Infection of the fetus during pregnancy, the consequences for the child. I. Newborns with clinical signs of sepsis. Treatment of intrauterine infection

29.07.2019

Quiet pregnancy, easy childbirth, the birth of a healthy child is sometimes overshadowed by a sudden deterioration in the baby's condition on the 2-3 day of life: lethargy, frequent regurgitation, lack of weight gain. All this can be the result of intrauterine infections of the fetus. What are these infections how to avoid them?

What are intrauterine fetal infections?

Intrauterine infection is the presence in a woman's body of pathogens that lead to inflammatory processes in the genitals and not only. The consequence of such an infection is the subsequent infection of the fetus during intrauterine development. In most cases, fetal infection occurs due to the same blood flow between the woman and the child. It is also possible to infect a newborn when passing through the birth canal and when swallowing infected amniotic fluid. Let's take a closer look at the infection routes.

What are intrauterine infections?

The type of infection depends on the pathogen that affects the female body during pregnancy or even before the baby is conceived. The cause of intrauterine infection can be pathogens:

viruses (herpes, flu, rubella, cytomegaly);
bacteria (Escherichia coli, chlamydia, streptococcus, treponema pallidum;
mushrooms;
protozoa (toxoplasma).

The risk of negative effects of these pathogens increases when a woman has chronic diseases, she works in hazardous industries, is exposed to constant stress, has bad habits, inflammatory processes of the genitourinary system untreated before pregnancy, and chronic diseases. For a child, the risk of being exposed to intrauterine infection increases if the mother with this infection meets for the first time during the period of gestation.

The group of intrauterine infections is usually called the TORCH group. All infections from it, having different pathogens, are almost equally manifested clinically and cause similar deviations in the development of the fetal nervous system.

TORCH is decrypted as follows:

T- toxoplasmosis

O- Others (this group includes other infectious diseases such as syphilis, chlamydia, enterovirus infection, hepatitis A and B, listeriosis, gonococcal infection, measles and mumps)

R- rubella

WITH- cytomegalovirus infection

N- herpes

Consider major intrauterine infections

Cytomegalovirus from the group of herpes viruses. Infection of the fetus occurs even in the prenatal period, less often during childbirth. The infection proceeds imperceptibly for a woman, but clearly manifests itself in a child born with this virus. The cause of a woman's infection is an immune deficiency, which has a detrimental effect on the body's inability to protect the child from infection. Treatment of infection is possible with specific drugs. In newborns, CMV is very rarely manifested by developmental disorders, therefore, drug treatment is prescribed only when the baby's life is threatened.

Herpetic infections Is another fairly common IUI. Infection of the fetus with this infection mainly occurs during its passage through the birth canal. In the case of diagnosing a disease in a woman, a planned cesarean section is most often prescribed before the amniotic fluid leaves. Newborns susceptible to intrauterine infections of this type undergo a course of specific therapy that minimizes the negative consequences for the development of the central nervous system.

Chlamydia sexually transmitted, therefore, you should be extremely careful in contacts when carrying a baby. This intrauterine infection is detected by analysis of smears from the female genital tract. In case of detection of the pathogen, the pregnant woman is prescribed antibiotic treatment. The sexual partner should also be treated.

The fetus can be infected, both during development inside the mother, and already during the birth process. Pathologies in newborns as a result of infection have not been identified, some minor consequences are possible with a decrease in appetite, frequent defecation, which is eliminated without medical intervention.

Rubella - this is the so-called childhood disease. If a woman did not get sick with it, then when planning a pregnancy, it is imperative to get vaccinated 3 months before the intended conception. The defeat of the body of a pregnant woman with the rubella virus can lead to the development of serious pathologies in the baby or to the termination of pregnancy. In a newborn, such an intrauterine infection can appear only after 1 to 2 years, if the baby has undergone an infection during childbirth.

What is the danger of intrauterine infection during pregnancy?

The mother develops immunity to most pathogens that cause intrauterine infections if she has ever met this pathogen. At the second meeting of the organism with the pathogen, the immune response prevents the virus from developing. If the meeting occurs for the first time during pregnancy, then the virus infects the body of both the mother and the child.

The degree of influence on the development and health of the fetus depends on when the infection occurs.

If infected before 12 weeks of gestation, intrauterine infection can lead to interruption or malformations of the fetus.

When the fetus is infected at 12 - 28 weeks of pregnancy, intrauterine development of the fetus is delayed, as a result of which it is born with low weight.

