Intrauterine infections: the concept of TORCH, etiology, routes of infection of the fetus, diagnostic methods, principles of therapy for pregnant women and newborns.

Intrauterine infections
(IUI) are various infectious diseases of the embryo, fetus and newborn, infection of which occurs in utero and during childbirth [1]. The causative agents of infection can be viruses, bacteria and (less commonly) parasites. The route of transmission is vertical, from mother to fetus. The result of infection can be a miscarriage, congenital malformations, or an acute infectious process in a newborn.

Content

• 1 Epidemiology 1.1 TORCH

Diagnostic methods

There are no distinctive symptoms to identify IUI without special tests. A pregnant woman does not feel the suffering of the fetus. The course of gestation does not change, the general condition of the expectant mother is not disturbed. There are only some indirect signs that allow one to suspect infection of the fetus:

• Increased uterine tone . The uterus tries to get rid of the infected fetus, which can lead to miscarriage or premature birth. Myometrial hypertonicity is felt as nagging pain in the lower abdomen and lower back.
• Pathological vaginal discharge indicates the presence of an infection in the genital tract, which theoretically can reach the fetus. Discharge that is considered abnormal is thick or too abundant, cloudy, yellow and yellow-green, white and grayish with a pungent odor. Accompanied by itching, burning, pain during intimacy.
• An increase in body temperature occurs with various infectious diseases that can lead to infection of the fetus.

To identify IUI, an examination is carried out:

Laboratory methods

In obstetric practice it is used:

• survey smear on the flora. Taken from the vagina, cervix and urethra;
• bacteriological culture from the cervical canal;
• polymerase chain reaction (PCR);
• immunological methods: ELISA, etc.

The first three methods allow you to identify the pathogen, determine its type and assess sensitivity to drugs. ELISA makes it possible to detect antibodies to certain microorganisms and evaluate the response of the immune system.

Important! These methods only reveal the infection of the mother, but do not make it clear whether dangerous microorganisms have penetrated the fetus and how they affected its condition.

Instrumental non-invasive diagnostics

Ultrasound is a safe and quite effective method for suspecting IUI. Evaluation of ultrasound data is carried out taking into account the duration of pregnancy.

In the first trimester, only indirect factors speak in favor of IUI:

• increased uterine tone;
• signs of chorionic detachment;
• deformation of the ovum;
• enlargement of the yolk sac;
• underdevelopment of the chorion;
• discrepancy between the size of the embryo and the size of the fetal egg, etc.

In the 2nd and 3rd trimesters he says about IUI:

• change in the thickness of the placenta;
• detection of suspended matter in amniotic fluid;
• polyhydramnios or oligohydramnios;
• areas of fetal brain necrosis;
• detection of calcifications in the liver and spleen;
• dropsy - accumulation of fluid in soft tissues;
• fetal hypoxia;
• delayed fetal development.

Instrumental invasive diagnostics

To identify pathology, the following are used:

• Chorionic villus biopsy - sampling of material for histological examination;
• amniocentesis - assessment of amniotic fluid;
• cordocentesis - collection of umbilical cord blood.

Intrauterine infection is determined by isolation of the causative agent or detection of YgM and YgG antibodies in the umbilical cord blood of the fetus.

After the birth of the child, a histological examination of the placenta is performed. Certain signs can confirm or refute intrauterine infection.

Epidemiology

The true frequency of congenital infections has not yet been established, but, according to a number of authors, the prevalence of this pathology in the human population can reach 10%.

Intrauterine infections have the same patterns as infectious diseases in general.

They have a leading place in the structure of infant mortality.

The share of IUI in the structure of perinatal mortality in our country is almost 25%, however, transplacental infection of the fetus is considered one of the most likely causes of 80% of congenital malformations, which, in turn, account for about 30% of all deaths of children under 1 year of age [2 ][3]

TORCH

In 1971, WHO identified the concept of TORCH syndrome

.
This is an abbreviation for the most common intrauterine infections : T - toxoplasmosis, O - others, which includes mycoplasma, syphilis, hepatitis, streptococci, candida and other viral and bacterial infections, R - rubella (rubella), C - cytomegalovirus, H - herpes
If not clear etiological diagnosis, they talk about TORCH syndrome.

HIV infection

The insidiousness of HIV infection lies in the fact that its latent period can be up to one and a half years. If a woman has been infected, she may not know about it at the time of planning pregnancy, and modern medicine, for a favorable pregnancy outcome, insists on preliminary drug treatment in HIV-positive mothers at least 14 days before conception. If HIV infection is detected in a woman after the start of pregnancy, the patient is prescribed antibacterial drugs to reduce the level of the virus in the blood and reduce the risk of the infection passing through the placental barrier. In the early stages of fetal development, the risk of transmission of the disease from mother to child is low, but during childbirth the risk increases. HIV infection increases the chances of premature birth. The probability of infection of the fetus at the time of passage of the birth canal is 1:7. After birth, a child can become infected during breastfeeding, so the child is prescribed special infant formula.

The consequences of bearing a child by a mother with a positive reaction to HIV can most likely be expected:

1. Risks of spontaneous miscarriages.
2. Stillbirths.
3. Hypotrophy.
4. CNS lesions.
5. Chronic diarrhea.
6. Oral thrush.
7. Developmental delays.

To prevent intrauterine infection, an HIV-positive woman is prescribed antiretroviral therapy, which uses didanosine and phosphazide, which replace the commonly used zidovudine and nevirapine. These drugs are used to prevent infection of the fetus during pregnancy.

Etiology

An infectious process in the fetus can be caused by a wide variety of pathogens. According to this principle, several groups can be distinguished.

• A group of IUIs caused by viruses: rubella, CMV, herpes viruses, viral hepatitis, etc.
• Diseases caused by bacteria: syphilis, listeriosis, tuberculosis, STDs
• Parasitic infections: toxoplasmosis
• Fungal infections, including iatrogenic origin
• Mixed infections (combined).

It is noteworthy that infection with the same infections in the postneonatal period occurs in most cases asymptomatically or in the form of a mild infectious process. The causative agents of infectious diseases that the mother first encountered during pregnancy are especially dangerous for the fetus, since during this period the primary immune response is reduced, while the secondary one is normal.

Source of infection

The source of infection is the mother. But there are also iatrogenic causes of infection during medical procedures [4] [5].

Routes of infection

• Transplacental (hematogenous) route - from mother to fetus through the placenta. Viral IUIs are more often transmitted, since the virus easily penetrates the blood-placental barrier (like Toxoplasma).
• Ascending - when an infection from the genital tract enters the uterine cavity and can then infect the fetus. More often these are bacterial infections, STDs, chlamydia, fungi, mycoplasmas, enterococci.
• Descending path - from the fallopian tubes into the uterine cavity
• Contact (intranatal) route - infection during passage through the birth canal.

Outcome of fetal infection

1. Infection,
2. Sanitation of the pathogen with the acquisition of immunity,
3. Carriage of an infectious agent with the possibility of developing the disease in the future. Thus, the presence of an infection in the mother, an infectious lesion of the placenta and infection do not mean 100% development of IUI in the fetus and newborn[1]

Treatment of intrauterine infections

It must be said that not all intrauterine infections can be treated. Sometimes it is impossible to cure them. For such therapy, it is first necessary to establish the condition of the mother and child and only then prescribe appropriate treatment. Treatment with antibiotics is indicated only in particularly dangerous cases. It is also selected depending on the causative agent of the infection. Sometimes it is enough to prescribe immunoglobulins to a woman to maintain the immune system and increase immune resistance to the pathogen.

In some cases, vaccination is done during pregnancy. For example, they can provide a vaccine against herpes. In addition, the duration of pregnancy also influences the treatment methods.

And, it should be noted that the best thing an expectant mother can do is to prevent the development of intrauterine infection , which will help avoid further problems and pathologies. THEREFORE, it is best to take preventive measures regarding this. Preventive measures include, first of all, pregnancy planning.

At the planning stage, a woman can take all the necessary tests, check her health and eliminate problems, if any. When planning, both partners need to undergo an examination, and if any diseases are detected in a man, he also needs to undergo the necessary treatment.

In addition, already during pregnancy, a woman needs to carefully monitor her hygiene, wash her hands, vegetables and fruits, and hygiene is also needed in relationships with her sexual partner.

Proper nutrition strengthens the body's defenses and has a beneficial effect on a woman's health, which means it is also a good preventive measure against all kinds of infectious diseases.

