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intrauterine infection. Intrauterine infection in newborns

Carrying a child, a woman tries to protect him from adverse external influences. The health of a developing baby is the most important thing during this period, all protective mechanisms are aimed at preserving it. But there are situations when the body cannot cope, and the fetus is affected in utero - most often it is an infection. Why it develops, how it manifests itself and what risks it carries for the child - these are the main questions that concern expectant mothers.

The reasons

In order for an infection to appear, including intrauterine, the presence of several points is necessary: ​​the pathogen, the route of transmission and the susceptible organism. Microbes are considered the direct cause of the disease. The list of possible pathogens is very wide and includes various representatives - bacteria, viruses, fungi and protozoa. It should be noted that intrauterine infection is mainly due to microbial associations, that is, it has a mixed character, but monoinfections are not uncommon. Among the common pathogens, it is worth noting the following:

  1. Bacteria: staphylo-, strepto- and enterococci, E. coli, Klebsiella, Proteus.
  2. Viruses: herpes, rubella, hepatitis B, HIV.
  3. Intracellular agents: chlamydia, mycoplasma, ureaplasma.
  4. Fungi: candida.
  5. The simplest: toxoplasma.

Separately, a group of infections was identified that, despite all the differences in morphology and biological properties, cause similar symptoms and are associated with persistent developmental defects in the fetus. They are known by the abbreviation TORCH: toxoplasma, rubella, cytomegalovirus, herpes and others. It should also be said that in recent years there have been certain changes in the structure of intrauterine infections, which is associated with the improvement of diagnostic methods and the identification of new pathogens (for example, listeria).

The infection can enter the child in several ways: through the blood (hematogenous or transplacental), amniotic fluid (amniotic), the mother's genital tract (ascending), from the uterine wall (transmural), through the fallopian tubes (descending) and with direct contact. Accordingly, there are certain risk factors for infection that a woman and a doctor should be aware of:

  • Inflammatory pathology of the gynecological sphere (colpitis, cervicitis, bacterial vaginosis, adnexitis, endometritis).
  • Invasive interventions during pregnancy and childbirth (amnio- or cordocentesis, chorionic biopsy, caesarean section).
  • Abortions and complications in the postpartum period (earlier transferred).
  • Insufficiency of the cervix.
  • Polyhydramnios.
  • Fetoplacental insufficiency.
  • General infectious diseases.
  • Foci of chronic inflammation.
  • Early onset of sexual activity and promiscuity in sexual relations.

In addition, many infections are characterized by a latent course, undergoing reactivation in violation of metabolic and hormonal processes in the female body: hypovitaminosis, anemia, heavy physical exertion, psycho-emotional stress, endocrine disorders, exacerbation of chronic diseases. Those who have identified such factors are at high risk of intrauterine infection of the fetus. He also shows regular monitoring of the condition and preventive measures aimed at minimizing the likelihood of developing pathology and its consequences.

Intrauterine infection develops when infected with microbes, which is facilitated by many factors from the maternal organism.

Mechanisms

The degree of pathological impact is determined by the characteristics of the morphological development of the fetus at a particular stage of pregnancy, its reaction to the infectious process (maturity of the immune system), and the duration of microbial aggression. The severity and nature of the lesion is not always strictly proportional to the virulence of the pathogen (the degree of its pathogenicity). Often a latent infection caused by chlamydial, viral or fungal agents leads to intrauterine death or the birth of a child with serious abnormalities. This is due to the biological tropism of microbes, i.e., the tendency to reproduce in embryonic tissues.

Infectious agents have different effects on the fetus. They can provoke an inflammatory process in various organs with the further development of a morphofunctional defect or have a direct teratogenic effect with the appearance of structural anomalies and malformations. Equally important are the intoxication of the fetus with products of microbial metabolism, disorders of metabolic processes and hemocirculation with hypoxia. As a result, the development of the fetus suffers and the differentiation of internal organs is disturbed.

Symptoms

The clinical manifestations and severity of the infection are determined by many factors: the type and characteristics of the pathogen, the mechanism of its transmission, the intensity of the immune system and the stage of the pathological process in the pregnant woman, the gestational age at which the infection occurred. In general terms, this can be represented as follows (table):

Symptoms of intrauterine infection are noticeable immediately after birth or in the first 3 days. But it should be remembered that some diseases may have a longer incubation (latent) period or, conversely, appear earlier (for example, in premature babies). Most often, the pathology is manifested by the infection syndrome of the newborn, manifested by the following symptoms:

  • Decreased reflexes.
  • Muscle hypotension.
  • Refusal to feed.
  • Frequent vomiting.
  • Pale skin with periods of cyanosis.
  • Change in the rhythm and frequency of breathing.
  • Muffled heart sounds.

Specific manifestations of pathology include a wide range of disorders. Based on the tissue tropism of the pathogen, intrauterine infection during pregnancy can manifest itself:

  1. Vesiculopustulosis: rash on the skin in the form of vesicles and pustules.
  2. Conjunctivitis, otitis and rhinitis.
  3. Pneumonia: shortness of breath, cyanosis of the skin, wheezing in the lungs.
  4. Enterocolitis: diarrhea, bloating, sluggish sucking, regurgitation.
  5. Meningitis and encephalitis: weak reflexes, vomiting, hydrocephalus.

Along with a local pathological process, the disease can be widespread - in the form of sepsis. However, its diagnosis in newborns is difficult, which is associated with the low immune reactivity of the child's body. At first, the clinic is rather poor, since there are only symptoms of general intoxication, including those already listed above. In addition, the baby has a lack of body weight, the umbilical wound does not heal well, jaundice appears, the liver and spleen increase (hepatosplenomegaly).

In children infected in the prenatal period, disturbances are detected in many vital systems, including the nervous, cardiovascular, respiratory, humoral, and immune systems. Key adaptive mechanisms are violated, which is manifested by hypoxic syndrome, malnutrition, cerebral and metabolic disorders.

The clinical picture of intrauterine infections is very diverse - it includes specific and general signs.

Cytomegalovirus

Most children infected with cytomegalovirus have no visible abnormalities at birth. But in the future, signs of neurological disorders are revealed: deafness, slowing down of neuropsychic development (mild mental retardation). Unfortunately, these disorders are irreversible. They may progress with the development of cerebral palsy or epilepsy. In addition, a congenital infection can manifest itself:

  • Hepatitis.
  • Pneumonia.
  • hemolytic anemia.
  • thrombocytopenia.

These disorders disappear over a certain period even without treatment. Chorioretinopathy may occur, which is rarely accompanied by decreased vision. Severe and life-threatening conditions are very rare.

herpetic infection

The greatest danger to the fetus is a primary genital infection in the mother or an exacerbation of a chronic disease. Then the child becomes infected by contact, passing during childbirth through the affected genital tract. Intrauterine infection is less common, it occurs before the natural end of pregnancy, when the fetal bladder bursts, or at other times - from the first to the third trimester.

Infection of the fetus in the first months of pregnancy is accompanied by heart defects, hydrocephalus, anomalies of the digestive system, intrauterine growth retardation, and spontaneous abortions. In the second and third trimesters, pathology leads to the following abnormalities:

  • anemia.
  • Jaundice.
  • Hypotrophy.
  • Meningoencephalitis.
  • Hepatosplenomegaly.

And herpes infection in newborns is diagnosed by bubble (vesicular) lesions of the skin and mucous membranes, chorioretinitis and encephalitis. There are also common forms, when several systems and organs are involved in the pathological process.