Infection of the fetus in the womb at a later date can pathologically affect the already formed organs of the baby. The most vulnerable in this case is the brain, since its development continues until birth. Also, the liver, lungs and heart of the baby can be negatively affected by intrauterine infection during pregnancy.

Signs of intrauterine infections

During pregnancy, a woman is repeatedly tested for blood and urine. These measures are taken by doctors to check the general condition of the pregnant woman or to detect infections in the woman's body.

The presence of intrauterine infections in a woman's body is shown by tests. But even when examined on a gynecological chair, which is performed when registering for pregnancy, inflammatory processes in the genitourinary system can be detected. Most often, there is inflammation of the vagina and cervix. But in most cases, the development of infection in the body is not accompanied by any symptoms. Then it remains to rely only on analyzes.

A baby may have the following signs of intrauterine infection, which appear before or after birth:

developmental delay;
enlargement of the liver and spleen;
jaundice;
rash;
disorder of the respiratory system;
cardiovascular insufficiency;
disorders of the nervous system;
lethargy;
lack of appetite;
pallor;
increased regurgitation.

If signs of infection are observed in a baby long before childbirth, the baby is born with an already developing disease. If the fetus is infected before childbirth, then the child's infection may manifest itself with pneumonia, meningitis, enterocolitis, or other diseases.

All these signs can appear only on the third day after the birth of the baby. Only in case of infection during the passage through the birth canal, the signs become apparent immediately.

Methods of infection with intrauterine infections

Infection of the fetus occurs in two ways: through the mother's blood or during the passage through the birth canal.

The way the infection penetrates the fetus depends on the type of pathogen. Harmful viruses can enter the fetus through the vagina or fallopian tubes if a woman is sexually infected. Also, the infection gets through the amniotic fluid, blood or amniotic fluid. This is possible if a woman is exposed to rubella, endometritis, placentitis.

A woman can contract all of the above infections from a sexual partner through contact with a sick person, drinking raw water or poorly processed food.

Treatment

Not all intrauterine infections are treated. Antibiotic treatment is prescribed in especially dangerous cases, depending on the type of infection and the condition of the child and mother. A woman may be prescribed immunoglobulins to increase the immune response to the pathogen. Vaccination can be carried out already during pregnancy (this applies to herpes vaccination). Treatment is chosen depending on the duration of pregnancy and the type of pathogen.

Prophylaxis

The best prevention of intrauterine infections is planning a pregnancy. In this case, both partners must undergo a complete examination and treat all identified infections.

During pregnancy, it is worth observing all hygiene standards, both in relations with sexual partners and in everyday life: thoroughly washing your hands, vegetables, fruits, and processing food before eating.

Proper nutrition and a healthy lifestyle will also have a beneficial effect on the course of pregnancy and the body's resistance to infections.

The expectant mother should be very attentive to her health. Having heard about the possibility of an intrauterine infection, you should not panic. Modern methods of treatment, timely diagnosis of disorders in the health of the mother or baby, in most cases, give positive results for the preservation of pregnancy and the birth of healthy children.

Intrauterine infections during pregnancy

Replies

There are 3 main routes of infection of the placenta, membranes and fetus. One of them, the most likely if the mother has chronic sources of infection, is descending or transdecidual, from septic foci under the decidua. Penetrating through the membranes into the amniotic fluid, microorganisms simultaneously spread between the membranes, reaching the basal plate of the placenta, where leukocyte infiltration occurs in response. In the amniotic fluid, the pathogen also multiplies with the development of reactive amnionitis, which results in a violation of the enzymatic and adsorption function of the amniotic membranes, which is manifested by polyhydramnios and the accumulation of unlysed meconium. Fetal infection can occur through ingestion and aspiration of contaminated amniotic fluid.

In the ascending path, the causative agents of vaginal infections predominate, causing significant violations of the vaginal microcenosis. The pathogenesis of the lesion in this case is similar to that of the descending path.

The most dangerous is the third, hematogenous route of infection, which prevails in the presence of a purulent-inflammatory focus and recurrent viral infection in the mother's body. In case of violation of the barrier function of the placenta with damage to its fruit part, the pathogen may enter the bloodstream of the fetus. Transplacental infection can cause fetal abnormalities and intrauterine sepsis.

Thus, the route of infection is determined by the type of pathogen: the bacterial infection spreads mainly ascending; all true viral infections are characterized by a hematogenous route of infection, it is also typical for such infectious diseases as listeriosis, toxoplasmosis and syphilis.

