic relief, and abstinence from sexual contact Route of delivery: caesarean section if active genital lesions are present at time of delivery and no documented fetal infection otherwise vaginally Neonatal management: no need for isolating the fetus from the mother or stop breastfeeding unless a lesion is present

14 Herpes B Virus (HBV) Infection Infection caused by DNA hepadenavirus type I HBV is endemic in Saudi Arabia Transmitted via body fluids. Mother-infant transmission causes 40% of all chronic infections Types of infection: - Asymptomatic: 75% of all infected patients - Acute hepatitis: jaundice and  liver enzymes - Chronic hepatitis: in 10% of infected adults and 80% of infected infants

15 Sequelae of Chronic Hepatitis Immunological markers: HBsAg for screening. Others HBcAg & HBeAg Maternal: cirrhosis and hepatocellular carcinoma Fetal: uncommon infection, occurs in third trimester, can cause premature birth, low birth weight or neonatal death Carrier mothers may transmit infection in 10% if only HBsAg or 80% if both HBsAg & HBeAg

16 HBV Dx: all pregnant women should be screened for HBsAg at 1st visit (repeat at 28 wks if high risk) Treatment: no specific therapy Route of delivery: vaginal Prevention: neonates of HBsAg +ve women should receive HBIg and active vaccine. Avoid scalp electrode, scalp needles after delivery, and avoid breastfeeding

17 Human Immunodeficiency Virus Single-stranded RNA virus causes AIDS Virus transmitted via sexual contact with infected partner, blood Tx, transplacental, & needle stick 1 in 3 neonates delivered to HIV +ve mothers AIDS manifestations Dx: ELISA (for screening) and Western Plot HIV screening is recommended for all high-risk mothers

18 Group B Streptococci (GBS) GBS is part of normal flora in G.I tract Transmission occurs via colonized birth canal Vaginal colonization rate is 35% (?lower in S.A) Risk of transmission from colonized woman to neonate is 50%, but attack rate is only 1% Dx: culture in specific media or rapid assays (low sensitivity but good specificity)

19 GBS Clinical Issues Obstetric complications: preterm labour/delivery, PROM, intrapartum or postpartum infection Neonatal complications: Early-onset infection: occurs within 48hrs, 50% mortality. Sepsis, pneumonia, meningitis Late-onset infection: occurs after 1 st week, 25% mortality. Meningitis is most common presentation

20 Prevention of GBS Neonatal Infection Intrapartum antibiotic prophylaxis prevents 70% of GBS neonatal infection Women selection by either screening approach (all pregnant women at 35-37 wks) or risk factors Pen G is the antibiotic of choice Others: Ampicillin, Cefalozin, Erythromycin, or Clindamycin Check CDC recommendations

21 Management of HIV +ve Mother 1.Maternal counseling 2.Antiviral prophylaxis with AZT (start at 14wks) 3.Multidrug antiviral therapy if viral load is high 4.Treatment for infectious diseases 5.Maternal vaccination against HBV 6.Maternal prophylaxis for P. carinii pneumonia 7.Avoid scalp electrode or instrumental delivery 8.Mode of delivery (caesarean section is protective)


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