During pregnancy, a woman should especially closely monitor her health, take the necessary tests and undergo examinations in a timely manner. And even if the doctor talks about possible infection of the fetus, you should not panic ahead of time. Timely diagnosis and modern medicine in most cases have a positive impact on both the health of the expectant mother and the health of the newborn. And even with intrauterine infections, absolutely healthy babies are born.

Symptoms

All IUIs have a number of common symptoms. The similarity of symptoms is associated with several points: the characteristics of the pathogens are often intracellular infections, the body cannot independently eliminate infections - as a result, a persistent course. In addition, newborns have age-related weakened immunity, which is why infections take a slow course. As a result of the effect of infection on the fetus, a complex of effects occurs, such as hyperthermia, the pathological effect of microorganisms and their toxins, resulting in a disruption of the placentation process and metabolic disorders [6]. [7]

• Manifestations of infection are determined by the timing of infection of the fetus in the first 2 weeks after conception - blastopathy, which often ends in spontaneous abortion at a very early stage.
• from 2 to 10 weeks of pregnancy - true malformations due to lesions at the cellular level.
• from 10 to 28 weeks of pregnancy - early fetopathies. The fetus can respond to the introduction of an infection with a generalized inflammatory reaction (the 1st and 3rd phases of inflammation, alteration and proliferation and fibrosis are clearly expressed, and the 2nd phase - exudation is not pronounced) as a result of which the child develops multiple malformations, for example fibroelastosis.
• from 28 to 40 weeks of pregnancy - late fetopathies. The fetus can already respond with a full-fledged inflammatory reaction, most often several organs are involved
• infection during childbirth - inflammation, more often than one organ - pneumonia, hepatitis.

General signs[6]:

• intrauterine growth restriction
• hepatosplenomegaly
• minor developmental anomalies (stigmas of disembryogenesis) early or prolonged or intense jaundice
• rashes of various types
• respiratory distress syndrome
• cardiovascular failure
• severe neurological disorders
• febrile conditions in the first days of life

Rubella

The rubella virus poses perhaps the greatest danger to the embryo and fetus from the point of view of developmental anomalies and significant damage to the fetus. The risk of rubella infection in a pregnant woman is observed in the absence of antibodies to the rubella virus in the mother's blood. If rubella disease occurs in the first 2 months of pregnancy, then the probability of infection of the embryo reaches 80%, and the occurrence of developmental abnormalities is possible with a probability of 25%. Infection of an embryo with the rubella virus can lead to its death or leads to the formation of congenital heart defects, deafness, cataracts, microophthalmia, chorioretinitis and microcephaly. Infection of the fetus at a later date may be accompanied by the appearance of typical skin rashes in the newborn, which disappear after some time.

Taking into account the high risk of developmental anomalies during the disease in the first 2-3 months of pregnancy, it must be interrupted. A child who was born to a woman who had rubella during pregnancy is himself a carrier of the virus, and therefore his isolation is necessary. In case of contact of a pregnant woman with a patient with rubella, if she has not had it before, vaccination is necessary, but not earlier than 8-10 weeks of pregnancy, since a live attenuated vaccine is used for this purpose, and a negative effect on the embryo is possible.

Diagnostics

Diagnosis of IUI includes two mandatory components: 1) clarification of the nature (etiology) of the infection and 2) proof of the intrauterine genesis of the disease. Diagnosing IUI is extremely difficult. Anamnesis data and features of the course of pregnancy can only suggest the possibility of intrauterine infection. Accurate diagnosis involves examining 1) the mother, 2) the placenta, and 3) the fetus (newborn, child). The study of the placenta (placenta, membranes and umbilical cord) must be of high quality, which involves studying at least 2 pieces of the umbilical cord, 2 rollers of the membranes (twisted from the site of rupture to the place of attachment to the placenta) and 10 pieces of the placenta. It is necessary to conduct bacteriological and immunohistochemical (IHC) studies of the placenta and membranes. The introduction of IHC studies into the practice of a pathologist is absolutely necessary. This is the only way to overcome the existing overdiagnosis of chlamydia, mycoplasmosis, toxoplasmosis, “deenkova” and other infections. The immunofluorescence method when examining the placenta gives a large number of false positive results. Methods for laboratory diagnosis of IUI can be divided into direct and indirect.

Direct ones include:

• microscopy
• culture method, virus replication on tissues
• Detection of antigens by RIF, ELISA and IHC.
• PCR[8]

Indirect diagnostic methods are serological studies using enzyme-linked immunosorbent assay (ELISA), qualitative and quantitative analysis of IgM, IgG, IgA. The newborn's blood is examined. The presence of IgG may indicate transplacental transfer of maternal antibodies, so the newborn’s blood is tested again after 3-4 weeks. An increase in IgG titer of 4 times or more is diagnostically significant[9]. The detection of IgM in the blood of a newborn indicates the presence of an active infection in the child. From additional studies, a general blood test can detect leukocytosis with a shift to the left, leukocytosis with neutropenia, toxic granularity of neutrophils, anemia. In addition, children with suspected IUI need to undergo abdominal ultrasound to detect hepatosplenomegaly and neurosonography [10] [11].

Treatment is light, and non-treatment is darkness. Diseases that threaten intrauterine infection of the fetus

Billions of different bacteria, cocci, fungi and other representatives of the microcosm, considered relatively harmless, live in the intestines, bronchopulmonary, genitourinary and other human systems. Thousands of other microbes (including those that are considered causative agents of infectious diseases) invade the human body from the outside almost every day. The immune system of an adult tightly controls the activities of both the first and the second - with more or less harmless microbes it maintains an “armed truce”, but it gives immediate and brutal combat to pathogenic microbes - in a war as in a war. In general, a healthy person usually does not think about exactly how his body’s relationship with microbes develops. Unless, of course, this healthy person is a woman expecting a child.

It is during pregnancy that the problem of even completely asymptomatic infection of the female body by microbes becomes particularly important. Not to mention infectious diseases suffered by a woman at different stages of pregnancy. The situation is really difficult - on the one hand, intrauterine infection of the fetus (quite real if the woman is a carrier of pathogenic microbes) can indeed lead to an unfavorable pregnancy outcome. On the other hand, the risk of such an outcome is not always as great as many expectant mothers tend to imagine after a laconic conversation with a doctor in a antenatal clinic. So what should a woman planning a pregnancy and a woman already expecting a child do if the tests turn out to be “bad”? Let's try to figure out this problem together.

Normally, the fetus is practically sterile - the mother’s immune system and the placenta with membranes more or less reliably protect it from premature encounters with microbes. When these barriers fail, intrauterine (congenital) infection actually occurs. This term refers to infection by any microorganisms of the fetus located in the uterus or moving along the birth canal - in the latter case, the placenta and fetal membranes, of course, no longer protect the child from infection. Transmission of infection to the fetus can occur in two main ways - hematogenous and ascending. With hematogenous infection, the pathogen is carried by maternal blood into the placenta, and from there through the umbilical cord enters the fetus. With an ascending infection, the pathogen rises from the mother’s genital tract into the uterine cavity, infects the fetal membranes, then multiplies in the amniotic fluid and with it penetrates the gastrointestinal tract or respiratory tract of the fetus. Direct contact infection is also possible.

The consequences for the fetus depend on many conditions - the duration of pregnancy, for example. As well as from the state of maternal immunity, designed to resist microbial expansion. Well, and from the properties of the microbes themselves, of course.

Massive infection of the embryo in the early stages (from the 5-6th day to the 12th week) often leads to its intrauterine death and subsequent spontaneous miscarriage. This occurs due to severe malformations of the fetus caused by microbes or gross failure of the so-called provisional organs - chorion (outer embryonic membrane), placenta, etc. Moreover, in this case, the type of microorganism does not play a special role (with rare exceptions).

With milder infections at such early stages, some microbes can cause life-compatible malformations of the organs and tissues of the fetus, which are difficult to treat after birth. Let us emphasize once again that in this case we can only talk about some microbes. Such as the rubella virus, in particular. Expectant mothers should know: for the vast majority of microbes, the ability to cause deformities in the fetus in cases of mild infection is not a scientifically proven fact. And therefore, any talk about a “high” risk of deformities in the fetus is completely unjustified here.