The degree of structural and functional disorders in the mother-placenta-fetus system largely depends on the characteristics of the course of the infectious process during pregnancy - an acute process, a stage of remission, exacerbation or carriage. Acute infectious process is especially unfavorable. However, the degree of the teratogenic effect of infection on the fetal-placental complex is not always unambiguously predictable: even an asymptomatic infection in the mother can have a fatal effect, and a specific acute infection disappear without a trace.

The concept of "intrauterine infection" is conditional, it supplements the clinical diagnosis with the prospect of giving birth to a child with the consequences of an infectious effect or an acute inflammatory disease. This is what should in a certain way affect the obstetric tactics of pregnancy and delivery.

It is not possible to reliably establish the prevalence of the infectious process in IUI without a special study of the fetal material. Therefore, the terms “placentitis, chorionitis, amnionitis, intrauterine pneumonia of the fetus” appearing in clinical diagnoses and conclusions of EI are not diagnostically reliable.

The identification of acute infectious processes with typical clinical manifestations in pregnant women does not cause serious problems. However, the specificity of IUI currently lies in the chronic persistent course of diseases with atypical manifestations and the manifestation of associated pathogens in the third trimester of pregnancy. As a result, even the preventive measures taken during the pre-gravid preparation of the patient or in the first half of pregnancy do not always achieve the desired goal.

When managing pregnant women in the high-risk group of IUI, it is important to observe the stages of examination and conduct of therapeutic and prophylactic measures. An algorithmized approach to solving this problem allows you to minimize the likelihood of having a child with an acute infectious process and avoid the unjustified use of immunostimulating and antibacterial medications that increase the level of allergization of newborns.

Stages of examination of pregnant women with a high risk of intrauterine infection

Primary laboratory examination for BVI carriage in the presence of an increased risk of IUI based on the results of anamnestic testing (prenatal counseling) should be carried out in the first trimester of pregnancy using the following methods:

ELISA of blood for IgM and IgG antibodies;
polymerase chain reaction (PCR) scraping of the mucous membrane of the cervical canal, the surface of the cervix and the walls of the vagina;
bacterial culture of the detachable cervical canal and vagina;
bacterial culture of urine;
viruria.

Search for prognostic echographic markers IUI:

premature maturation of the placenta (according to the classification of P. Grannum);
contrasting the basal plate of the placenta (up to 24 weeks);
hyperechoic inclusions (foci) in the placenta;
expansion of gaps and profit centers;
thickening of the placenta, not corresponding to the gestational age, with a normal area (size);
bilateral pyeloectasia in the fetus with a contrasting pattern of the calyx-pelvic system;
increased hydrophilicity (or reduced echogenicity) of the fetal brain tissue;
hyperechoic inclusions in the structures of the fetal brain;
cysts of the choroid plexuses of the fetal brain;
hyperechoic focus in the fetal heart;
hyperechoic intestine.

To ascertain in the conclusion of EI the presence of echographic signs of IUI, it is sufficient to identify three markers concerning the fetus, placenta and amniotic fluid.

In conclusion, the use of the term "placentitis" and the establishment of the diagnosis "intrauterine infection", implying certain clinical signs of an infectious process and morphological changes in the placenta, are categorically unjustified.

Based on the EI data, conclusions should be made on the identification of echographic signs of the influence of an infectious agent, which gives grounds for:

extended laboratory examination of a pregnant woman in the absence of early detection of the fact of the carrier of the infection;
carrying out immunostimulating and specific antibacterial therapy in a pregnant woman with an established carrier.

Rubella, prenatal management

Fetal exposure to rubella virus

Maternal infection, whether symptomatic or asymptomatic, can lead to fetal infection. If a woman becomes sick with rubella in the first trimester of pregnancy, the fetus may be infected with the rubella virus or have an implicit infection without clinical consequences; he may have a single organ lesion (usually hearing impairment) or multiple organ lesions.

Variants of fetal developmental disorders

Most frequent

Developmental delay (prenatal malnutrition).
Deafness.
Cataract, retinopathy.
Non-clogging of the ductus arteriosus.
Pulmonary hypoplasia (or valve stenosis).
Hepatosplenomegaly.

Less frequent

Thrombocytopenic purpura.
Delayed psychomotor development.
Meningoencephalitis.
Osteoporosis of tubular bones.
Coarctation of the aorta.
Myocardial necrosis.

