Bacterial Vaginosis
Bacterial Vaginosis: An Update
1998 American Family Physician
Brucellosis
Brucellosis in Pregnant Women
2001 Clinical Infectious Diseases
Cytomegalovirus infection
Presents as a mononucleosis-like illness.
TERATOGENIC: May cause IUGR, microcephaly, periventricular calcifications,sensorineural
deafness, blindness with chorioretinitis, mental retardation, hepatosplenomegaly,
thrombocytopenic purpura, hemolytic anemia
Incidence of sequelae is 25% for primary infection, and 8% with recurrent infection [1]
REFERENCES:
1.N Engl J MED 326:663-667.1992
ADDITIONAL READING: Congenital
cytomegalovirus infection. Is there a breakthrough?
Motherisk
Cytomegalovirus infection in pregnancy
1999 Contemporary OB/GYN
Hepatitis B Infection
Hepatitis C Infection
Herpes Simplex II
Primary maternal infection may present as a flu-like syndrome with fever, headache, malaise, and myalgias. Grouped painful, superficial genital ulcers are typical.
Transplacental infection of the fetus is rare during pregnancy. Intrauterine HSV infection has uncommonly been associated with skin lesions, chorioretinitis, microcephaly, hydranencephaly , and microphthalmia[1,2].
While primary HSV infections in the first trimester are associated with higher rates of spontaneous abortion and stillbirth [3].
infection later in pregnancy appears more likely to be associated with preterm labor or growth restriction[4].
Of greatest concern is the risk of primary infection acquired at birth which could lead to herpetic meningitis.
The infection rate is nearly 50% for infants born vaginally in primary infection. The risk falls to 4% for infants born during a recurrent infection [4, 5].
Cesarean section is recommended for all women in labor with active herpes infection.
REFERENCES:
1. Shepard TH. Catalog of Teratogenic Agents pp 1323. 9th ed.Baltimore,
MD: Johns Hopkins University Press, 1998
2. Hutto C, Arvin A, Jacobs R, Steele R, Stagno S, Lyrene R, Willett L, Powell D, Andersen R, Werthammer J, et al.
Intrauterine herpes simplex virus infections.
J Pediatr. 110:97-101, 1987
PubMed
3. Freij BJ, Sever JL: Herpesvirus infections in pregnancy: Risks to embryo, fetus, and neonate. Clin Perinatol 15:203-231, 1988
4. Brown ZA, Vontver LA, Benedetti J, et al: Effects on infants of a first episode of genital herpes during pregnancy. N Engl J Med 312:1246, 1987
5. Stagno S, Whitley RJ: Herpesvirus infections of pregnancy. Part II: Herpes simplex, virus and varicella zoster infections. N Engl J Med 313:1327-1330, 1985
PubMed
ADDITIONAL READING:
Genital Herpes In Pregnancy
2002 eMedicine
Herpes simplex virus infection in pregnancy
1999 Contemporary OB/GYN
HIV
Nonteratogenic[1].
In the absence of interventions the perinatal transmission rate is ~30%.
BREAST FEEDING:Contraindicated
REFERENCES:
1. Shepard TH. Catalog of Teratogenic Agents.pp 31 9th ed.Baltimore,
MD: Johns Hopkins University Press, 1998
ADDITIONAL READING:
HIV in pregnancy more patients, choices
2001 OBG Management
Managing the HIV-infected pregnant patient
2000 Contemporary OB/GYN
State-of-the-Art
Management of the HIV-Infected Pregnant Woman
2000 Medscape
Influenza
ADDITIONAL READING:
Viral influenza in pregnancy
1999 Contemporary OB/GYN
Leishmaniasis
ADDITIONAL READING:
Congenital Transmission of Visceral Leishmaniasis (Kala Azar)
From an
Asymptomatic Mother to Her Child
1999 Pediatrics
Listeria
ADDITIONAL READING:
Listeria infection in pregnancy
1999 Contemporary OB/GYN
Lyme Disease
ADDITIONAL READING:
Lyme disease in pregnancy
1998 Contemporary OB/GYN
Malaria
ADDITIONAL READING:
Congenital
Malaria as a Result of Plasmodium malariae --- North Carolina, 2000
MMWR March 1, 2002 /
51(08);164-5
Preventing Malaria in the
Pregnant Woman
2001 Centers for Disease Control
Measles (Rubeola) Virus
Nonteratogenic.[1].