Rubella

A child can become infected from the mother at any stage of pregnancy, and clinical manifestations will also depend on the time of infection. The disease is accompanied by damage to the placenta and fetus, intrauterine death of the latter, or does not give any consequences at all. Children born with an infection are characterized by rather specific anomalies:

  • Cataract.
  • Deafness.
  • Heart defects.

But in addition to these signs, there may be other structural abnormalities, for example, microcephaly, "cleft palate", disorders of the skeleton, genitourinary system, hepatitis, pneumonia. But in many children born infected, no pathology is detected, and in the first five years of life problems begin - hearing deteriorates, psychomotor development slows down, autism and diabetes mellitus appear.

Rubella has a clear teratogenic effect on the fetus, leading to various anomalies, or provokes its death (spontaneous abortion).

Toxoplasmosis

Infection with toxoplasmosis in early pregnancy can be accompanied by severe consequences for the fetus. Intrauterine infection provokes the death of a child or the occurrence of multiple anomalies in him, including hydrocephalus, brain cysts, edematous syndrome, and destruction of internal organs. A congenital disease is often widespread, manifesting itself with the following symptoms:

  • anemia.
  • Hepatosplenomegaly.
  • Jaundice.
  • Lymphadenopathy (enlarged lymph nodes).
  • Fever.
  • Chorioretinitis.

When infected at a later date, the clinical manifestations are rather poor and are mainly characterized by a decrease in vision or unexpressed disorders in the nervous system, which often remain undetected.

Additional diagnostics

Prenatal diagnosis of infectious lesions of the fetus is of great importance. To determine the pathology, laboratory and instrumental methods are used to identify the pathogen and identify deviations in the development of the child at various stages of pregnancy. If intrauterine infection is suspected, perform:

  1. Biochemical blood test (antibodies or microbial antigens).
  2. Analysis of smears from the genital tract and amniotic fluid (microscopy, bacteriology and virology).
  3. Genetic identification (PCR).
  4. Ultrasound (fetometry, placentography, dopplerography).
  5. Cardiotocography.

After birth, newborns are examined (skin swabs, blood tests) and the placenta (histological examination). Comprehensive diagnostics allows you to identify pathology at the preclinical stage and plan further treatment. The nature of the activities carried out will be determined by the type of infection, its spread and the clinical picture. Prenatal prevention and proper management of pregnancy also play an important role.

Despite the normal course of pregnancy and easy delivery, the baby who was born, who at first glance is healthy, becomes lethargic a few days after birth, often burps, and does not gain weight. It is highly likely that during the gestation period he suffered from an infection. What are the latter and how to avoid them?

Intrauterine infection of the fetus (IUI) - what is it?

This condition is said to be in the presence of pathogens of inflammatory processes in the body of the expectant mother. Such diseases increase the risk of fetal developmental disorders. Infection occurs through a single bloodstream of the mother and child, sometimes this happens at the time the child passes through the birth canal or when amniotic fluid is swallowed.

Which IUIs are at risk during pregnancy?

The type of infection directly depends on its pathogen, which is introduced into the female body even before pregnancy or already during it. The most common pathogens are viruses (influenza, rubella, herpes, cytomegaly), fungi, protozoa (toxoplasma), bacteria (chlamydia, treponema pallidum, streptococci, E. coli).

The risk of infection increases under the influence of adverse factors: the presence of chronic diseases; work in hazardous production; bad habits; constant stress; inflammatory processes of the genitourinary system. The probability of infection of a child in the womb also increases if a woman first encounters an infection during this period.

Intrauterine infections are called the TORCH group. All infections of this group, despite completely different pathogens, manifest themselves in almost the same way, provoke the occurrence of similar disorders in the development of the child. An analysis for IUI is done during pregnancy, as a rule, twice: when registering and at 24-28 weeks.

The abbreviation TORCH stands for:

  • T - toxoplasmosis;
  • O - other infectious diseases, for example, chlamydia, syphilis, hepatitis A and B, enterovirus and gonococcal infection, mumps, measles, listeriosis;
  • R - rubella;
  • C, cytomegalovirus;
  • H - herpes.

The threat of IUI: what is manifested during pregnancy?


Herpetic infections are a fairly common type of IUI. In the vast majority of cases, infection occurs at the time of birth, that is, when moving through the mother's birth canal. If detected during the gestation period, as a rule, a planned caesarean section is prescribed before the discharge of amniotic fluid. After birth, infected babies undergo a course of specific therapy, which is aimed at the most effective elimination of the consequences for the central nervous system.

Cytomegalovirus belongs to the group of herpes. Children are more likely to become infected in the womb, but there are cases of infection during childbirth. The main danger in this case lies in the fact that the disease does not affect the woman in any way, but it has a very bad effect on the baby. The expectant mother most often becomes infected due to immune deficiency, which becomes a favorable factor for the penetration of the virus to the fetus.

Treatment is carried out with the help of specific medications. In newborns who have cytomegalovirus markers, developmental disorders very rarely occur, therefore, therapy is resorted to only when there is a threat to the life of the child.

Chlamydia is a sexually transmitted disease. The expectant mother, even at the planning stage, should be tested for the presence of such diseases and be sure to cure them. It is worth being especially careful in sexual intercourse. A smear from the genital tract helps to identify chlamydia.

When the diagnosis is confirmed, antibiotic therapy (antibiotics) is prescribed. The sexual partner is also subject to treatment. The baby can become infected both in the womb and at birth. In the vast majority of cases, newborns do not show any developmental pathologies, frequent defecation, and poor appetite are possible.


The problem can be solved even in childhood by allowing a little girl to contact animals. In this case, the disease will not occur during gestation in the future. This is due to the fact that after the first infection, which proceeds as a mild allergy or SARS, immunity is produced in the body. Otherwise, it will be necessary to take measures aimed at improving the health of the baby after birth.

Rubella is included in the category of childhood diseases. If it was not possible to transfer it, then it is recommended to be vaccinated at the planning stage 3 months before the expected date of conception. If the infection first occurred during pregnancy, then there is a threat of miscarriage and a high probability of serious defects in the baby. It is worth noting that in a sick child, the first signs of the disease may occur only a year or two after birth.

What is the danger of IUI during pregnancy?


If a woman has previously met with any of the above pathogens, then she should have developed immunity to them.

When re-infected, the immune system will respond to the pathogen and prevent it from developing.

If the primary infection occurred during the gestation period, then both the mother and the child suffer.

The degree of influence on the fetus in the majority depends on the time when the infection occurred:

  • Up to 12 weeks (1 trimester), there is a high probability of spontaneous abortion and fetal malformations;
  • IUI during pregnancy, when the 2nd trimester (12-28 weeks) has come, delays the development of the child, as a result, he is born underweight;
  • In the third trimester, all organs and systems of the fetus are already formed, but pathogenic microorganisms can harm them. The brain suffers the most, because its development continues until birth. The liver, heart and lungs also suffer.

IUI symptoms that occur during pregnancy

At this time, a woman often takes a blood and urine test. These two events allow you to constantly monitor the general condition of a woman and allow you to timely detect the presence of an infection in her body.

IUI markers can be tested during pregnancy with a number of tests. In some cases, even a routine gynecological examination allows you to suspect something was wrong. However, many infections occur in a latent form, that is, they do not manifest themselves in any way. In such situations, only a laboratory blood test can be trusted.