Microcephaly.
Calcification of the brain.
Septal defects of the heart.
Glaucoma.
Hepatitis.

Late manifestations (after 3-12 months of life)

Interstitial pneumonia.
Chronic rubella-like rash.
Repeated infections.
Hypogammaglobulinemia.
Chronic diarrhea.
Diabetes.

Frequency of malformations by trimester

Only primary infection is at increased risk to the fetus. Rubella disease in the first weeks of pregnancy is accompanied by twice the frequency of spontaneous abortions. The highest risk of congenital rubella disease is noted at 4-8 weeks of pregnancy (according to prospective studies, 50-60%), in the rest of the first trimester of pregnancy it is 25-30%. In all cases, congenital rubella disease after 9 weeks of gestation is accompanied by hearing loss, retinopathy, and delayed psychomotor development. Deafness and retinopathy more often occur with rubella before the 120th day (up to 17-18 weeks). Cataracts and heart disease are almost always associated with a disease that developed before the 60th day of development (up to 9 weeks). Some risk may be associated with the occurrence of this infection before conception or after 20 weeks of pregnancy.

Pathogenesis

When infected with rubella, the virus begins to multiply in the mucous membrane of the upper respiratory tract and in the adjacent lymph nodes. After 7-10 days, it enters the bloodstream and circulates in it until the appearance of antibodies - usually another 7 days. The total incubation period (from the time of contact until the onset of symptoms) is 14-21 days (usually 16-18 days).

Diagnostic methods

The virus can be found in the blood a week before the rash.

The titer of hemagglutinin-inhibiting antibodies begins to increase when symptoms of the disease appear, reaching a maximum level after 1-3 weeks, after which their level remains almost unchanged for several years. Complement-binding antibodies build up more slowly (the maximum level is observed approximately 1-2 weeks after the peak of hemagglutinin-inhibiting antibodies), and disappear after several years.

Rubella-specific IgM antibodies are detected shortly after the rash, reach a maximum by day 30, and cease to be detected by day 80. IgG antibodies build up in parallel with IgM antibodies, but remain at a high level indefinitely. The titer of rubella-specific IgM antibodies increases rapidly after a recent infection and is not detected 4-5 weeks after the onset of the disease; in these terms, only IgG is determined as residual antibodies. Rubella-specific IgM is the most accurate indicator of recent infection. A negative IgM test is of little diagnostic value unless supported by other laboratory tests.

Obstetric tactics

Many contacts with rubella are actually contacts with patients who have a nonspecific skin rash with a viral disease. Therefore, it is necessary to make sure of contact with rubella by serological examination of the alleged patient. To resolve the issue of the possibility of contracting rubella in a pregnant woman, a serological diagnosis of the disease is carried out.

When diagnosing rubella in a pregnant woman before 20 weeks, it is most advisable to terminate the pregnancy due to the high risk of fetal developmental abnormalities that are not available for prenatal diagnosis.

Prenatal tactics

Determination of IgM and IgG in the blood of the fetus for the diagnosis of acute rubella infection (fetal T-lymphocytes are able to recognize and inactivate Ig-mothers from 16-17 weeks of gestation). Disadvantage of the method: low production of immunoglobulins in the fetus.

Isolation of the virus from the blood of the fetus on culture media. Disadvantage of the method: low cultivation efficiency.

Echographic signs of probable intrauterine infection

The question of determining IUI is one of the most difficult in the field of prenatal diagnostics. Any deviation of echographic indicators accompanying the infectious history of a pregnant woman is just one of the manifestations of disorders in the fetal-placental complex. And each of the signs can only conditionally be interpreted as a consequence of the inflammatory process.

When considering the problem of IUI, it is necessary to correctly interpret this concept as a diagnostic position (diagnosis) both in prenatal diagnosis and in obstetric practice. The diagnosis of IUI can serve as a reason for a number of therapeutic measures, including antibiotic therapy.

However, the accepted abbreviation IUI should not be unambiguously interpreted as infection of the fetus - the effect of an infectious agent can be limited to the membranes and the placenta, especially since it is difficult to interpret the signs of the infectious state of the fetus itself.

In this regard, the conclusion of EI signs of IUI should be regarded as giving grounds for a special examination of the pregnant woman and the implementation of preventive therapeutic measures.

It is advisable to replace IUI with the influence of an infectious factor (VIF), as in the proposed publication.