REFERENCES:
1. Shepard TH. Catalog of Teratogenic Agents.pp 2373 9th ed.Baltimore,
MD: Johns Hopkins University Press, 1998
ADDITIONAL READING:
Measles in pregnancy
2000 Contemporary OB/GYN
Mumps Virus
Neisseria meningitidis infection
The disease is too rare in pregnancy to allow an accurate assessment
of fetal risk.
Fetal infection may be acquired transplacentally or through the birth
canal.
REFERENCES:
1. Gleicher Norbert ed. Principles & Practice of
Medical Therapy in Pregnancy. 3rd ed. Stamford, CT: Appleton & Lange,
1998
Parasites
ADDITIONAL READING:
Parasites of the Intestinal tract
Centers for Disease Control and Prevention
Parasitic infections in pregnancy
1997 Contemporary OB/GYN
Parvovirus B19
The illness presents in the mother as fever, malaise, polyarthralgia (particularly of the peripheral joints),
coryza. There is a lacelike rash on trunk , extremities and face. The infection may be mistaken for rubella.
Incubation is 4 to 14 days.
TERATOGENIC:Fetal anemia leading to nonimmune hydrops(NIH).
The overall fetal loss after infection is probably < 2%. Roughly 1/3 of NIH may resolve without
transfusion. [1,2]
The highest risk to the nonimmune (IgG and IgM absent) woman occurs
after exposure to a child living within the same household. B19 IgM production
begins after the 3rd day of rash and is more likely to be present in symptomatic
women [3].
REFERENCES:
1. Gratecos E,et al. J Infect Dis 1995;171:1360-1363.
2. Rodis JF et al, Am J Obstet Gynecol 1998;179:985-8
3. James H. Harger et al Obste Gynecol 1998:91:413-420
ADDITIONAL READING:
Managing the gravida with parvovirus
2000 OBG Management
Parvovirus B19 Infection in utero - natural history and spectrum of sonographic manifestations in 7 cases
2000 Canadian Association of Radiologists
Parvovirus B19 infection
1997 Contemporary OB/GYN
Parvovirus B19 Infections
1999 American Academy of Family Physicians
Current Trends Risks Associated with
Human Parvovirus B19 Infection MMWR 38(6);81-88,93-97
MMWR 1989
Rocky Mountain Spotted Fever
ADDITIONAL READING:
Rocky Mountain Spotted Fever and Pregnancy:A Case Report and Review of the Literature
2001 Obstetrical and Gynecological Survey
Rubella
TERATOGENIC:"Blueberry muffin skin",cataracts, glaucoma, microphthalmia, sensorineural
deafness,PDA, AV septal defects, pulmonary artery stenosis, microcephaly,
meningoencephalitis,IUGR, hepatosplenomegaly, interstitial pneumonitis,
thrombocytopenia
For exposure in seronegative mother:
50% malformation rate in first month
20% in second month
6% in third month
1-2% in fourth and fifth month
Deafness may be a late manifestation .