Infection of the fetus and newborn baby can be determined by the following conditions:


  • Enlargement of the spleen and liver;
  • developmental delay;
  • Rash;
  • Jaundice;
  • Cardiovascular insufficiency;
  • Respiratory dysfunction;
  • Disorders of the nervous system;
  • lethargy;
  • Paleness of the skin;
  • poor appetite;
  • Frequent vomiting.

When signs of infection are detected in the fetus long before delivery, the child is born with a progressive disease. Infection just before childbirth can lead to meningitis, pneumonia, enterocolitis and a number of other diseases in the newborn. Symptoms become noticeable only a few days after childbirth, but if the infection occurred at the time of passage through the birth canal, they appear immediately.

Intrauterine infections (IUI) (synonym: congenital infections) are a group of infectious and inflammatory diseases of the fetus and young children, which are caused by various pathogens, but are characterized by similar epidemiological parameters and often have the same clinical manifestations. Congenital infections develop as a result of intrauterine (ante- and / or intranatal) infection of the fetus. In most cases, the source of infection for the fetus is the mother. However, the use of invasive methods of monitoring women during pregnancy (amniocentesis, puncture of the umbilical cord vessels, etc.) and intrauterine administration (through the vessels of the umbilical cord) of blood products to the fetus (erythrocyte mass, plasma, immunoglobulins) can lead to iatrogenic infection of the fetus. 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%. IUI are serious diseases and largely determine the level of infant mortality. At the same time, the relevance of the problem of IUI is due not only to significant peri- and postnatal losses, but also to the fact that children who have had severe forms of congenital infection very often develop serious health disorders, often leading to disability and a decrease in the quality of life in general. Taking into account the wide distribution and severity of the prognosis, it can be concluded that the development of high-precision methods for early diagnosis, effective treatment and effective prevention of congenital infections is one of the priorities of modern pediatrics.

Epidemiology, etiology, pathogenesis. The main source of infection in IUI, as already noted, is the mother of the child, from which the pathogen enters the fetus in the ante- and / or intranatal period (vertical transmission mechanism). In this case, the vertical transmission of infection can be carried out by ascending, transplacental and transovarial routes in the antenatal period, as well as by contact and aspiration directly during childbirth. Antenatal infection is more typical for agents of a viral nature (cytomegaly viruses (CMV), rubella, Coxsackie, etc.) and intracellular pathogens (toxoplasma, less often - representatives of the mycoplasma family). Intranatal contamination is more typical for agents of a bacterial nature. At the same time, the spectrum of potential pathogens is individual and depends on the characteristics of the microbial landscape of the mucous membranes of the mother's birth canal. Most often during this period, the fetus is infected with microorganisms such as streptococci (group B), enterobacteria, as well as herpes simplex viruses (HSV) types 1 and 2, mycoplasma, ureaplasma, chlamydia, etc.. Until recently, it was believed that the most common causative agents of IUI were CMV viruses, HSV types 1 and 2, and Toxoplasma ( Toxoplasma gondii). However, the results of studies conducted in the last decade have largely changed our understanding of both the etiological structure of IUI and the frequency of intrauterine infection in general. Thus, it has been shown that the prevalence of intrauterine infection among newborns is much higher than previously thought, and in some cases can exceed 10%. At the same time, it was found that the etiology of intrauterine infection is represented by a wider range of microorganisms, among which, in addition to traditional pathogens, enteroviruses, chlamydia ( Chlamydia trachomatis), some members of the family Mycoplasmatacae (Ureaplasma urealyticum, Mycoplasma hominis), as well as influenza viruses and a number of other infectious agents. The results of our own studies indicate a high level of intrauterine infection (22.6%). At the same time, we most often noted intrauterine transmission Ureaplasma urealyticum, while vertical infection with CMV was detected only in isolated cases. In addition, in recent years, we, regardless of C. B. Hall et al. (2004), have shown the possibility of intrauterine infection with herpes viruses type 4 ( Human Herpes Virus IV (Epstein-Barr virus)) and type 6 ( Human Herpes Virus VI) .

It should be especially noted that the potential threat of intrauterine transmission of infectious agents from a mother to her unborn child increases significantly in cases where a woman has a aggravated somatic, obstetric-gynecological and infectious history. At the same time, risk factors for intrauterine infection are: inflammatory diseases of the urogenital tract in the mother, unfavorable course of pregnancy (severe preeclampsia, the threat of interruption, the pathological state of the utero-placental barrier, infectious diseases).

However, intrauterine infection does not always lead to the development of manifest forms of the disease and largely depends on the characteristics of the fetus and newborn. So, the risk of implementing a congenital infection increases significantly:

  • with prematurity;
  • delayed prenatal development;
  • perinatal damage to the central nervous system;
  • pathological course of the intra- and / or early neonatal period.

In addition, the prognosis of intrauterine transmission depends on the gestational age at which infection occurred, the characteristics of the pathogen (its pathogenic and immunogenic properties), the type of maternal infection (primary or secondary), the functional state of the mother's immune system, the integrity of the uteroplacental barrier, etc.

The nature of damage to the embryo and fetus, the severity of inflammatory changes, as well as the characteristics of clinical symptoms in congenital infections depend on a number of factors: the properties of the pathogen, the massiveness of infection, the maturity of the fetus, the state of its defense systems, the characteristics of the mother's immunity, etc. the duration of the gestational period in which infection occurred, and the nature of the infectious process in the mother (primary infection or reactivation of a latent infection). The infection is called primary if the organism is infected with this pathogen for the first time, i.e., the development of the infectious process occurs in a previously seronegative patient. If the infectious process develops as a result of activation of the pathogen that was previously in the body in a latent state (reactivation), or due to re-infection (reinfection), then such an infection is classified as secondary.

It has been established that the infection of the fetus and the development of severe IUI variants are most often observed in cases where a woman suffers a primary infection during pregnancy.

In cases where infection occurs in the embryonic period, spontaneous miscarriages are more often noted or severe, life-threatening malformations occur. The penetration of the pathogen into the body of the fetus in the early fetal period can lead to the development of an infectious-inflammatory process, characterized by the predominance of the alternative component with the formation of fibrosclerotic deformities in the damaged organs. Infection of the fetus in the late fetal period can be accompanied by inflammatory damage to both individual organs and systems (hepatitis, carditis, meningitis or meningoencephalitis, chorioretinitis, damage to hematopoietic organs with the development of thrombocytopenia, anemia, etc.), and generalized damage. In general, with antenatal infection, the clinical symptoms of the disease, as a rule, appear already at birth.

At the same time, with intranatal infection, the timing of the implementation of the infectious-inflammatory process can be significantly delayed, as a result of which the clinical manifestation of IUI can debut not only in the first weeks of life, but even in the postneonatal period.

Infectious diseases specific to the perinatal period (P35 - P39)

It has been established that in the vast majority of cases of IUI of various etiologies in newborns, they have similar clinical manifestations. The most typical symptoms of IUI detected in the early neonatal period are intrauterine growth retardation, hepatosplenomegaly, jaundice, exanthema, respiratory disorders, cardiovascular failure and severe neurological disorders, and thrombocytopenia. At the same time, attempts to verify the etiology of a congenital infection only on the basis of clinical symptoms, as a rule, are rarely successful. Given the low specificity of the clinical manifestations of congenital infections, in the English literature, the term “TORCH syndrome” is used to designate IUI of unknown etiology, which includes the first letters of the Latin names of the most frequently verified congenital infections: T stands for toxoplasmosis ( Toxoplasmosis), R — rubella ( Rubella), C - cytomegaly ( Cytomegalia), H - herpes ( Herpes) and O — other infections ( Other), i.e. those that can also be transmitted vertically and lead to the development of intrauterine infectious and inflammatory processes (syphilis, listeriosis, viral hepatitis, chlamydia, HIV infection, mycoplasmosis, etc.).