The VIF echographic marker is never the only one, isolated. By analogy with the syndromic complex of congenital diseases, there should be at least two echographic signs of VIF. At the same time, in order to establish a clinical diagnosis of the "influence of an infectious factor", three correlating conditions must be observed:

echographic signs of a probable VIF are combined with the corresponding clinical picture of the course of pregnancy;
in the distant or near history there is confirmation of the likelihood of infection;
in gestation periods of more than 26 weeks, when assessing SP PC, signs of placental dysfunction or insufficiency are revealed.

Extraembryonic formations are subject to the predominant and most pronounced changes in HIF.

The earliest signs of infectious effects in the first trimester of pregnancy are increased echogenicity and dispersion of exocoelomic contents, as well as thickening of the walls of the yolk sac.

The subsequent manifestation may be an excessive thickening of the chorion with the presence of anechoic small cystic inclusions.

A rarely detected sign is a hyperechoic focus on the amniotic membrane. When this echographic phenomenon is detected, it is necessary to differentiate it from the area of the former attachment of the yolk sac, which is subject to the umbilical cord. Concomitant signs of the possible impact of BVI in this case may be nonspecific changes in the chorion, increased echogenicity of exocoelomic contents, as well as an increase in the tone of the myometrium as a sign of the threat of termination of pregnancy.

The most common variant of blastopathies in IUI, which manifests itself at the beginning of the second trimester of pregnancy, is hypoplasia of the amniotic cavity with the presence of excess exocoelomic space.

From the second trimester of pregnancy, the echographic manifestations of VIF become more pronounced and distinct.

An increase in the thickness of the placenta, expansion of the MEP, between which zones of increased echogenicity are determined, are associated with edema of the terminal villi and a slowdown in blood flow in the lacunae.

Hemangiomas in the area of the marginal sinuses can have the form of multi-chamber formations and amniotic cords. At the same time, amniotic cords can create a picture of multi-chambered cavity fluid formations, subject to the placenta.

This is due to the extremely low speed and non-directional movement of blood elements.

The slowing down of blood flow in the lacunae leads to the formation of hemangiomas of various sizes.

Differential diagnosis can be difficult and depends on the professional training of the doctor. But in both cases, the origin of these formations can be associated with HIF, and their presence can be interpreted as markers of the postponed inflammatory process.

In an acute infectious process, the echographic picture may resemble placental cysts.

This is due to vasodilation, hemorrhages, heart attacks and degenerative changes.

It should be noted that placental cysts can have a varied appearance - more distinct contours and reduced echogenicity of the internal structure. Cysts with similar echographic characteristics can occur due to the influence of non-infectious factors.

A sign of the end of the inflammatory process is the appearance in the thickness of the placental tissue of diffusely scattered hyperechoic foci - calcifications or calcified foci of heart attacks 3-5 mm in size.

It is categorically incorrect from the point of view of pathomorphology to identify these echographic findings with fatty inclusions in the placenta, which often appears in the conclusions of echographic studies of specialists of the first screening level.

The consequence of the inflammatory state of the placenta is always the accumulation and deposition of fibrin in the lacunae and MEP, causing a picture of premature maturation of the placenta.

A coarse echo-positive suspension in the amniotic fluid - meconium, particles of compacted cheese-like lubricant appear when the production of proteolytic enzyme and adsorption function of the amniotic membranes are disturbed.

TORCH syndrome is set when there is no exact etiological diagnosis, they do not know what kind of intrauterine infection of the fetus is the diagnosis. Diagnosis of IUI is very difficult. It is necessary to examine not only the child, but also the mother, as well as the afterbirth and the umbilical cord. An indirect diagnostic method is an ELISA blood test for infections. However, even if antibodies to any infection are found in a child, this is not always evidence of IUI. After all, they could have been introduced into the child's body from the mother. Then the child is re-taken a blood test after 3-4 months, and if the antibody titer has increased 4 times or more, this is considered a diagnostically significant sign.

The causes of intrauterine infections during pregnancy are, as a rule, infection with these diseases of the mother. Infection of the fetus occurs more often precisely in the case of the first meeting of the mother's body with infectious pathogens.

In turn, the diagnosis of intrauterine infections during pregnancy is almost impossible. There are only signs by which one can suspect that the child is not well. Including they are determined using ultrasound.

