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Infectious Diseases of Pregnancy
Transcript of Infectious Diseases of Pregnancy
5.5 million of these infants die (4)
99% occur in developing countries
33% are due to mostly preventable infections Common Congenital Infections
T O R C H E S 22 year old G0 presenting for routine
prenatal care, LMP was 6 weeks ago,
at-home pregnancy test was positive.
Patient has had one episode of
Gonorrheal infection 2 years prior. What are the current infectious disease
screening recommendations? Prenatal screening recommendations (2):
Group B Streptococcus - 35-37 weeks High risk screening recommendations (2):
HIV (Third trimester or at delivery if HIV status is unknown)
Syphillis (Third trimester and at delivery)
Hepatitis B (At delivery, consider vaccination)
Gonorrhea/Chlamydia (Third trimester)
Hepatitis C (Initial prenatal visit)
HSV/Bacterial Vaginosis/Trichomonas (Symptomatic only) Toxoplasmosis Rubella HIV Herpes Syphilis CMV Prevention:
Thoroughly cook all meats
Clean all fruits and vegetables
Wear gloves when working with soil
Avoid exposure to cats that are not fed processed foods
Spiramycin in HIV infected/high risk mothers
Greatest risk - 3rd trimester/More severe - 1st trimester
Toxoplasmosis Antibody Titers - Radiologic
Severe mental retardation
Epilepsy, Intracranial calcifications
Pyrimethamine + Sulfadiazine
Not proven to decrease transmission (6) http://www.tedmontgomery.com/the_eye/eyephotos/toxoplasmosischorioretinitis.html http://www.pathobio.sdu.edu.cn/sdjsc/engparabook/ch084.htm http://www.med.uc.edu/neurorad/webpage/bfa.html Prevention:
Screening and antibiotic prophylaxis
-High risk/Status Unknown (1)
Preterm labor (<37 weeks)
ROM >18 hours
-Early-onset (First week)/Late-onset (>3 Months)
Penicillin, Ampicillin prophylaxis, primary treatment
Infant - [Third-generation Cephalosporin] or Aminoglycosides GBS http://richmondmidwife.com/GroupBStrepGBS.aspx Prevention:
Vaccination at least 1 month prior to conception (live attenuated virus)
Vaccination after delivery in pregnant women not immune
Congenital heart disease - Patent ductus arteriosus
Buzz phrase: "Blueberry muffin" rash
No treatment CDC CDC General:
Most common congenital infection
Primary maternal infection is highest risk
Most are asymptomatic
Microcephaly, periventricular calcifications
(MC) Long term - hearing loss and neurologic impairment
No treatment, ganciclovir and foscarnet (not proven effective, 1)
No vaccine available http://www.asm.org/Division/c/viruses.htm http://radiographics.rsna.org/content/30/7/1779/F2.expansion.html Prevention:
Screening: Dark-field microscopy, VDRL/RPR, FTA-ABS
Prophylaxis - Penicillin
Complications/Findings (10-14 days after delivery):
Maculopapular skin rash
Hutchinson's triad - interstitial keratitis, peg-shaped incisors, deafness
Penicillin (G) (8) http://www.sciencephoto.com/media/295804/view CDC CDC General:
Infection occurs during or after delivery
Primary Infection - no evidence of prior infection, high risk
Recurrent - low risk to fetus
Localized infections do well
Disseminated do poorly, encephalitis
Active vaginal lesions require C/S
Acyclovir - starting at 36 weeks (3) References
1. Beckman, Charles, et al. Obstetrics and Gynecology, Sixth Edition. Baltimore: Lippincott Williams and Wilkins, 2010.
2. Department of Health and Human Services, Centers for Disease Control and Prevention. "Sexually Transmitted Disease Treatment Guidelines, 2010." Morbidity and Mortality Weekly Report (2010): 8-10.
3. Hollier, Lisa M and George D Wendel. "Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection." Cochrane Database of Systemic Reviews (2008).
4. Lawn, Joy E, Simon Cousens and Jelka Zupan. "4 million neonatal deaths: When? Where? Why?" The Lancet (2005): 891-900.
5. Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. "Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States." 24 May 2010. AIDSinfo. 21 May 2011 <http://aidsinfo.nih.gov/ContentFiles/PerinatalGL.pdf>.
6. Peyron, Francois, et al. "Treatments for toxoplasmosis in pregnancy." Cochrane Database of Systemic Reviews (2010).
7. United States Central Intelligence Agency. "The World Factbook." 17 May 2011. Central Intelligency Agency. 21 May 2011 <https://www.cia.gov/library/publications/the-world-factbook/geos/xx.html>.
8. Walker, Godfrey. "Antibiotics for syphilis diagnosed during pregnancy." Cochrane Database of Systematic Reviews (2010). Prevention:
Screening and prophylaxis - ELISA (Confirmatory Western Blot)
Discourage breastfeeding - linked with transmission
Reduce time from ROM - Early C/S for >1000 copies/mL viral load
Combined antiretroviral therapy decreases transmission to 1% (5) - [Zidovudine], Neviparine, Lamivudine
Neonatal treatment (Ziduvidine for 6 weeks if ART, combined if not) http://www.articlesbase.com/diseases-and-conditions-articles/how-to-treat-genital-herpes-2407924.html