Infection with any microbes that occurs at a later stage (in the second and third trimesters), as a rule, is no longer the cause of gross malformations in the fetus, since its organs and systems are basically formed. But the infectious process can cause microbial damage to the baby’s organs and tissues, as well as inflammation of the placenta (placentitis) and placental membranes (chorioamnionitis). In such cases, premature birth is likely, as well as the birth of sick and weakened children. The nature of the problems detected in prenatally infected babies very much depends on the properties of the microbes that have entered the fetal body.

Below we will look at the causative agents of some of the most common human infectious diseases that cause intrauterine infections. We warn you in advance: we are going to “introduce” you to only a very small part of the vast world of microorganisms. In particular, the already mentioned rubella virus, toxoplasma, cytomegalovirus and herpes simplex virus are deliberately left out of the scope of this article - these pathogens have already been described in detail in an article on TORCH infections, previously published in the journal (No. 4, 2001). The causative agent of syphilis and gonococcus will not be mentioned - these infections deserve a separate story. Another of the “excluded” microbes, the influenza virus, will also be given an “honorable” place in one of the upcoming issues of the journal.

I would like to remind you that all medications and medical procedures are prescribed by the attending physician. Self-medication, as you know, is evil. Self-medication during pregnancy is a double evil. It can lead to very serious consequences for both the child and the mother!

Mycoplasmas

Mycoplasmas are the smallest organisms existing in nature that can live and reproduce independently. The mycoplasma group includes two genera of microorganisms - mycoplasma itself and ureaplasma.

Actually mycoplasma. Two of the three types of pathogenic (disease-causing) mycoplasmas are transmitted through sexual contact (urogenital mycoplasmosis), one is transmitted by airborne droplets (respiratory mycoplasmosis). Mycoplasmas “in alliance” with other microorganisms can cause a wide variety of diseases in adults - they parasitize the genitourinary and respiratory organs, causing vaginitis, salpingitis, pyelonephritis, male infertility, pneumonia, and acute respiratory infections. Diseases caused by mycoplasmas “in their pure form” are usually asymptomatic or even asymptomatic - some scientists even doubt the ability of these microbes to cause disease at all. Methods for diagnosing mycoplasma infections - culture on nutrient media, enzyme-linked immunosorbent assay (ELISA), DNA diagnostics.

During pregnancy, latent (asymptomatic) mycoplasma infection sometimes becomes active. Externally, this can manifest itself as symptoms of inflammation of the genitourinary system - increased vaginal discharge, pain and burning when urinating, nagging pain in the lower abdomen, etc. In collaboration with other microbes, “runaway” mycoplasmas are quite capable of causing inflammation of the membranes, which can ultimately lead to premature birth. When examining a newborn, signs of mycoplasma infection may be detected - sometimes very severe (up to inflammation of the meninges and general blood poisoning). But this happens very rarely, and usually damage to the child’s organs and systems is caused not only by mycoplasma, but also by microbes that become active simultaneously with it.

Some time ago, domestic scientists suggested a connection between mycoplasma infection during pregnancy and the development of congenital deformities in the fetus. However, world science still does not have convincing evidence of the validity of this hypothesis.

Mycoplasma infections are treated with antibiotics. The doctor prescribes treatment individually - for a pregnant woman it depends on the duration and characteristics of the pregnancy. In particular, antibiotic therapy is prescribed only after the 12th week of pregnancy, with preference given to drugs that are least toxic to the fetus, for example, Zithromax or erythromycin.

Ureaplasma. Ureaplasmosis usually occurs as a chronic urinary tract infection. Women are most often asymptomatic carriers of ureaplasma. To diagnose ureaplasmosis, almost the same laboratory methods are used as for detecting mycoplasmas.

In utero, the fetus becomes infected with ureaplasma in the rarest cases, since, as a rule, this microbe does not penetrate the placenta. But during childbirth, passing through the birth canal of an infected mother, the child becomes infected in 50% of cases. To minimize the risk, ureaplasmosis is treated during pregnancy - usually after the 12th week. Antibacterial drugs (most often the same Zithromax and erythromycin) are prescribed by the attending obstetrician-gynecologist.

Chlamydia

In terms of their properties, chlamydia occupy an intermediate position between viruses and bacteria. The mechanism of transmission of chlamydia is sexual; people's susceptibility to this infection is quite high. Immunity to chlamydia is not developed, so re-infection is possible. The incubation period is approximately 1-3 weeks. With the disease, characteristic glassy discharge from the urethra may be observed - more often in the morning. Sometimes there is itching or discomfort when urinating, general weakness, and a slight increase in temperature. However, it should be noted that in most cases the disease is asymptomatic or mild.

Chlamydia is quite often complicated by sluggish inflammatory diseases of the genitourinary area. In women, these are endometritis, salpingitis, cervicitis, obstruction of the fallopian tubes (and as a result, ectopic pregnancy or infertility). In addition to the genitourinary system, chlamydia can also affect other organs - when the pathogen is transferred (for example, with dirty hands) with discharge from the genitourinary organs to the mucous membrane of the eyes and nasopharynx.

During pregnancy, chlamydia can cause problems very similar to the consequences of mycoplasma infection, but in a slightly milder form. This is due to the fact that chlamydia less often cooperates with other microbes - they are quite capable of causing the disease “alone”. The most common manifestation of congenital chlamydial infection in children is conjunctivitis (inflammation of the mucous membrane of the eyes). More severe lesions are also possible - but, fortunately, they are very rare.

Diagnosis of chlamydia during pregnancy can be carried out using different methods - using enzyme immunoassay and direct immunofluorescence, polymerase chain reaction, culture on special nutrient media, etc.

Treatment of chlamydia is quite difficult and time-consuming. In addition to antibacterial therapy (erythromycin, amoxicillin - but not the fluoroquinolone drugs usually used in treating adults!), it usually includes other drug methods, as well as diet and abstinence from sexual activity for the duration of treatment. Both sexual partners definitely need to be treated. At the end of the course, repeated tests are carried out. If chlamydia is not detected, the tests are repeated two more times at intervals of a month.

Bacteria

Of this very large group of microorganisms, we will briefly dwell only on the causative agent of listeriosis. This infectious disease is caused by a bacillus called listeria. Rodents, as well as some domestic animals, serve as a natural “reservoir” of infection. There are two main routes of infection - “nutritional” (i.e. microbes enter the human body with food contaminated with them) and intrauterine (congenital listeriosis). The state of the human immune system plays an important role in the development of infection. There are many forms of listeriosis, so it probably doesn’t make sense to talk about its symptoms in a popular science article - this is rather the topic of a separate monograph.

It is important to note, however, that among the various forms of listeriosis, “pregnancy listeriosis” is specifically distinguished. A study of a large number of women - mothers of children with congenital listeriosis showed, firstly, that most of them did not have typical manifestations of listeriosis infection during pregnancy, and secondly, that not every carrier of the bacterium leads to intrauterine infection of the fetus. When the fetus becomes infected during pregnancy, acute chorioamnionitis usually develops, leading to stillbirth or premature birth, and infectious damage to many organs and systems of the fetus. When a newborn is infected during childbirth, signs of congenital listeriosis appear 1-2 weeks after birth. The disease is often very severe; listeria can cause broncho-pneumonia, liver enlargement, jaundice and other serious diseases and symptoms.

I think those who read these lines do not need to be convinced that listeriosis in pregnant women is very dangerous for the fetus. Therefore, early diagnosis of this rather insidious disease is extremely important. In what cases should an expectant mother be wary? With frequently recurring sore throats, inflammation of the ovaries, cervix, if there have been several miscarriages or stillbirths in the past. If a woman is pregnant, the pathological course of pregnancy can be added to the listed indications. To diagnose listeriosis, a sample of blood is usually taken for testing, as well as mucus from the nasopharynx and throat (for symptoms of sore throat). Pregnant women are most often prescribed antibacterial treatment with penicillin and other members of this family of antibiotics, which is relatively safe for the health of the fetus.

Protozoa

The most significant representatives of this group are Toxoplasma and Trichomonas. Toxoplasma was discussed in detail in the previous issue of the magazine.

Trichomonas can cause a whole complex of inflammatory diseases of the genitourinary system, collectively called trichomoniasis. In women it can be vulvitis, colpitis, cervicitis, bartholinitis, etc. Infection usually occurs through sexual contact. Between the “fatal” sexual intercourse and the appearance of the first signs of the disease, it can take from 4 days to 4 weeks (most often about a week). Women often feel heaviness in the lower abdomen, itching and burning in the vagina. Often, a whitish liquid with an unpleasant odor is released from the vagina - leucorrhoea. However, often the disease is asymptomatic (only leucorrhoea is observed) or completely asymptomatic. The diagnosis is made based on analysis of genital discharge. As a rule, a healthy body gets rid of trichomonas on its own, so people who get sick are mostly people who are weakened for one reason or another, or who lead a very chaotic lifestyle. However, you should not treat Trichomonas too kindly: inside these protozoa there are often other – often much more formidable – “villains” “hiding”. For example, the causative agents of syphilis and gonorrhea.