Laboratory diagnostics. The absence of specific symptoms and the uniformity of clinical manifestations of congenital infections substantiate the need for the timely use of special laboratory methods aimed at reliable verification of the etiology of IUI. At the same time, the examination of newborns and children of the first months must necessarily include methods aimed both at direct detection of the causative agent of the disease, its genome or antigens (“direct”), and at the detection of markers of a specific immune response (“indirect” diagnostic methods). Direct diagnostic methods include classical microbiological methods (virological, bacteriological), as well as modern molecular biological methods (polymerase chain reaction (PCR), DNA hybridization) and immunofluorescence. With the help of indirect diagnostic methods, specific antibodies to the pathogen antigens are detected in the child's blood serum. In recent years, enzyme-linked immunosorbent assay (ELISA) has been most widely used for this purpose. In order to obtain reliable results of serological examination of newborns and children of the first month of life and to adequately interpret these data, certain rules must be observed.

  • Serological examination should be carried out before the introduction of blood products (plasma, immunoglobulins, etc.).
  • Serological examination of newborns and children of the first months of life should be carried out with simultaneous serological examination of mothers (to clarify the origin: "maternal" or "own").
  • Serological examination should be carried out by the method of "paired sera" with an interval of 2-3 weeks. In this case, the study must be performed using the same technique in the same laboratory. It should be especially noted that in cases where, after the initial serological examination, blood products (immunoglobulin, plasma, etc.) were administered to the child, the study of “paired sera” is not carried out.
  • The evaluation of the results of serological studies should be carried out taking into account the possible features of the nature and phase of the immune response.

It should be emphasized that seroconversion (the appearance of specific antibodies in a previously seronegative patient or an increase in antibody titers in dynamics) appears later than the onset of clinical manifestations of infection.

Thus, in the presence of clinical and anamnestic data indicating the likelihood of IUI in a newborn child, verification of the disease must be carried out using a complex of direct and indirect research methods. In this case, the identification of the pathogen can be carried out by any of the available methods. In recent years, PCR has been increasingly used for pathogen detection. In this case, any biological environment of the body can serve as a material (cord blood, saliva, urine, swabs of the trachea, oropharynx, smears from the conjunctiva, from the urethra, etc.). However, in cases where the etiology of the disease is associated with viral agents, the criterion for the active period of IUI is the detection of the pathogen in the blood or cerebrospinal fluid (if there is a CNS lesion). In cases where the virus genome is found in cells of other biological media, it is very difficult to unambiguously determine the period of the disease.

In this case, a parallel assessment of the nature of the specific immune response is necessary (see the figure in the “Under glass” section).

At the same time, to clarify the activity of the infectious process, it is shown to conduct a serological study by ELISA with the quantitative determination of specific antibodies of the IgM, IgG classes and an assessment of their avidity level. Avidity is a concept that characterizes the speed and strength of antigen-antibody binding (AT + AGV). Avidity is an indirect sign of the functional activity of antibodies. In the acute period of infection, specific IgM antibodies are first formed, and a little later, specific low-avid IgG antibodies are formed. Thus, they can be considered a marker of the active period of the disease. As the severity of the process subsides, the avidity of IgG antibodies increases, highly avid immunoglobulins are formed, which almost completely replace the synthesis of IgM. Thus, serological markers of the acute phase of the infectious process are IgM and low-avid IgG.

Identification of specific IgM in umbilical cord blood, as well as in the blood of a child in the first weeks of life, is one of the important criteria for diagnosing IUI. Confirmation of the active period of congenital infection is also the detection of low-avid specific IgG antibodies with an increase in their titers over time. It should be emphasized that repeated serological testing should be carried out after 2-3 weeks ("paired sera"). In this case, a comparison with the results of a parallel serological examination of the mother is necessarily carried out.

It should be especially noted that the isolated detection of IgG antibodies in the blood serum of a newborn without specifying the avidity index and without comparing with maternal titers does not allow unambiguous interpretation of the data obtained, since antibodies can be of maternal origin (introduction into the fetus due to their transplacental transfer). Only with a dynamic (with an interval of 14-21 days) comparison of the levels of specific IgG antibodies of a newborn child and mother can one judge their nature. If the titers of specific IgG antibodies in a child at birth are equal to maternal ones, and upon re-examination they decrease, then it is highly likely that they are of maternal origin.

The totality of the results of direct and indirect research methods allows you to establish the etiology of the disease, as well as determine its severity and stage. The molecular biological method, PCR, is currently used as the main method of etiological verification of an infectious disease. Numerous studies have confirmed the reliability of PCR results in the search for IUI pathogens. The possibilities inherent in the PCR method make it possible to achieve maximum specificity of the analysis. We are talking about the absence of cross-reactions with similar microorganisms, as well as the ability to identify typical nucleotide sequences of a particular infectious agent in the presence of other microorganisms. The advantages of the PCR method are the possibility of early detection of the pathogen in the patient's body even before the formation of the immune response, as well as the possibility of detecting infectious agents in latent forms of the infectious process. These advantages of the PCR method over indirect methods for diagnosing an infectious process (ELISA) are especially evident in newborns, which is associated with the specifics of their immune system. At the same time, the most significant are the presence in the blood serum of newborns of maternal antibodies transmitted transplacentally, immunological tolerance and transient immaturity of immunity. The latter is especially characteristic of premature infants, in whom a pronounced immaturity of immunity causes an inadequacy of the immune response. In addition, intrauterine infection of the fetus can create prerequisites for the development of immunological tolerance to this pathogen with the formation of its long-term persistence and reactivation in the postnatal period. Some authors also point to the ability of pathogens of the TORCH group to suppress the immune response.

Among the most well-studied IUIs are such diseases as rubella, cytomegalovirus infection (CMVI), herpes infection and toxoplasmosis.

congenital rubella syndrome

Rubella virus belongs to the family Togaviridae, kind Rubivirus. The virus genome is a single-stranded plus-stranded RNA. The rubella virus belongs to the facultative pathogens of slow viral infections. Congenital rubella is a slow viral infection that develops as a result of transplacental infection of the fetus. Rubeolar infection suffered by a woman in the first months of pregnancy, especially before the 14-16th week of gestation, leads to miscarriages, severe fetal damage, stillbirth, prematurity and various health disorders in the postnatal period. In children born alive, severe malformations and embryofetopathies are often detected, leading to an unfavorable outcome already in the neonatal period. So, L. L. Nisevich (2000) notes that rubella virus antigens are detected in 63% of fetuses and dead newborns with signs of embryofetopathies. It was found that the most common clinical signs of manifest forms of congenital rubella in newborns are: congenital heart disease (in 75%), prematurity and/or prenatal malnutrition (in 62-66%), hepatosplenomegaly (in 59-66%), thrombocytopenic purpura (in 58%) and damage to the organs of vision (in 50-59%). It should be especially noted that in the case of manifest forms of the disease, a high level of adverse outcome persists in the postneonatal period. Thus, the overall mortality among these patients during the first 18 months of life reaches 13%.