Some of the symptoms of intrauterine infection during pregnancy that doctors pay attention to:

delayed fetal development (determined by measuring the length of the uterus - with a delay in development, it grows slowly, and according to ultrasound data on the size of the head, limbs, trunk volume);
polyhydramnios or low water;
pathology of the placenta;
polycystic lung disease;
hydrocephalus, etc.

The danger of intrauterine infection during pregnancy is known to many women who have lost their children shortly before childbirth or within a few days after birth. It is IUI that is the most common cause of early infant mortality. In about 80% of children born with developmental defects, IUI is determined.

The consequences of intrauterine infections during pregnancy in a born child can be expressed in respiratory dysfunctions, cardiovascular pathology, jaundice, febrile conditions, lesions of the eyes, mucous membranes, encephalitis, etc.

Infection can occur in the following ways:

through the blood, the placenta, thus very easily penetrates the child's body, for example, toxoplasma - the causative agent of toxoplasmosis;
from the genital tract, this happens with infections such as herpes during pregnancy, mycoplasmosis, chlamydia, etc., that is, those that are sexually transmitted, are manifested precisely by the defeat of the genitals;
from the fallopian tubes;
at the birth of a child in a natural way.

Prophylaxis

Every woman planning a pregnancy should undergo a general examination before pregnancy to detect possible infections (they can be asymptomatic) and treatment if necessary. During pregnancy, all known preventive measures must be followed to reduce the risk of contracting various infections. We will present several such measures.

1. Clean the toilet of animals only with protected hands, wash your hands. Be sure to thoroughly cook the meat, boil it well. Otherwise, you can become infected with toxoplasmosis - a very dangerous infection for a child.

2. Do not visit children's groups if there is no rubella vaccination, and it has not been transferred earlier. If a woman falls ill with rubella in the first trimester of pregnancy, she is recommended to have an abortion, since this disease almost always causes severe malformations in a fetus whose organs have just begun to form.

3. Do not ride on public transport, do not go without a mask during the flu period. Any ARVI and ARI, with severe course, can kill a child. Do not go out "to the people" without special need. And if you go out, be sure to lubricate your nose with oxolinic ointment and wear a medical mask. Do not touch your face with unwashed hands. Wash your hands thoroughly with antibacterial soap after visiting clinics, hospitals, shops, public transport.

4. If herpes (cold) appears on the lips, the infection can be easily transferred to the genitals by the expectant mother herself. And genital herpes, and even at the first manifestations during pregnancy, almost always greatly affects the health of the unborn child.

This is part of the measures that are guaranteed to keep you and your child safe from some dangerous infectious diseases.

The main source of infection in IUI is the mother of the child, from whose body the pathogen enters the fetus (vertical transmission mechanism). In this case, infection occurs both ascending, transplacental and transovarial routes, as well as contact and aspiration (directly during childbirth) routes. Moreover, for antenatal infections, the most typical hematogenous, and for intranatal infections, the ascending route of infection. It has been proven that today the most common infections that are transmitted from mother to fetus are sexually transmissible bacterial infections, among which genital chlamydia and genital herpes are the most common.

In the pathogenesis of the onset and development of IUI, the gestational age is of particular importance. The fetus does not react to infectious antigens until 12-14 weeks of gestation, since it lacks immunocompetent cells, immunoglobulins and does not manifest immune reactions. Infectious damage to the embryo at 3 - 12 weeks is usually associated with a viral infection that freely penetrates the chorion. Since during this period (period - organogenesis, placentation), as mentioned above, the fetus does not yet have anti-infective defense systems, IUI leads to the formation of malformations (teratogenic) or death of the embryo (embryotoxic effect).

With the onset of the second trimester of pregnancy, the mechanism of action of the ascending infection changes due to the fusion of the deciduas capsularis with the deciduas parietalis *. At this time, an ascending infection can penetrate the fetus from the vagina or cervical canal. From this period of pregnancy, the internal pharynx of the cervical canal comes into contact with the aqueous membranes of the fetus and, in the presence of infection, microorganisms penetrate the amniotic fluid. The amniotic fluid acquires antimicrobial properties only after the 20th week of pregnancy, when, in response to the action of an infectious agent, an inflammatory proliferative reaction develops, limiting the further penetration of infection, due to the appearance of lysozyme, complement, interferons, immunoglobulins.