During pregnancy, Trichomonas actively multiplying in a woman’s body can pose a serious danger to the fetus. Spreading upward to the level of the uterus, this microbe is capable of causing severe inflammation of the membranes of the fetus (chorioamnionitis), sometimes leading to serious consequences - even miscarriage and stillbirth. Fortunately, such an outcome is rare; its likelihood is relatively high only in cases of advanced, inadequately treated trichomoniasis.

Metronidazole (Trichopol) is usually used to treat trichomoniasis during pregnancy. Although this drug is not completely harmless to the fetus (especially in the first trimester of pregnancy), its use for this infection is quite justified. However, of course, not in terms of self-medication! Any medications during pregnancy should be prescribed by a doctor - after a thorough analysis of all indications and contraindications for their use.

Mushrooms

The most common “culprit” of infectious problems during pregnancy (from this group of microbes) is a yeast fungus with the very poetic name “white candida”.

This fungus causes an infectious disease called candidiasis (or candidiasis), popularly known as “thrush”. Candidiasis is a fairly common disease among women (including pregnant women). In fact, this fungus is a frequent companion of humans. Even in completely healthy people, a certain amount of candida parasitizes the mucous membranes of some organs. But if the immune system is working at full strength, defense mechanisms do not allow the fungus to have a harmful effect. In cases where the human body is weakened, the harmful fungus can carry out “subversive activities” with impunity. Candida is introduced into a woman's genital tract by dirty hands, infected objects, and sometimes through sexual contact. There it begins to actively divide, causing inflammation of the vagina, cervix, and urethra. One of the most common symptoms of candidiasis is itching and heavy vaginal discharge.

In pregnant women, candidiasis occurs 2-3 times more often than in non-pregnant women. The fact is that during pregnancy, the chemical environment in the vagina becomes more acidic - and candida really “likes” this. At the same time, hormonal changes in the body lead to a decrease in cellular immunity and leukocyte activity, which also contributes to increased proliferation of the fungus in the genital tract of the expectant mother. Infection of the fetus usually occurs through an ascending route. The pathogen can affect many organs and systems of the fetus, but is more often limited to the umbilical cord, skin, oral mucosa and bronchopulmonary system. If the microbe spreads significantly, the consequences for the fetus can be severe (even death).

The diagnosis of candidiasis is confirmed or excluded by microscopic examination of a smear taken from the woman’s genital tract.

During pregnancy, candidiasis is, in principle, treated in the same way as in its absence. However, it is important to know that a number of drugs that are successfully used in other cases are contraindicated in pregnant women: this applies to the vast majority of antifungal agents available in the form of oral tablets and injection solutions. Instead, topical preparations are usually used - ointments, creams and other “external” dosage forms containing clotrimazole, miconazole or natamycin.

Of course, within the framework of one article it is impossible to fully cover such a serious problem as intrauterine infection. But, it seems, the above information will still bring some benefit to expectant mothers - at least, the generally accepted recommendations in world medicine for combating intrauterine infection will become clearer to many of them than before.

The meaning of these recommendations is simple: prevention and prevention again.

When preparing for pregnancy and carrying it to term, future parents should take maximum measures to prevent the development of infection in the woman’s body. Ideally, every married couple who is just planning to have children would do well to be examined for carriage of microbes potentially harmful to the fetus - fortunately, modern diagnostic methods make it possible to quickly and accurately determine whether the spouses are infected and prescribe adequate treatment. Targeted antibiotics, vaccines, immunoglobulins, interferon preparations and its inducers, antiviral, antiprotozoal and other agents will help expel the infection from the body even before conception. To do this, it is only necessary and sufficient to contact the appropriate specialist in a timely manner. It should also be remembered that an orderly sex life and safe sex techniques significantly reduce the likelihood of contracting sexually transmitted diseases - and during pregnancy this fact is even more relevant than outside of it.

Regular medical examinations should not be neglected during pregnancy either - tests prescribed by an obstetrician-gynecologist will allow timely detection of the presence of microbes in a woman’s body that are potentially dangerous to the fetus. And if this happens, you should under no circumstances give in to panic. Firstly, because the risk of severe consequences for the fetus is most often low. And secondly, because in the arsenal of modern medicine there are quite enough medicines and therapeutic techniques to make this risk even lower. The danger of intrauterine infection should definitely be remembered. But one should not give in to this danger. And then everything will be fine.

Clinical forms

Neonatal herpes

Of the herpes family viruses, all the main types can cause herpes infection in a newborn: herpes simplex virus types 1 and 2, herpes simplex virus type 3 (varicella zoster), type 4 - Epstein-Barr virus, hairy leukoplakia of the tongue, immune depression syndrome, 5- 1st type - cytomegalovirus infection, 6th type - roseola, 7th type - chronic fatigue syndrome, 8th type - Kaposi's sarcoma. However, the term “neonatal herpes” is used only in relation to diseases caused by herpes simplex virus types 1 and 2. The most dangerous for a child is HSV-2.

The likelihood of a child becoming infected depends on how long the mother has been infected. The “fresh” the infection, the more likely the child is to become infected. If at the time of birth the mother has a rash, this is an indication for a cesarean section[12].

Clinical manifestations

• 1. Local form (mucocutaneous) - damage to the skin, mucous membranes, and, less commonly, encephalitis.
• 2. Cerebral form - the clinical picture corresponds to the general signs of IUI, but there are also specific signs: damage to the eyes and mucous membranes; herpetic encephalitis, which is necrotic in nature, resulting in destruction of the brain down to the hemispheres; severe thrombocytopenia with hemorrhagic syndrome.
• 3. Disseminated neonatal herpes

Diagnosis
In the diagnosis of neonatal herpes, assessment of the mother's specific medical history is important. During a clinical examination of children born to mothers with acute or recurrent genital herpes, examination of the skin and mucous membranes must be done with special care. If a newborn has seizures of unknown etiology, a lumbar puncture is indicated (with herpetic encephalitis, lymphocytosis, monocytosis and a high protein concentration are noted). If a newborn develops sepsis and there is no effect of antibiotics, an examination for herpes is necessary. Among laboratory diagnostic methods, the gold standard is the isolation of the virus from blood, cerebrospinal fluid, and vesicles by the cultural method. In the cutaneous form, the contents of the vesicles or scrapings from the skin can be examined using the immunofluorescent method to detect the virus antigen. And in case of generalized infection and meningoencephalitis, blood and cerebrospinal fluid are examined using the PCR method. The level of IgG antibodies is not informative, since these are maternal antibodies. IgM levels indicate acute infection in the newborn.

Treatment

For all forms of neonatal herpes, systemic antiviral therapy is indicated, since the localized form may precede the generalized one. With early administration of antiviral drugs, the outcome is favorable. Regardless of the form of infection, acyclovir is used. Acyclovir (Zovirax, Virolex) intravenously for 2-3 weeks plus antiherpetic immunoglobulin for 2 weeks[12]. It makes no sense to stop breastfeeding, since HSV is unlikely to pass into mother's milk, except for rashes on the mother's breasts. Local remedies for ophthalmic herpes include vidarabine, florenal, and bonaftone ointment.

Congenital cytomegalovirus infection

The frequency of occurrence is 0.2-2.5%. The virus is transmitted by all secretions (saliva, urine, blood, tears). Clinical manifestations during primary infection in pregnant women are nonspecific and may resemble the clinical manifestations of acute respiratory viral infection. There are a number of factors contributing to the high incidence of intrauterine infection with cytomegaly virus. These include epidemiological features, such as significant genetic variability of CMV strains, the widespread distribution of CMV infection in the human population (in the vast majority - in the form of a latent-persistent course), the predominance of subclinical forms, both in primary and secondary infection, diversity mechanisms and routes of transmission of infection. The next factor is the immaturity of the immune system of the fetus and newborn. And finally, adaptive immune changes in a woman’s body during pregnancy (decreased functional activity of cellular immune mechanisms), during which reactivation of a latent-persistent CMV infection is possible.