The manifest course of congenital rubella in the neonatal period occurs only in 15-25% of children with intrauterine infection. At the same time, the presence of congenital heart defects in a child, anomalies of the organs of vision (cataract, less often microphthalmia, glaucoma) and hearing impairment, described as Gregg's triad, allow us to assume with a high degree of probability that the cause of these lesions is congenital rubeolar infection. However, it should be noted that the classic Gregg triad is extremely rare. In most cases, there is the development of others - nonspecific clinical manifestations of TORCH syndrome (intrauterine growth and development retardation, hepatosplenomegaly, thrombocytopenia, jaundice, etc.). Verification of the etiology of a congenital infection is possible only on the basis of the results of a laboratory examination (virological, immunological, molecular biological methods).

An even more difficult task is the diagnosis of subclinical forms of congenital rubella. It should be noted that this variant of the course of congenital rubeolar infection is observed in the vast majority of children (75-85%).

At the same time, newborns do not have symptoms of TORCH syndrome, and various health disorders appear only at further stages of postnatal development. Prospective observation of this contingent of children allows in the following months and years of life to identify serious lesions of various organs and systems in 70-90% of cases. Drugs for the specific treatment of rubella have not been developed.

The primary goal of prevention is to protect women of childbearing age. At the same time, rubella is one of the few perinatal infections that can be prevented by routine vaccination. Pregnant women, especially in early pregnancy, should avoid contact with patients with rubella, as well as with children of the first year of life who had signs of congenital rubeolar infection at birth.

Congenital cytomegalovirus infection

Pathogen Cytomegalovirus hominis— a DNA-containing virus of the family herpesviridae, subfamilies Betaherpesviridae. According to the classification proposed by the International Committee on the Taxonomy of Viruses (1995), CMV belongs to the "Human Herpesvirus-5" group. The incidence of congenital CMVI ranges from 0.21 to 3.0% depending on the type of population studied.

With intrauterine infection with CMV, which occurs in the early stages of pregnancy, teratogenic effects of the virus are possible with the development of dys- and hypoplasia of the fetal organs. However, it should be noted that, compared with other viruses (enteroviruses, rubella virus, etc.), CMV is characterized by a less pronounced teratogenic effect. Congenital CMVI can occur in clinical and subclinical forms. Symptomatic forms of CMVI are rare and do not exceed 10% of the total number of all cases of intrauterine infection with CMV. Manifest forms of intrauterine CMVI are characterized by severe symptoms and severe course. In this case, jaundice, hepatosplenomegaly, lesions of the nervous system, hemorrhagic syndrome, thrombocytopenia are most often noted. Severe variants of manifest forms of congenital CMVI are characterized by a high mortality rate (more than 30%). Surviving children often have serious health problems in the form of gross mental retardation, sensorineural hearing loss, chorioretinitis, etc. Factors that cause an unfavorable neuropsychiatric prognosis are the presence of microcephaly, chorioretinitis, intracranial calcifications, and hydrocephalus. It has been established that severe forms of CMVI develop, as a rule, in cases where the mother suffered a primary infection during pregnancy. Much less often, intrauterine infection occurs if the mother suffers recurrent CMVI during pregnancy. It is noted that children with an asymptomatic form of intrauterine CMVI may also have health problems. So, for example, K. W. Fowler et al. (1999) detected sensorineural hearing loss in 15% of children with asymptomatic variants of intrauterine CMVI.

Treatment of congenital CMVI consists of etiotropic and syndromic therapy. The indication for etiotropic therapy of congenital CMVI is the active period of the clinically manifest form of the disease. The criteria for the activity of the CMV infection process are laboratory markers of active virus replication (viremia, DNAemia, AGemia). Serological markers of CMVI activity (seroconversion, anti-CMV-IgM and/or an increase in the concentration of low-avid anti-CMV-IgG over time) are less reliable. This is due to the fact that the results of a serological examination often turn out to be both false positive (for example, anti-CMV-IgG detected in a child can be maternal, transplacental, etc.) and false negative (for example, the absence of specific antibodies in the child’s blood serum to CMV due to immunological tolerance or due to a low concentration of antibodies to CMV (beyond the sensitivity of test systems) in the initial period of the immune response, etc.).

The drug of choice for the etiotropic treatment of congenital CMVI is cytotect. Cytotect is a specific hyperimmune anticytomegalovirus immunoglobulin for intravenous administration. The therapeutic efficacy of the cytotect is due to the active neutralization of the cytomegalovirus by specific anti-CMV antibodies of the IgG class contained in the preparation, as well as the activation of antibody-dependent cytotoxicity processes.

Cytotect is available as a 10% solution ready for use. Cytotect is administered intravenously to newborns using a perfusion pump at a rate of no more than 5-7 ml/h. In case of manifest forms of CMVI, cytotect is prescribed: 2 ml / kg / day with an injection every 1 day, for a course - 3-5 injections or 4 ml / kg / day - administration every 3 days - on the 1st day of therapy, on 5th and 9th day of therapy. In the future, the daily dose is reduced to 2 ml / kg / day, and depending on the clinical symptoms and the activity of the infectious process, cytotect is administered 1-3 more times at the same interval.

In addition, recombinant interferon alfa-2b (Viferon, etc.) is used as antiviral and immunomodulatory therapy. Viferon is available in the form of rectal suppositories containing 150,000 IU of interferon alfa-2b (Viferon-1) or 500,000 IU of interferon alfa-2b (Viferon-2). Method of application: rectally. Dosage regimen: 1 suppository 2 times a day - daily, for 7-10 days, followed by the introduction of 1 suppository 2 times a day after 1 day for 2-3 weeks.

Due to the high toxicity of anti-CMV drugs (ganciclovir, foscarnet sodium), they are not used for the treatment of neonatal CMVI. The issue of the need for etiotropic treatment of newborns with asymptomatic congenital CMVI has not been finally resolved. The expediency of prescribing various immunomodulators is also not recognized by all.

Prevention of congenital CMVI is based on the identification of a seronegative layer among women of childbearing age. Preventive measures include limiting exposure of seronegative pregnant women to potential sources of CMVI. Since the highest incidence of CMVI is observed in children of early and preschool age, such women are not allowed to work with children (in kindergartens, schools, hospitals, etc.). Seronegative pregnant women should also not be allowed to care for children with congenital CMVI due to the high risk of infection.

Effective methods of active specific immunoprophylaxis of CMVI have not yet been developed.

Congenital and neonatal herpes infection

The terms "congenital" and "neonatal" herpes are used only in relation to diseases caused by HSV types 1 and 2, although the possibility of vertical transmission and other members of the Herpesviridae family (types 4 and 6) has now been proven. Intrauterine and neonatal herpes are more often caused by HSV type 2 (75% of all cases), although both types of pathogen can lead to the formation of a similar pathology of the fetus and newborn.

The frequency of neonatal herpes differs significantly in different regions and, depending on the population studied, ranges from 1.65 to 50 cases per 100,000 population. Despite the low prevalence of neonatal herpes, it is a serious problem due to the increased risk of adverse outcomes. It has been established that serious neurological complications may occur in the future even with the appointment of antiviral therapy. As in the case of CMVI, neonatal HSV infection is more common in children whose mothers had a primary infection during pregnancy. In cases where a woman during pregnancy suffers a recurrent herpes infection, the risk of antenatal infection is much lower. The level of intrauterine infection in primary genital herpes in the mother during gestation ranges from 30 to 80%, while in recurrent - no more than 3-5%. At the same time, it has been established that in cases where the recurrence of genital herpes occurs at the end of pregnancy, and childbirth occurs naturally, the risk of intranatal infection reaches 50%. It should be emphasized that even the presence of specific antibodies does not prevent the development of severe forms of the disease. So, in 60-80% of infected newborns, herpetic encephalitis develops. Among the risk factors for the development of herpes infection in a newborn, there are: the first episode of maternal infection in the third trimester of pregnancy, invasive measures during the management of pregnancy, childbirth before the 38th week of gestation, maternal age up to 21 years.