* Decidua (decidua) is the lining of the uterus after implantation. The decidua from the 4th month after fertilization and before childbirth has three parts: Decidua basalis - that part of the uterine mucosa, which is located under the placenta. Decidua capsularis - Covers the embryo and separates it from the uterine cavity. Decidua parietalis - the rest of the uterine lining, on the sides and opposite the implantation site. As Decidua capsularis and Decidua parietalis grow, they come into contact with each other and connect.

In the third trimester of pregnancy, the antibacterial protection of amniotic fluid increases. During this period, the role of the exudative component prevails in the inflammatory reaction of fetal tissues, when in response to the penetration of infection, inflammatory leukocyte reactions develop in the fetus (encephalitis, hepatitis, pneumonia, interstitial nephritis).

Particularly dangerous with IUI in the II and III trimesters of pregnancy is fetal brain damage, which manifests itself in various severe disorders in the formation of the brain: hydrocephalus, subependymal cysts, cystic degeneration of the brain substance, anomalies in the development of the cortex, microcephaly (development of ventriculitis is also possible), which, in in turn, leads to mental retardation, retardation of the psychomotor development of children.

Changes in the state of the fetus and the functioning of the fetoplacental system caused by intrauterine infection of the fetus are reflected in the composition and properties of the amniotic fluid. When an infectious agent enters the amniotic fluid, it multiplies unhindered, followed by the development of chorionitis (placentitis) and chorioamnionitis. The syndrome of "infection of amniotic fluid" develops. The fetus finds itself in an infected environment, which creates favorable conditions for infecting the fetus by contact, i.e. through the skin, mucous membranes, respiratory and gastrointestinal tracts. When swallowing and aspiration of infected waters in a newborn, such signs of intrauterine infection appear as pneumonia, enterocolitis, vesiculosis, omphalitis, conjunctivitis, etc.

With intrauterine infection (against the background of amnionitis), as a rule, polyhydramnios occurs, which is usually secondary in nature, due to a change in the ratio of the processes of production and resorption of amniotic fluid by cells of the amniotic epithelium against the background of kidney or urinary tract damage of the fetus. IUI-induced vascular disorders lead to placental insufficiency.

A typical manifestation of intrauterine infection is miscarriage and premature birth due to the fact that bacterial phospholipases trigger the prostaglandin cascade, and inflammatory toxins have a damaging effect on the membranes. In addition, phospholipases of gram-negative bacteria contribute to the destruction of the surfactant in the lungs of the fetus, which subsequently manifests itself in respiratory disorders in the newborn.

Currently, the following types of intrauterine lesions in IUI are distinguished:

IUI often does not have clear clinical manifestations. Rarely, the first signs in a newborn are present immediately after birth, more often they appear during the first 3 days of life. When infected in the postnatal period, the symptoms of the infectious process are detected at a later date. The clinical appearance of congenital bacterial or mycotic skin lesions in a newborn may have the character of vesiculo-pustulosis. Conjunctivitis, rhinitis and otitis media that appear on the 1st - 3rd day of life can also be manifestations of IUI.

Congenital aspiration pneumonia can also appear on the 2nd - 3rd day of life. From the moment of birth, children show signs of respiratory failure: shortness of breath, cyanosis, often dullness of percussion sound and fine bubbling moist rales. The course of intrauterine pneumonia is severe, since as a result of aspiration, large areas of the lung (lower and middle lobes) are turned off from respiration due to obturation of the bronchi with infected amniotic fluid containing an admixture of meconium and fetal skin flakes.

Enterocolitis in newborns occurs as a result of the penetration of the pathogen along with the amniotic fluid into the gastrointestinal tract. Dyspeptic symptoms usually develop on the 2nd - 3rd day of life. Characterized by sluggish sucking, regurgitation, bloating, hepatosplenomegaly, expansion of the venous network of the anterior abdominal wall, frequent loose stools. In the microbiological study of intestinal contents, the predominance of Klebsiella, Proteus and Pseudomonas aeruginosa.

The defeat of the central nervous system in IUI in newborns can be both primary (meningitis, encephalitis) and secondary, due to intoxication. With damage to the vascular plexuses of the lateral ventricles of the brain, congenital hydrocephalus develops. It is necessary to pay attention to symptoms such as lethargy, poor sucking, regurgitation, delayed recovery or secondary weight loss, delayed healing of the umbilical wound, the development of omphalitis.

Typical symptoms of infectious intoxication in a newborn are respiratory and tissue metabolism disorders. There is a pale cyanotic coloration of the skin with a pronounced vascular pattern. Intoxication is accompanied by impaired excretory function of the liver and kidneys, enlargement of the spleen and peripheral lymph nodes.