Infection most often occurs during childbirth, or through mother's milk. During pregnancy, infection occurs only if the mother becomes infected for the first time during pregnancy.

Clinical manifestations

Congenital hepatitis with severe jaundice, severe thrombocytopenia with hemorrhagic syndrome, meningoencephalitis. Specific signs are calcifications in the subependymal parts of the brain and chorioretinitis. The long-term prognosis is determined by the degree of brain damage. If meningoencephalitis is suffered early, children are usually disabled; if hepatitis, cirrhosis develops early; if carditis, chronic heart failure develops.

Diagnostics

Children with symptoms of congenital infection, as well as without clinical manifestations of TORCH syndrome, if they are born to women at risk, are subject to examination for CMV infection. In newborns in the early neonatal period, if CMV is suspected, the pathogen is first identified by any available method. Most often, PCR or detection of virus antigens is used; the virological method is less often used. Any biological fluid (urine, saliva, blood, tears) can serve as material for PCR; however, active CMV infection is indicated only when the CMV genome is detected by PCR in the blood and cerebrospinal fluid. When viral DNA is found in other environments, an unambiguous assessment of the period of the disease cannot be given. To clarify the severity of the process, serological methods are used - anti-cytomegalovirus antibodies of classes M and G are determined. Moreover, the study of “paired sera” is mandatory, that is, monitoring the study of antibody titers after 3-4 weeks. Detection of IgM class antibodies in umbilical cord blood and in the blood of a child in the first weeks of life is an important diagnostic sign. And the detection of IgG in the child’s blood without comparison with maternal titers is not diagnostically significant, since transplacental transfer of antibodies from the mother’s body is possible.

Treatment

Therapy for congenital CMV infection consists of etiotropic and syndromic therapy. The indication for etiotropic therapy is the active period of congenital CMV infection. The drug of choice for etiotropic treatment is Cytotect. Children are administered anticytomegalovirus immunoglobulin (cytotect) intravenously 2 ml/kg 2 times a day every 2 days for 3 weeks [13].

If there is a danger to life, then ganciclovir is added intravenously for 14-21 days, although virostatics (antiviral drugs) such as ganciclovir and foscarnet are used extremely rarely due to their high toxicity.

Congenital toxoplasmosis

Frequency 1:1000 newborns Toxoplasma oocysts are usually found in the feces of cats and goats, from where they are released into the external environment. In pregnant women, the clinical course of the disease is similar to mononucleosis or influenza, with high fever or very long-term low-grade fever, and enlarged lymph nodes. Arthralgia or arthritis is often associated.

The likelihood of infection of the fetus: infection usually occurs if the infection is fresh and depends on the duration of infection. If the 1st trimester - the probability is 15%, in the second 30%, in the third - 60%.

Clinical manifestations

In the fetus and newborn, the infection can take two forms: damage to the eyes and brain or generalized toxoplasmosis. In addition to the general signs of infectious toxicosis, hepatitis, meningoencephalitis, eye damage (congenital cataract, possibly glaucoma, optic nerve atrophy) are added.

Diagnostics

Scheme of examination for toxoplasmosis of newborns: in the presence of clinical signs of toxoplasmosis, antibodies are examined. If no antibodies are detected, the test is repeated after 2 weeks; if there are no antibodies during the second test, then further monitoring is not needed. If detected, specific therapy is indicated. If IgM class antibodies are detected during the initial study, then etiotropic therapy is immediately indicated. If only IgG is detected, the test is repeated after 4 weeks. Therapy is indicated when the antibody titer increases. If the titer drops, the child does not need treatment, but further monitoring is necessary.

Treatment

Treatment of toxoplasmosis can be carried out antenatally - that is, treatment of a pregnant woman. If the infection is in the 1st half of pregnancy, spiramycin, claforan, rovamycin are used. If in the 2nd half of pregnancy - chloridine + sulfasalazine + folic acid. Treatment of children is effective during periods of circulation in the blood of non-cystic forms of the parasite; drugs do not act on cystic forms. There is no need for complete sanitation, since cystic forms (carriage) provide normal non-sterile immunity. The most effective drugs are pyrimethamine in combination with sulfonamides. There are combination drugs: Fansidar, Metakelfin. Co-trimoxazole is also used in age-specific dosages[14]. Treatment of newborns involves the following regimen: chloridine + sulfadimezine + folic acid. Course 4-6 weeks. During the first year, 4 courses with a break of 1.5 months, and during the break, spiramycin for 1.5 months [12][15][16].

Chlamydia

WHO data indicate that 35-50% of newborns whose mothers are infected with C. trachomatis

, chlamydial ophthalmia develops (5 times more often than gonococcal ophthalmia), and in 11-20% pneumonia develops[17].
Infection usually occurs during childbirth, the probability of transmission is 40-70%. The disease does not appear immediately, but after 7-14 days. Clinical manifestations
There are three forms of infection in newborns:

• persistent
• latent
• acute (generalized infection - meningoencephalitis, intrauterine pneumonia, gastroenteritis)[17][18].

The main manifestations of the disease in a newborn are:

• nasopharyngitis 25%
• conjunctivitis resistant to the use of conventional remedies, responds only to treatment with tetracycline ointment,
• pneumonia 10-15% - mild toxicosis, but pronounced obstructive syndrome, paroxysmal painful cough.
• high eosinophilia
• proctitis, gastroenteritis - 5%
• vulvitis, urethritis 15%

Treatment
In addition to the child, it is necessary to treat both the father and mother. A newborn child is prescribed erythromycin in suppositories for 24 days or erigran orally. Azithromycin can also be used[12][19].

Mycoplasmosis

Mycoplasma infection usually occurs during childbirth. The frequency of detection of the pathogen in pregnant women is 20-50%, the risk of infection of the fetus is unknown. Pregnant women with seropositive mycoplasmosis are treated after the 16th week of pregnancy, which reduces the incidence of morbidity in newborns.

Clinical manifestations

In newborns, it manifests itself in the form of pneumonia, which begins imperceptibly with toxicosis, pallor appears, shortness of breath increases, and only then physical findings appear. On the radiograph, a specific sign is the “blizzard symptom” - bilateral fine-focal, sometimes confluent pneumonia. Mortality rate is 15%.

Treatment

Newborns are prescribed erythromycin or azithromycin, and in severe forms, chloramphenicol [20][12].

Congenital rubella syndrome

If the mother becomes infected in the first 12 weeks, it is better to terminate the pregnancy. Before pregnancy, it is necessary to be examined, and if the mother is seronegative, then vaccinated[12]. If a mother becomes infected with rubella in the 1st trimester, the child has a 25% chance, after the 5th month – 1-2%.

Clinical manifestations

A characteristic clinical manifestation is Greg's triad

:

• congenital heart disease such as patent ductus arteriosus, ventricular septal defect, atrial septal defect, pulmonary stenosis, myocardial necrosis
• eye defects (cataracts, microphthalmia, glaucoma)
• deafness.

In 2/3 children, congenital rubella manifests itself at the end of the perinatal period.

Treatment

There is no specific therapy; treatment is symptomatic.

Candidiasis of newborns

The frequency of candidiasis in the structure of infectious and inflammatory diseases of newborns is about 15-30% of cases, and in half of them it remains unrecognized or diagnosed late[21]. Candidiasis can be caused by any of the species, but most often by Candida albicans. Risk factors for the development of candidiasis in newborns include: prematurity, diabetes mellitus in the mother during pregnancy, urogenital candidiasis in the mother during pregnancy, repeated courses of antibiotics, especially in combination with immunosuppressive therapy, immune disorders, especially neutropenia, the presence of mechanical ventilation in the early neonatal period, resuscitation measures, abdominal operations.

Clinical manifestations

Based on the time of infection, congenital

candidiasis that developed during antenatal or intrapartum infection and
postnatal
candidiasis. Depending on the localization of the process, candidiasis is divided into:

• cutaneous candidiasis is a lesion of the skin and its appendages. The lesion may be localized or widespread.
• candidiasis of the mucous membranes of the oral cavity, conjunctiva, external genitalia
• generalized candidiasis - damage to internal organs that do not communicate with the external environment with the addition of candidemia.
• visceral candidiasis - damage to internal organs and other systems that do not communicate with the external environment, for example carditis, hepatitis, nephritis.
• systemic candidiasis - affects one or more organs that communicate with the external environment - for example, candidiasis of the gastrointestinal tract.
• candidiasis - the presence of Candida in natural habitats in greater than the prescribed concentration.