There are three clinical forms of neonatal herpes: a localized form with damage to the skin, mucous membranes of the mouth and eyes; a generalized form with multiple organ damage and herpetic lesions of the central nervous system in the form of encephalitis and meningoencephalitis (). In cases where prenatal transmission of the pathogen has occurred, clinical manifestations of herpes infection can be detected already at birth. At the same time, with intranatal infection, clinical manifestation does not occur immediately, but after 5-14 days. At the same time, localized and generalized forms of neonatal herpes, as a rule, debut at the end of the first, less often at the beginning of the second week of life. The most severe neonatal herpes occurs in the form of generalized forms and is especially unfavorable in those cases when herpetic lesions of the central nervous system are associated with it. It should be noted that, unlike localized forms, in which there are always typical skin or mucocutaneous manifestations of herpes infection, generalized forms are often hidden "under the guise" of a septic process that is resistant to traditional therapy. Isolated herpetic lesions of the central nervous system (meningitis, meningoencephalitis) often develop on the 2-3rd week of life. At the same time, neurological changes (convulsive syndrome, impaired consciousness, etc.) prevail in the clinical picture, and a high protein level and lymphomonocytic pleocytosis are revealed in the study of cerebrospinal fluid.

It should be noted that in a significant proportion of children with generalized forms of neonatal herpes, as well as with isolated herpetic lesions of the central nervous system, mucocutaneous manifestations are extremely rare, and the maternal history in most of them does not indicate a herpes infection. In the light of the foregoing, the role of modern diagnostic technologies becomes clear, allowing to verify the etiology of the disease in the shortest possible time and with a high degree of reliability.

The herpetic etiology of the disease is confirmed by the detection of the virus (classical or accelerated virological methods), its genome (PCR) or antigens by ELISA in the blood, cerebrospinal fluid, urine, and nasopharyngeal contents. The detection of specific antibodies related to IgM indicates the presence of a herpes infection in a newborn, however, the timing of their appearance in the blood serum often lags behind the clinical manifestations of the disease.

Treatment. In all forms of neonatal herpes infection, specific antiviral therapy with acyclovir is indicated, while the drug should be administered intravenously. Acyclovir in all cases, even with a localized form, is administered intravenously, since there is a high risk of generalization of a herpes infection.

With localized forms of the disease, acyclovir is used at a daily dose of 45 mg / kg / day, with generalized infection and meningoencephalitis - at a dose of 60 mg / kg / day. The drug is administered in three divided doses by intravenous infusion. The duration of treatment with acyclovir depends on the form of neonatal herpes: a localized form requires therapy for 10-14 days, a generalized form and meningoencephalitis - at least 21 days.

In addition, for the treatment of a generalized form, standard intravenous immunoglobulins and immunoglobulins with a high titer of antibodies to HSV, as well as viferon in suppositories at a dose of 150,000 IU 1 time per day for 5 days, can be included in the complex therapy of newborns.

Prevention. In the prevention of neonatal herpes, an essential role belongs to the early detection of high-risk pregnant women, their timely and adequate treatment, and delivery. In doing so, you must adhere to the following recommendations:

  • if a woman has a primary herpes infection less than 6 weeks before the expected birth, she must be prepared for a planned caesarean section;
  • if the primary herpes infection occurred more than 6 weeks before delivery, then vaginal delivery is possible. At the same time, to reduce the risk of exacerbation of the disease by the time of delivery, it is advisable to use acyclovir from the 36th week of pregnancy;
  • disseminated and severe primary maternal infections require acyclovir therapy, regardless of the gestational age;
  • in cases where a woman gave birth naturally and genital herpes was detected during this period, the newborn is prescribed prophylactic therapy with acyclovir and an additional examination for herpes infection is performed. Upon receipt of a negative result of a laboratory examination and against the background of the absence of clinical manifestations of the disease, antiviral therapy is stopped.

Very severe variants of the disease (diffuse encephalopathy, encephalitis, pneumonia, myocarditis) occur only in adults with immunodeficiencies (AIDS) and preterm infants infected in utero.

The fetus becomes infected only if the woman became infected during pregnancy. Typical signs of congenital infection are chorioretinitis, foci of calcification in the brain, severe psychomotor retardation, hydro- or microcephaly, and convulsive syndrome. At the same time, there is a relationship between the severity of the disease in the fetus and the gestational age in which the infection occurred. In severe forms of the disease, the fetus dies or is born prematurely. Signs of the disease may appear at birth or remain unnoticed for many days after childbirth. Clinical symptoms may include intrauterine growth retardation, generalized lymphadenopathy, hepatosplenomegaly, jaundice, hydrocephalus, microphthalmia, and seizures alone or in combination. Intracranial calcifications and chorioretinitis can be detected already at the time of birth, but often appear later.

According to the results of studies by G. Desmonts and J. Couvreur, 63% of women who fell ill with toxoplasmosis during pregnancy gave birth to healthy children. Clinical manifestations of the disease in most newborns were minimal or absent. Only 16% of infected neonates were severely ill, 20% were moderately ill, and 64% were asymptomatic. To confirm the diagnosis, the PCR method is used, the determination of Toxoplasma (Toxoplasma gondii) antigens in the blood by the method of immunofluorescence reaction, as well as serological methods for determining the titer of antibodies to Toxoplasma, the avidity index of these antibodies.

The scheme of using medicines in cycles justified itself: 5 days tindurin, sulfanilamide - 2 days more (7 days); three such cycles are carried out with breaks between them of 7-14 days.

According to the indications (chronic, recurrent form in immunodeficiency, exacerbation of chorioretinitis), this course of therapy is repeated after 1-2 months.

Side effects of all antifolates are eliminated by the appointment of folic acid, folic acid derivatives are also active; the drug compensates for the deficiency of the patient's folic acid and helps to restore the biosynthesis of nucleic acids. The official drug leucovorin (calcium folinate) is prescribed at a dose of 1-5 mg every 3 days (in tablets 0.005) during the entire course of therapy.

Spiramycin is prescribed in two doses for 10 days with a body weight of up to 10 kg 2 bags of granules of 0.375 million IU; roxithromycin (rulid) - 5-8 mg / kg / day for 7-10 days.

There is evidence of the effectiveness of clindamycin (with chorioretinitis in its late manifestation); in children over the age of 8 years, a tetracycline drug - doxycycline monohydrate (unidox solutab) can be used: for the first 2 days, 4 mg / kg per dose, then 2 mg / kg 1 time per day - for 7-8 days. There are recommendations regarding the use of such anticoccidial drugs as aminoquinol, chemococcid, but the degree of their effectiveness and side effects have not been verified enough.

Prevention of congenital toxoplasmosis is aimed at identifying high-risk groups - seronegative girls and young women, followed by their clinical and serological observation before and during pregnancy. In addition, prevention issues are raised during planned sanitary education. At the same time, special attention is drawn to the need to comply with hygiene rules (do not try raw minced meat when cooking, eat only thermally processed meat, well-washed fruits and vegetables, sanitize cat feces, etc.). Active specific immunoprophylaxis of toxoplasmosis has not been developed.