ADDITIONAL READING:
Rubella in pregnancy
1997 Contemporary OB/GYN
Sexually Transmitted Disease, General
Sexually Transmitted Diseases Treatment Guidelines ---
2002
Centers
for Disease Control and Prevention
Syphilis infection
TERATOGENIC:Stillbirth,IUGR, nonimmune hydrops, rhinitis, hepatosplenomegaly,"mulberry
molars","saber shins", saddle nose deformity, interstitial keratitis, eigth
nerve deafness,peg-shaped incisors
Risk of congenital infection:
50% in primary and secondary syphilis
40% in latent
10% in latent
ADDITIONAL READING:
Congenital syphilis--United States, 1998
Centers for Disease Control and Prevention MMWR 1999;48:757-761
Guidelines
for the Prevention and Control of Congenital Syphilis
1988 Centers for Disease Control and Prevention
Syphilis in pregnancy
1999 Contemporary OB/GYN
Toxoplasmosis infection
Presents as "mono-like"syndrome with postauricular adenopathy in mother.
TERATOGENIC: 3/4 of infants are asymptomatic at birth. Infection may cause chorioretinitis, hydrocephaly,microcephaly,
aqueductal stenosis, agenesis of corpus callosum, cerebral calcifications,
nonimmune hydrops
For initial infections in pregnancy, incidence of infection increases with gestational age, but severity of malformations decreases.
IgM typically turns positive after 1 week and may remain positive for
years. IgG follows same course, but remains positive for life. The diagnosis of an acute infection is made if specific titers are greater
than 1:512 Better tests are PCR and IgA
ADDITIONAL READING:
Congenital
toxoplasmosis:
systematic review of evidence of efficacy of treatment
in pregnancy
1999 British Medical Journal
Toxoplasmosis in pregnancy
1998 Contemporary OB/GYN
Vaccinia (Smallpox)
ADDITIONAL READING:
Congenital Vaccinia
Centers for Disease Control and Prevention
Varicella (Chickenpox)
Infection in the mother presents as fever followed by small papules evolving into vesicules, pustules and
crusts. The rash begins on face and scalp then spreads to trunk. The incubation period ranges from 10 to 21 days. The patient is contagious for 1-2 days
before the onset of rash until all lesions are crusted. The crusts are not infectious.
TERATOGENIC: Primary varicella infection during the first half of pregnancy has been associated with limb hypoplasia, cicatricial lesions,psychomotor
retardation, cutaneous scars, chorioretinitis, cataracts, cortical atrophy, microcephaly, microphthalmus, and IUGR. The risk of developing the syndrome
is 1% if less than 20 weeks and 2% at 13-20weeks [1,2].
In a prospective study of varicella and herpes zoster in pregnancy no infants with clinical evidence of intrauterine infection were born to the 366 women with reactivation of the varicella-zoster virus (shingles)throughout their pregnancies [2].
VZIG
"Administration of VZIG to susceptible, pregnant women has not been found
to prevent viremia, fetal infection, congenital varicella syndrome, or
neonatal varicella. Thus, the primary indication for VZIG in pregnant women
is to prevent complications of varicella in the mother, rather than to
protect the fetus. - VZIG is supplied in two different dosages -- the 125-U vial and the 625-U vial. The recommended dose is 125 U/10 kg (22 lbs) of body weight, up to a maximum of 625 U. The minimum dose is 125 U; fractional doses are not recommended. " [3]
Newborns are administered VZIG if the mother had onset of chickenpox <
5 days before delivery to 48h postpartum. should receive another full dose
of VZIG. [2]
REFERENCES:
1.Pastuszak AL, Levy M, Schick B, et al: Outcome after maternal varicella infection in the first 20 weeks of pregnancy. N Engl J Med 1994;330:901-5.
MEDLINE
2.Enders G, Miller E, Cradock-Watson J, Bolley I, Ridehalgh. Consequences of varicella and herpes zoster in pregnancy: prospective study of 1739 cases. Lancet 1994; 343:1548-51.
MEDLINE
3. Prevention of Varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP)MMWR 45(RR11);1-25
ADDITIONAL READING:
Chickenpox
in pregnancy
The Royal College of Obstetricians and Gynecologists
Varicella-zoster infection in pregnancy
2002 Contemporary OB/GYN
Created: 12/10/2001
Last update: 1/29/2003
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