Candidiasis is also classified according to the severity of the process as mild.

and
severe
forms, depending on the location and volume of the lesion, the presence of infectious toxicosis.
In addition, there are acute
(7-14 days) and
protracted
(more than 6 weeks) course of the disease.
Diagnosis
Diagnosis of neonatal candidiasis is based on the clinical picture. In the cutaneous and mucocutaneous form there is no need for laboratory confirmation. Laboratory diagnosis becomes crucial for generalized, visceral and systemic candidiasis. Laboratory criteria can be considered the identification of fungi in an active state by microscopy of the substrate, the isolation of antigens and DNA in sterile substrates, the isolation in quantities greater than those allowed for sowing of substrates that are the site of saprotification of fungi.

Treatment

For localized skin candidiasis, local therapy with antifungal ointments (clotrimazole, isoconazole, ketoconazole, natamycin) is used. In case of prolonged course, systemic antimycotics are prescribed - fluconazole orally. The daily dose is 5-8 mg/kg once a day. For mucosal candidiasis, the affected areas are treated with a 2% soda solution or a 0.1% hexoral solution. In case of relapse, fluconazole is used. For systemic candidiasis for the treatment of the gastrointestinal tract, respiratory, genitourinary system, as well as for visceral and generalized candidiasis, treatment begins with fluconazole, and if ineffective, amphotericin B or ambisome is prescribed intravenously for 5-7 days[22].

Early congenital syphilis

Against the backdrop of an epidemic increase in the incidence of syphilis in Russia in the 90s, the incidence of congenital syphilis increased sharply: in 1997, the overall incidence of syphilis exceeded the level of 1990 by 51 times, and that of congenital syphilis by 47 times. The dynamics of the increase in the incidence of congenital syphilis is similar to the dynamics of the proportion of pregnant women among women with syphilis. According to L.I. Tikhonova (1999), in 1995-97. in Russia this figure was constantly growing: 4.9%, 5.5%, 6.5%[23].

Congenital syphilis can be prevented by identifying and treating infected mothers during pregnancy. Therefore, pregnant women are examined serologically three times, including immediately before birth.

Early congenital syphilis is an IUI that manifests itself in a child under 2 years of age (according to ICD-10). Early congenital syphilis may be manifest

(with clinical manifestations) and
hidden
.
Clinical manifestations
In newborns with early congenital syphilis, the following symptoms are observed: syphilitic rhinitis, diffuse Hochsinger infiltration, chorioretinitis, hepatosplenomegaly, syphilitic pemphigus, roseolous and pustular rash, osteochondritis, periostitis, osteoporosis.

Diagnostics

In newborns born to mothers with syphilis, umbilical cord blood is taken for analysis at birth to carry out a set of serological tests. In addition, weighing and pathological examination of the placenta are carried out. With syphilis, the placenta is enlarged and there are signs of inflammation. A spinal tap must be performed. In the analysis of cerebrospinal fluid there are specific changes: lymphocytic cytosis above 20 cells in 1 ml, protein above 1.5-1.7 g/l, positive results of RIF and a complex of serological reactions. On the 7-8th day of the child’s life, serological blood tests are repeated - microprecipitation reaction, immunofluorescence reaction, immobilization reaction of Treponema pallidum, enzyme immunoassay to detect IgM.

Treatment

Treatment is carried out with one of the penicillin drugs for 2-3 weeks. The choice of drug depends on the analysis of the cerebrospinal fluid. After completion of treatment, the child is discharged under the supervision of a dermatovenerologist, and the diagnosis is reported to the district clinic only with the consent of the mother. In the KVD, clinical and serological control is carried out once every 3 months until the child reaches the age of 3 years[24].

Notes

1. ↑ 1 2 V.V. Vlasyuk
   Morphological diagnosis of intrauterine infections. Tutorial. St. Petersburg, 2010 - 47 p. ISBN - 5-00-001976-8/
2. Okhotnikova I.M., Ageikin V.A., Lozovskaya L.S. The significance of intrauterine viral infection in organ pathology of infants // Med. scientific and educational-methodological. magazine. - 2001. - No. 5. - P. 81-87.
3. Congenital malformations. Prenatal diagnosis and tactics / Ed. B. M. Petrikovsky, M. V. Medvedev, E. V. Yudina. - M.: RAVUZDPG: Realnoe Vremya, 1999. - 325 p.
4. https://spravka.komarovskiy.net/vnutriutrobnye-infekcii.html Komarovsky. Intrauterine infections
5. https://www.ic.omskreg.ru/~medstat/BIBLIO/opport/index.htm Dolgikh T. I., Noskova F. V. Opportunistic infections in children (issues of diagnosis, clinic and treatment). Omsk: Publishing house OGMA, 1999. - 99 p.
6. ↑ 12
   A. L. Zaplatnikov, N. A. Korovina, M. Yu. Korneva, A. V. Cheburkin A. L. Zaplatnikov, N. A. Korovina, M. Yu. Korneva, A. V. Cheburkin Attending physician 08- 2005 https://www.lvrach.ru/doctor/2005/08/4532901/
7. A. Ya. Senchuk, Z. M. Dubossarskaya.
   Perinatal infections: practical. allowance. - M.: MIA, 2004. - 448 p.
8. Diagnosis of intrauterine infections in newborns using the polymerase chain reaction method
9. Intrauterine infections. Symptoms. Diagnostics. Prevention. | EUROLAB | Pediatrics
10. Volodina N. N., Degtyareva D. N.
    Diagnosis and treatment of intrauterine infections. - M.: Method. rec. for neonatologists, 1999.
11. https://www.rae.ru/ru/publishing/mono07_811.html MODERN PRINCIPLES FOR DIAGNOSIS OF INTRAuterine INFECTION OF THE FETAL
12. ↑ 123456
    Perinatal infections (issues of pathogenesis, morphological diagnosis and clinical and morphological comparisons) Tsinzerling V. A., Melnikova V. F.
13. Clinical and laboratory characteristics, pathomorphological features, diagnosis and treatment of cytomegalovirus pneumonia “Infectious Diseases”, 2004. - T. 2, No. 1. - P. 73-80. V. I. Shakhgildyan, O. A. Tishkevich, O. Yu. Shipulina. https://www.hivrussia.ru/pub/2006/16.shtml
14. Cheburkin A.V. Clinic and differential diagnosis of congenital toxoplasmosis “Medical parasitology and parasitic diseases” No. 5, 1984, p. 53-57.
15. On the detection and prevention of toxoplasmosis in Moscow. Methodological recommendations (No. 25). M., 2007
16. Clinic, diagnosis and treatment of toxoplasmosis G. Yu. Nikitina, F. K. Dzutseva, Yu. V. Borisenko, L. P. Ivanova Attending physician 10-2008 https://www.lvrach.ru/doctore/2008/10/ 5828652/
17. ↑ 12
    Urogenital chlamydia Chlamydial Genitourinary Infections https://www.venuro.info/venera/chlamidioz.php
18. Chlamydia Uskov Alexander Nikolaevich https://queerlvov.narod.ru/hlamidioz.html
19. https://www.hlamidioz.info/6.html Chlamydia in children
20. Perinatal infections: practical. manual / ed. A. Ya. Senchuk, Z. M. Dubossarskaya. M.: MIA, 2005. 318 p.
21. Protocols for diagnosis, treatment and prevention of intrauterine infections in newborns, Moscow, State Educational Establishment VUNMC Ministry of Health of the Russian Federation, 2001 p. 53
22. Protocols for diagnosis, treatment and prevention of intrauterine infections in newborns, Moscow, State Educational Establishment VUNMC Ministry of Health of the Russian Federation, 2001 pp. 55-57
23. https://www.ill.ru/news.art.shtml?c_article=142 Syphilis and pregnancy
24. Protocols for diagnosis, treatment and prevention of intrauterine infections in newborns, Moscow, State Educational Establishment VUNMC Ministry of Health of the Russian Federation, 2001 pp. 59-64

Viral hepatitis

Viral hepatitis is a serious liver disease. Depending on the type of virus that causes hepatitis, there are the following types: hepatitis A, hepatitis B, hepatitis C, hepatitis D, hepatitis E, hepatitis F and hepatitis G.