Thus, congenital infections continue to be one of the most serious diseases in newborns and young children. Diverse etiology and uniformity of symptoms complicate the clinical verification of IUI, which determines the need for timely special studies. At the same time, a targeted examination for IUI should be carried out in children at risk for intrauterine infection and the implementation of congenital infection. The risk group for intrauterine infection includes newborns born from mothers with a burdened urological and gynecological history, pathological pregnancy. In turn, the detection in newborns of such conditions as prematurity, prenatal retardation, severe intra- and / or early neonatal period, should be considered as risk factors for the implementation of IUI. In these cases, an immediate examination of newborns for IUI is indicated for timely verification of the etiology of the disease. The choice of methods for examining newborns for IUI should be based on a comprehensive assessment of clinical and laboratory parameters. At the same time, a combination of molecular (PCR) and immunological (ELISA) diagnostic methods is optimal for laboratory diagnosis of IUI. n

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A. L. Zaplatnikov,
N. A. Korovina, doctor of medical sciences, professor
M. Yu. Korneva
A. V. Cheburkin, Candidate of Medical Sciences, Associate Professor
RMAPO, Moscow

The deterioration of the health of the baby is provoked by intrauterine infections even during the gestation of the fetus.

The predominance in the female body of pathogens that tend to provoke inflammatory processes in the genitals and other systems is called intrauterine infection (IUI). The most negative of the disease is the possibility of infection of the future fetus in the female body. The factor of infection of the fetus is the blood that circulates through the body of a woman and a conceived child.

This is the most basic route of infection, but the possibility of infection entering the body of a conceived child through the birth canal is not excluded. Mostly the disease is detected in women who lead an unhygienic lifestyle, but not in all cases. So, let's consider what types of infections are and how they enter the body of the embryo?

Types of intrauterine infections

Infection is a loose concept, so the main causative agents of such a disease are:

If, during infection, the following additional factors also affect the female body, then problems can not be avoided not only with one’s own, but also with the health of the baby after birth. Additional factors are:

  1. Constant influence of mental upheavals.
  2. Work in production with high standards of harmfulness.
  3. With a predominance of chronic diseases.
  4. Use of alcohol, tobacco or drugs.

The risk of a child's disease also increases if the predominant pathogen in the woman's body for the first time. Thus, not only a woman during pregnancy is at risk, but also her small tenant in the tummy.

Description of VUI

Let us consider in more detail information about the pathogens of intrauterine infections. So, in medicine, the group of pathogens of such a disease is called TORCH. What does this mean? Each letter of this abbreviation hides the name of the pathogen:

T, toxoplasmosis;
O - other or from English. Others. Others include: syphilis, chlamydia, hepatitis, measles, etc.;
R - Rubella or rubella;
C - cytomegalovirus pathogen;
H - Herpes.

Let's pay attention to especially dangerous, and often predominant in the female body, and consider their main characteristics.

Toxoplasmosis - this type of infection is known throughout the world. First of all, it is worth mentioning that toxoplasmosis is the most dangerous pathogen. And such a virus is hidden mainly in pets. A woman can become infected after eating the meat of an infected animal, or through blood and skin. The risk of infection increases if a woman has not had pets throughout her life. In this case, any contact with an infected animal causes consequences in the form of infection of the body. To exclude the possibility of infection of the body with the toxoplasmosis virus, it is necessary to contact pets since childhood.

Chlamydia is an infection that can be transmitted through sexual intercourse. To reduce the risk of infection with chlamydia, you must use a condom during sexual intercourse.

Chlamydia during pregnancy is detected quite simply: for this, a smear is removed from the vagina and taken for analysis. If the analysis shows a positive result, then it is worth immediately starting the appropriate treatment, which can be found in more detail in the final sections of the article. It is imperative that when chlamydia is detected in a pregnant woman, it is also worth taking an analysis from her sexual partner, and if necessary, being treated. If the infection was detected already during pregnancy, then infection of the fetus is not excluded. But if the future mother is cured in time, then nothing threatens the child.

Rubella is a disease that most often manifests itself in childhood. Rubella is ill once in a lifetime, and therefore if a woman did not get it in childhood and plans to replenish her family, then she should take care of vaccinating against the causative agent of this disease. The risk of contracting rubella without vaccination is very high, and the consequences will be very serious. The development of pathological abnormalities is not excluded in a child, and signs of a predominance of intrauterine infection in a baby can appear even 1-2 years after his birth. A blood test can detect the presence of the rubella pathogen.

Cytomegalovirus - refers to bacterial microorganisms from the group of herpes viruses. Predominantly, the risk of infection is determined by the period of gestation, but in rare cases it can also be provoked during childbirth. For a woman, the signs of the disease are almost invisible, which cannot be said about the child. Immediately after birth, for 2-3 days, symptoms of intrauterine infection in a newborn baby become noticeable.

Herpes is the final VUI. First, it is worth noting that infection with the herpes virus of the fetus is carried out through the birth canal, that is, when the child is born. If during pregnancy the predominance of the herpes virus in the body of a woman is diagnosed, then the birth is carried out according to the method of Caesarean section. This is done to eliminate the risk of infection in the body of the fetus when it is born.

Thus, each of the above pathogens of IUI has characteristic features. But why is such an infection dangerous, and what serious consequences can arise? To do this, consider the danger of IUI.

Consequences and danger of IUI

The causative agents of IUI are common microbacteria that every person suffers from and mainly in childhood, so it is wrong to protect children from various diseases. Strengthening the immune system is formed on the basis of not taking vitamins (this is how immunity is maintained), but by meeting with various types of bacteria. It cannot be said that if a child does not get sick in childhood, then he has strong immunity. It's just that his parents carefully protect him from the influence of negative factors.

Based on this, it is worth noting that if a woman, being a girl, had contact with IUI viruses, then, therefore, her immunity developed an “antidote”. A woman can get sick again, but the risk of complications and the development of IUI will be minimal.

Depending on when the infection occurs, negative consequences are caused.

  1. If infection occurs from the beginning of conception to 12 weeks, then the consequences can be the most unfavorable: the risk of abortion, the occurrence of pathologies or malformations of the fetus are not excluded.
  2. If the infection was provoked between the 12th and 28th week of pregnancy, then the risk group for developing IUI does not decrease, and the consequences will be even more dangerous. In this case, there is a possibility of having a child with a heart defect or low weight.
  3. If the infection occurred mainly in the later stages of gestation, then the consequences can be tragic. IUI will have a direct negative impact on the already formed organs of the fetus, thereby causing their pathology. If measures are not taken, the baby may be born with ailments of the liver, lungs, heart or brain.

In addition, the possibility of infection of the urinary tract, encephalitis, meningitis and hepatitis is not excluded. But the symptoms of these diseases do not usually appear immediately, but several months after birth.

If diseases of the kidneys or liver are treatable, then abnormalities in the brain are difficult to diagnose and not at all curable. In this case, the child with growing up may experience deviations in development. Often, IUI forms the causes of disability, therefore, in order to eliminate such consequences and risk factors, it is worth taking appropriate measures.

Symptoms of the disease

It is very important to know the signs of the disease in order to identify them in time and take appropriate measures. First of all, in order to eliminate the risk of infection of the body, it is necessary to follow the schedule for testing. It is the analysis of blood and urine that gives a clear picture of the predominance of foreign bodies in the body of a pregnant woman. If the analysis is given periodically, then the risk group for infection with IUI decreases. Even if something is detected at an early stage of infection, the virus is eliminated without problems, even without resorting to taking antibiotic drugs.