Hepatitis A . The disease is caused by an RNA virus. The infection is transmitted to the mother through the fecal-oral route. Infection of the fetus is rare. Infection of a newborn occurs during breastfeeding while the virus is in the patient’s blood. The incubation period is 15-45 days. In pregnant women, the disease usually occurs in a mild or moderate form. Nausea, vomiting, liver enlargement, jaundice, and pain in the right hypochondrium are noted. Due to the fact that the hepatitis A virus does not penetrate the placenta, it does not lead to malformations in the fetus. Acute viral hepatitis A is cured after a short viremic phase, does not become chronic and does not cause cirrhosis of the liver. Diagnosis of acute hepatitis A is carried out by determining specific antibodies in the blood, which are detected within 2 weeks after infection. Treatment of hepatitis A is carried out according to general therapeutic, symptomatic criteria. In case of contact of a pregnant woman with a patient with hepatitis A, g-globulin is administered for prophylactic purposes.

Hepatitis B currently represents one of the important health problems, which is associated with an increase in the incidence of the disease and the development of unfavorable outcomes in the form of the formation of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. Hepatitis B is caused by a DNA virus. This virus is suspected to be oncogenic. In pregnant women, 1-2 cases of acute hepatitis B are registered per 1000 pregnancies and 5-15 cases of chronic hepatitis B. The source of infection is patients with acute and chronic hepatitis and virus carriers. The virus is transmitted through blood transfusions, blood products, and sexual contact. Infection is also possible through close household contacts (sharing toothbrushes, combs, handkerchiefs) and through the use of poorly treated medical instruments.

In 85-95% of cases, infection of the fetus occurs during childbirth due to contact with blood, infected secretions of the birth canal, or through ingestion of infected secretions. In 2-10% of cases, infection occurs during pregnancy through penetration of the virus through the placenta, especially when placental function is impaired due to fetoplacental insufficiency or placental abruption. In other cases, infection occurs through contaminated breast milk. After childbirth, it is also possible for the child to become infected through contact and household contact from the mother. The severity of the disease in newborns depends on the stage of pregnancy when infection occurred. If the infection occurred in the first or second trimester of pregnancy, the probability of infection is up to 10%. If the infection occurred in the third trimester, then the risk of transmission of the infection is 70%. If the HBsAg antigen is detected in the mother’s blood, then the risk of infection of the fetus is 20-40. With the additional presence of the HBeAg antigen, the risk increases to 70-90%.

With hepatitis B, there is an increased incidence of premature births and spontaneous abortions; the number of premature births triples. In most infected children, acute hepatitis B is mild. In the vast majority of cases (90%), children subsequently develop a state of chronic carriage of the virus with the risk of subsequent transmission of infection. There is also a risk of subsequent development of primary liver carcinoma or cirrhosis.

Diagnosis of hepatitis B is based on identifying various antigens and antibodies to the virus in the patient’s blood. If acute hepatitis B develops during pregnancy, therapy consists of supportive treatment (diet, correction of water and electrolyte balance, bed rest). When coagulopathy develops, fresh frozen plasma and cryoprecipitate are transfused. Pregnant women with various forms of hepatitis B should avoid various invasive procedures during pregnancy and childbirth. One should also strive to reduce the duration of the anhydrous interval and labor in general.

The presence of hepatitis B is not an indication for delivery by cesarean section, since it also does not exclude the possibility of infection (contact with infected blood). In the postpartum period, all newborns born to mothers who are carriers of the hepatitis B virus are subject to vaccination. Newborns are also advised to receive the protective immunoglobulin “Hepatotect” in the first 12 hours of life. If vaccinated immediately after birth, breastfeeding should not be avoided. The main method of preventing a child from becoming infected with viral hepatitis B is to screen pregnant women three times for the presence of HBsAg. If there is a risk of infection with the hepatitis B virus in a pregnant woman, it is advisable to vaccinate the patient 3 times with a recombinant vaccine without risk to the child and mother.

Hepatitis C is characterized by a tendency to develop chronically, with limited clinical symptoms and a poor response to antiviral therapy. Subsequently, the likelihood of developing hepatocellular carcinoma is high.

The causative agent of hepatitis C is an RNA virus. Sources of infection are patients with chronic and acute forms of hepatitis C, as well as latent carriers of the virus. The virus is transmitted through transfusion of infected blood or its components. Contact-household and sexual routes of infection are quite rare. The main route of infection in children is vertical transmission from the mother. The incubation period averages 7-8 weeks. The disease is divided into three phases: acute, latent and reactivation phase. The acute phase in most cases proceeds without clinical manifestations and in approximately 60-85% of cases turns into a chronic form of hepatitis with the risk of developing liver cirrhosis and hepatocellular carcinoma.

Acute hepatitis C, both latent and clinically manifested, in 30-50% of cases can result in recovery with complete elimination of HCV. However, in most cases it is replaced by a latent phase. During the latent phase, infected individuals consider themselves healthy and do not make any complaints. The reactivation phase corresponds to the onset of new clinical manifestations of hepatitis C with the subsequent development of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma.

There is currently no vaccine for hepatitis C. All pregnant women undergo mandatory screening for hepatitis C three times during pregnancy. Despite the fact that vertical transmission of the virus to the fetus is possible, hepatitis C is not a contraindication to pregnancy. The risk of fetal infection with hepatitis C does not depend on the time of infection of the mother and is about 6%. Transmission of the virus is possible both during pregnancy and during childbirth.

There is no consensus on the optimal method of delivery for pregnant women with hepatitis C. Some experts believe that cesarean section reduces the risk of infection of the fetus, while others deny this. Premature rupture of the membranes and a long anhydrous interval increases the risk of transmission of infection.

The hepatitis C virus is also found in breast milk, and in this regard, there is also no consensus on the safety of breastfeeding. All children born to mothers with hepatitis C will also have antibodies to the virus in their blood during the first 12 months of life. If antibodies persist more than 18 months after birth, this confirms that the child is infected with hepatitis C.

Hepatitis D. The causative agent of the disease is the hepatitis D virus, which is a defective RNA-containing virus that is able to replicate only with the help of the HBsAg antigen of the hepatitis B virus. The infection is transmitted through transfusion of blood or its components, as well as sexually. Infection of the fetus occurs vertically. Diagnosis of viral hepatitis D is based on the detection of antibodies in blood serum. When infected, a newborn develops chronic hepatitis D with a high risk of liver cirrhosis. For hepatitis D, a pregnant woman should be immunized according to the vaccination schedule as for hepatitis B. Treatment of the disease is carried out as part of general therapeutic measures.

Hepatitis E. The causative agent of the infection is an RNA virus that spreads through the fecal-oral route and causes acute hepatitis. The virus reaches the fetus through vertical transmission. With hepatitis E, the frequency of spontaneous miscarriages is increased. Diagnosis of the disease is based on direct detection of the virus and determination of specific antibodies. Treatment of acute hepatitis E is carried out according to the general principles of symptomatic therapy.

Hepatitis G. There is a high infectious risk for the newborn with this disease. In the presence of hepatitis G in pregnant women, 33% have vertical transmission to the fetus and newborn. However, to date, no clinical symptoms of hepatitis have been identified in newborns. The presence of the virus in milk was also NOT detected, however, by analogy with hepatitis C, it is advisable to refrain from breastfeeding the child. The diagnosis is made by detecting the virus using PCR. Treatment and prevention of acute and chronic forms of viral hepatitis G have not yet been fully developed.

Flu

Influenza, which can be severe in pregnant women, can lead to damage to the embryo and fetus. With this disease, spontaneous abortion, fetal death, and abnormalities in its development can occur. As a result of infection, the birth of premature and functionally immature children, as well as children with insufficient body weight, is possible.

The effect of the influenza virus during intrauterine infection is due to the influence of pathogens on the placenta and fetus, as well as severe intoxication, elevated body temperature, and impaired uteroplacental circulation with subsequent development of fetal hypoxia. During influenza outbreaks, pregnant women should be immunized with a multivalent killed vaccine.

additional literature

• Degtyarev D.N., Degtyareva M.V., Kovtun I.Yu., Shalamova L.V.
  Principles of diagnosing intrauterine infections in newborns and tactics for managing children at risk. - M.: Perinatology today, 1997. - T. 3. - P. 18-24.
• Volodina N. N., Degtyareva D. N.
  Diagnosis and treatment of intrauterine infections. - M.: Method. rec. for neonatologists, 1999.
• Cheburkin A.V., Cheburkin A.A.
  Perinatal infection. - M., 1999.
• N. N. Volodin.
  Current problems of neonatology. - M.: GEOTAR-MED, 2004. - 448 p.
• A. Ya. Senchuk, Z. M. Dubossarskaya.
  Perinatal infections: practical. allowance. - M.: MIA, 2004. - 448 p.