To identify the development of IUI, it is necessary to take a blood and urine test, as well as undergo a physical examination. During a physical examination, a picture of inflammation and redness of the cervix and vagina will be traced. But inspection in rare cases reveals infection of the body. What you should really rely on is a blood and urine test.

If signs of IUI were not detected in time in a woman during pregnancy, then the disease may affect the child with the following symptoms:

  • Low birth weight (up to 2 kg or less).
  • Developmental delay (physical and mental).
  • Lethargy.
  • The occurrence of rash and jaundice.
  • Insufficiency of the cardiovascular and nervous systems.
  • Decreased appetite and pallor of the skin.
  • Frequent vomiting of food.

All of these signs appear mainly on the third day after birth, and if the infection occurred during childbirth, then the symptoms will appear immediately.

How does an infection occur?

The most common routes of infection for IUI are blood and the birth canal. The method of infection depends primarily on the pathogen: if the infection is provoked through the sexual route, then the infection will enter the fetus through the fallopian tubes or vagina. With the predominance of the rubella virus, endometritis or toxoplasmosis in a pregnant woman, the infection of the fetus occurs through blood circulation, through the amniotic membrane or waters. The woman herself may fall under the risk of infection in case of contact with the patient, during sexual intercourse, through the use of raw water or unprocessed food. If simple hygiene measures are not observed, then the possibility of infection is also not excluded.

Treatment

Treatment is prescribed only if the disease is correctly diagnosed. Diagnostics involves the following procedures:

- take a blood test;
- vaginal smear analysis;
- Analysis of urine.

When the type of infection is clarified, appropriate treatment is prescribed.

Depending on each individual case, personal treatment is prescribed under the strict supervision of a doctor in order to eliminate the risk of developing pathologies.

Prevention

Prevention of the development of IUI should, first of all, include a full examination of both partners who are planning to conceive a child. It also does not interfere with vaccination, which will prevent the likelihood of infection with the herpes virus.

Everything else according to the standard scheme: hygiene, proper and wholesome nutrition, protection during sexual intercourse, treatment of all infectious diseases, rejection of bad habits. If you follow all these points, then the risk of developing IUI will be reduced to zero.

There are several ways of infection:

o hematogenous, during which the virus enters the embryo through the placenta;

o ascending, - an infection from the genital tract penetrates into the uterine cavity, after which it is able to infect the fetus;

o descending, when the pathogen from the fallopian tubes passes into the uterus, and from there into the body of the embryo;

o contact - the embryo becomes infected during childbirth;

Factors that provoke the development of perinatal infection:

o pathological course of pregnancy,

o diseases of the urinary tract in the expectant mother;

o infections during gestation;

o Immunodeficiency in the history of the expectant mother, including HIV infection;

o complications after transplantation of internal organs and tissues.

Symptoms

In the course of such a pathology, there are no signs in a pregnant woman. Manifestations relate to the fetus in the womb, and they can be very different, everything is due to the moment at which the infection occurred.

  • If the infection occurred in the period from 3 to 12 weeks, the manifestation may be a spontaneous miscarriage or the development of malformations in the fetus inside the womb;
  • If the infection occurred from the 11th to the 28th week of gestation: the baby is born with insufficient body weight, intrauterine developmental defects.

Infection in the third trimester of pregnancy causes disruption of the central nervous system, heart, liver, lungs, and vision.

Infection at 10-40 weeks provokes the development of fetal diseases.

Diagnosis of intrauterine infection in a pregnant woman

Diagnosing the presence of intrauterine infection is quite difficult.

1. In the process of pregnancy planning, each expectant mother should be tested for the presence of sexually transmitted diseases and popular urogenital infections using the PCR method, since the immune system during the period of gestation of a pregnant woman is in a depressed state, therefore, susceptibility to infections increases.

2. The expectant mother must take a blood test for TORCH-diseases, syphilis, HIV, hepatitis.

3. According to the composition and number of antibodies M and G, the doctor decides on the danger of perinatal infection of the fetus:

  • o the detection of a small number of IgG indicates that the infection developed earlier, immunity was obtained to such a pathogen, and the disease is not dangerous either for the expectant mother or for the fetus;
  • o an increase in IgG or the occurrence of IgM speak of a recurrence of the infection. The possibility of manifestation of perinatal infection is quite small;
  • o in the process of infection in a future woman in labor who has not been ill with this or that disease before, only IgM is detected. The risk of infection of the embryo when the expectant mother becomes ill is approximately 50 percent.

4. Ultrasound for diagnosing the functionality of the placenta, the blood supply of the embryo (changes in the structure of the placenta indicate the presence of perinatal infection of the embryo).

5. Study of the fetal membrane, bacteriological and immunohistochemical methods are used.

6. Sometimes a chorionic biopsy, amniocentesis, cordocentesis is performed with further bacteriological analysis for the presence of the pathogen.

7. Serological examinations of the child's blood by ELISA analysis in order to determine the presence of antibodies.

Often in the process of treatment, the help of an infectious disease specialist is required.

Complications

The presence of perinatal infections can lead to serious consequences for a pregnant woman, up to the interruption of the gestation process. In addition, pathologies in a newborn are practically guaranteed, these are complications such as:

  • the occurrence of congenital malformations in the fetus,
  • death of the baby in the first 1-7 days of life,
  • the birth of a dead child,
  • violations in the work of any internal organ,
  • occurrence of congenital immunodeficiency.

Other diseases in babies with perinatal infection are characterized by a serious clinical picture, a clear lesion of organs and systems. Likely:

  • o the development of an infectious process in a baby;
  • o the development of carriage of the pathogen with the risk of developing pathology in the future. Bacteriocarrier is a condition when a pathogenic agent lives in the body, but there are no symptoms of the disease;
  • o if the fetus has been infected for a long time before birth, then it may be born healthy, but will weigh little.

So, infections in expectant mothers are able to pass without perinatal infection of the embryo.

Treatment

What can you do

A pregnant woman needs to register with the antenatal clinic, follow all the doctor's prescriptions, take tests, undergo screenings, and report all disturbing symptoms to her gynecologist.

What does a doctor do

The therapy carried out by the doctor is due to a certain pathogen. The specialist is appointed

  • antibiotics;
  • antiviral agents;
  • immunostimulants;
  • symptomatic and restorative agents.

Prevention

Preventive measures should be taken even before the onset of pregnancy. This is competent preparation for conception, passing the necessary tests, curing existing diseases.

In the process of bearing, the expectant mother must carefully follow the recommendations of the doctor observing her pregnancy. She should not communicate with sick people, it is necessary to eat only fresh and wholesome food, if the slightest sign of SARS appears, consult a doctor.

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Arm yourself with knowledge and read a useful informative article about intrauterine infections during pregnancy. After all, being parents means studying everything that will help maintain the degree of health in the family at the level of “36.6”.

Find out what can cause intrauterine infections during pregnancy, how to recognize it in a timely manner. Find information about what are the signs by which you can determine the malaise. And what tests will help to identify the disease and make the correct diagnosis.

In the article you will read everything about the methods of treating such a disease as intrauterine infections during pregnancy. Specify what effective first aid should be. How to treat: choose drugs or folk methods?

You will also learn how untimely treatment of intrauterine infections during pregnancy can be dangerous, and why it is so important to avoid the consequences. All about how to prevent intrauterine infections during pregnancy and prevent complications. Be healthy!