Pregnancy management tactics when identifying IUI

In the first trimester it is shown:

• examination of a woman for possible infectious agents;
• screening your partner for sexually transmitted infections.

After identifying the pathogen, the issue of continuing the pregnancy is decided. Interruption is recommended when rubella, toxoplasmosis is detected, and during primary infection with the herpes virus and CMV. In other situations, it is possible to continue the pregnancy.

Treatment of identified infection in the first trimester is usually not carried out. The exceptions are diseases for which safe drugs have been developed:

• candida infection;
• bacterial vaginosis;
• herpes simplex virus (with reactivation of infection);
• trichomoniasis.

In the second and third trimesters, it is recommended to treat those infections for which treatment in the early stages is impossible. The vaginal microflora must be restored.

Control ultrasound examination and assessment of the fetal condition are performed during screening periods:

• 12-14 weeks;
• 18-21 weeks;
• 32-34 weeks.

If malformations incompatible with life are detected, termination of pregnancy is indicated (up to 22 weeks). When preserving the fetus, therapy is carried out aimed at improving placental blood flow and reducing uterine tone.

If an intrauterine infection is detected, childbirth can occur through the natural birth canal. It is recommended to avoid any obstetric surgeries or interventions that damage the skin of the fetus. Caesarean section is indicated when the child’s condition worsens, as well as in some forms of herpes and HIV infections.

Symptoms and consequences

The following are signs that indicate an infection in a pregnant woman:

• cough, shortness of breath
• rash
• lymph nodes are painful and enlarged
• heat
• joint pain and swelling
• runny nose, lacrimation, conjunctivitis
• chest pain

But these symptoms in some cases indicate an allergic reaction. If this is so, then there is no risk of intrauterine infection of the baby. In any case, if one or more of the above symptoms appear, you need to go for a face-to-face consultation with a doctor.

CMV (cytomegalovirus)

CMV (cytomegalovirus) belongs to the group of herpes viruses. It is contracted through sexual contact, through close household contacts, and also through blood (if an operation was performed with dirty instruments or a transfusion from a sick donor). If there is a primary infection of a pregnant woman, the virus enters the placenta, and from there to the baby. The child may have no consequences, which is the case in most cases. But 10 out of 100 children who had sick mothers are born with symptoms of IUI.

The consequences of intrauterine infection with CVM can be miscarriages and stillbirths, as well as:

• sensorineural hearing loss
• underweight at birth
• hydrocephalus
• microcephaly
• pneumonia
• hepatosplenomegaly
• psychomotor development delay
• blindness of various degrees

If there is a severe combined lesion, 1/3 of newborns die in the first 2-3 months after birth. Long-term consequences such as mental retardation, blindness and deafness are also very likely. If the infection is mild, the consequences are less serious. Today there is no medicine that would help with the manifestations of cytomegalovirus in recently born children. If a pregnant woman is infected with CVM, the pregnancy is not terminated because the child may not have symptoms. Doctors prescribe treatment for a pregnant woman to minimize the development of complications.

HSV (herpes simplex virus)

Congenital herpes infection develops if the pregnant woman had HSV, especially type 2 (which is sexually transmitted). Symptoms appear in the first month after birth. Mostly, IUI occurs during primary infection of a pregnant woman. The child picks up the infection in most cases during childbirth, when he passes through the birth canal. But the possibility of transmission of the pathogen through the placenta also needs to be taken into account.

Consequences of herpes for a child:

• lethargy, poor appetite
• miscarriage, stillbirth
• characteristic skin rashes
• fever
• bleeding disorder
• jaundice
• brain damage
• eye damage
• pneumonia

Severe congenital herpes is fraught with disability for the child:

• vegetative state
• mental retardation
• cerebral palsy

Rubella

Rubella is very dangerous for the embryo! It causes various deformities. The highest risk occurs during pregnancy before the 16th week. Consequences of IUI caused by this disease:

• microcephaly
• low birth weight
• miscarriage, stillbirth
• heart defects
• deafness (in half of cases IUI)
• cataract
• skin lesion
• pneumonia
• hepatosplenomegaly
• meningitis and encephalitis

Parvovirus B19

This is the causative agent of infectious epithema. In adults it is mostly unnoticed because it occurs latently. If a pregnant woman is infected with it, she may give birth to a stillborn child, and there is a risk of miscarriage or intrauterine infection of the embryo. Children die in 2.5-10 cases out of 100. It is especially dangerous to become infected with it in the 13-28th week of gestation.

Consequences for a child with IUI:

• swelling
• anemia
• brain damage
• peritonitis
• hepatitis
• myocarditis

Chicken pox

If a patient contracts chickenpox, it is very dangerous for the fetus. If a pregnant woman becomes infected and is about to give birth, there is a risk that her child will die. The fetus becomes infected in 25 out of 100 cases, but symptoms do not always appear.

Congenital chickenpox in children has the following symptoms:

• brain damage
• optic nerve atrophy, eye underdevelopment
• underdevelopment of the limbs
• rash, zigzag scars
• pneumonia

Newborns with IUI are not treated with chickenpox because the symptoms do not progress. If the mother became infected 5 days before the day of birth or later, doctors may advise administering immunoglobulin to the newborn, because antibodies were not transferred to him from the mother.

Hepatitis B

The hepatitis B virus is transmitted mainly through unprotected sexual contact with a sick person. It reaches the fetus through the placenta (“baby place”). It is very dangerous for a pregnant woman to become infected from the 4th to the 9th month of gestation. Consequences of IUI:

• hepatitis B with subsequent recovery
• liver cancer
• carriage and chronic form of hepatitis type B
• acute form of hepatitis (liver failure develops, the child dies)
• psychomotor development delay
• lack of oxygen
• light weight
• miscarriage, stillbirth

HIV infection

The human immunodeficiency virus (HIV) attacks specific immune lymphocytes. Infection occurs mainly through sexual contact. The child becomes infected while arriving in the womb, or passing through the infected genital tract of the mother at birth. If you do not treat a child with a congenital form of HIV, he will not survive even two years, because the virus progresses quickly in a weak body. Death occurs from infections that cannot be fatal in healthy children.

To detect HIV in a newborn, PCR is mainly used. In the first 3-6 months after birth, there is no point in doing an antibody test. It is important to detect HIV in those who are expecting a child. They are given antiretroviral drugs for the entire period, that is, mainly zidovudine is given from the 4th week of gestation. They should not breastfeed their newborn. This greatly increases the baby’s chances of health.

Listeriosis

This disease is caused by the bacterium listeria. It can penetrate the embryo through the placenta, which many bacteria cannot. The routes of infection are described above. A pregnant woman may not have any symptoms of the disease. In some cases there are:

• heat
• diarrhea
• vomit
• flu-like symptoms

Consequences of fetal infection:

• multiple purulent foci, rash
• sepsis
• meningitis
• fever
• refusal to eat
• stillbirth, spontaneous abortion

If symptoms appear in the first 7 days after birth, then children die in 60 cases out of 100. Therefore, if a pregnant woman has an accurate diagnosis of listeriosis, she is prescribed ampicillin for 2 weeks. IUI is also treated if the child actually became infected from the mother.

Syphilis

Primary syphilis in pregnant women, which has not been treated, is transmitted in almost 100 cases out of 100. Out of 10 children, 6 die, while others develop a congenital form of the disease. In a sick pregnant woman, a primary ulcer first forms, and then the disease goes into a latent form, exacerbating from time to time.

Infection of the embryo occurs, even if the mother has a latent disease, from the 4th week of gestation. The consequences of IUI are:

• deafness mental retardation
• damage to the eyes, ears, hands, feet, teeth
• cracks in the skin
• rashes on the skin
• anemia, jaundice in a baby
• premature birth or stillbirth

Toxoplasmosis

It is transmitted to humans mainly from cats, but can also be transmitted from other animals. A pregnant woman can become infected when she cleans up after her pet or eats undercooked meat or dirty vegetables. By the time of pregnancy, most women have already had this disease, so it will not be passed on to the child.

During primary infection during pregnancy, in 50 out of 100 cases, the pathogen overcomes the placental barrier, infecting the embryo. Consequences of IUI for a baby:

• hydro-, microcephaly
• eye damage
• jaundice, enlarged liver and spleen
• encephalitis, meningitis, seizures
• stillbirth, miscarriage
• psychomotor development delay