There are 3 stages in the diagnosis of intrauterine infection:

Of the non-invasive methods of prenatal diagnostics of IUI, the most informative are ultrasound and Doppler sonography. Ultrasound research methods allow us to determine indirect signs of fetal IUI: polyhydramnios, ventriculomegaly, microcephaly, hepatomegaly, an increase in the thickness of the placenta, a fine suspension in amniotic fluid; and structural changes in various organs.

Direct methods of laboratory diagnostics - cordocentesis, dark-field microscopy, PCR, ELISA (determination of antibodies in the blood to chlamydia, mycoplasma and ureaplasma, CMV and HSV), culture - can detect the pathogen in biological fluids or tissue biopsies of an infected child. Indirect methods for diagnosing IUI include the clinical symptoms of the mother, ultrasound and help to make only a presumptive diagnosis of IUI. Screening tests for IUI in newborns include examinations of smears of amniotic fluid, placenta, cultures of umbilical cord blood and stomach contents of a newborn, and sometimes a culture study of blood. The "gold standard" of post-diagnosis of IUI is the histological examination of the placenta, umbilical cord and membranes.

Any changes in homeostasis in the mother's body are reflected in the cellular and chemical parameters of the amniotic fluid, which very subtly characterize the course of the pathological process, and therefore the amniotic fluid can serve as an important diagnostic material. According to I.V. Bakhareva (2009), the most significant in the diagnosis of IUI is the determination of the antimicrobial activity of the amniotic fluid based on the migration of leukocytes in it when bacteria accumulate in the amniotic membrane exceeding 10 x 3 CFU / ml. The appearance in the amniotic fluid of a large number of leukocytes, an increase in cytosis due to epithelial cells without the detection of microflora may indicate IUI.

Sexually transmitted bacterial infections are treated with modern antibiotics. Treatment of infected pregnant women is always subject to certain restrictions due to the adverse effects of antibiotics on the fetus. Antibiotics - macrolides ("new" macrolides) are deprived of this unpleasant property (for example, wilprafen [josamycin]). The treatment of viral infections seems to be more difficult, since they all have the ability to preserve for life in the body with periodic reactivation with a decrease in immunity. Despite the extensive list of immunomodulators and immunostimulants, their use during pregnancy is very limited, if not contraindicated. Newer antiherpetic drugs also have limited use in pregnant women and newborns.

Intrauterine infection is a whole group of ailments of both the fetus and the baby that has already been born. The reason for the development of such diseases lies in the infection that occurred either in the process of carrying a child, or during childbirth. As of today, there are no specific and clear statistics regarding intrauterine infections, but it is believed that at least 10% of newborns come to our world with this problem.

An intrauterine infection is very dangerous for a baby. As you probably know, even a newborn baby's immunity is very weak, his body is still developing, and any disease can cause serious harm to his health. It is obvious that an infection that a fetus has contracted during intrauterine development or even a newborn during childbirth has an even stronger negative effect on it. Situations are different, however, theoretically, intrauterine infections can lead to miscarriage, premature birth, death of the baby, the appearance of congenital defects, diseases of the internal organs and the nervous system. This is one of the most serious problems in modern pediatrics.

What causes intrauterine infections?

Doctors identify several main ways of infecting the fetus with infectious diseases:

Ascending. This means that pathogens enter the uterine cavity from the genital tract. There they penetrate into the tissues of the embryo itself. In this way, infection with chlamydia most often occurs, as well as ailments that provoke enterococci.
Descending. This is the name of infection when pathogenic microorganisms enter the uterine cavity from the fallopian tubes.
Transplant(also called hematogenous). In this way, the infection enters the fetal tissue through the placenta. In a similar way, a child can become infected with toxoplasmosis and a number of viral ailments.
Contact, or intranatal. In this case, the causative agents of infectious diseases fall on the mucous membranes of the child in the process of swallowing amniotic fluid.

The main symptoms of intrauterine fetal infection in pregnant women

The following signs can be distinguished, suggesting that a pregnant woman has developed an intrauterine infection:

High body temperature.
The appearance of a rash on the skin (regardless of where on the body).
Swollen lymph nodes, painful sensations when pressing on them.
The appearance of shortness of breath, cough, pulling sensations in the chest.
The development of conjunctivitis or excessive tearing of the eyes.
Joint problems (aching pain, swelling).

It should be noted right away that intrauterine infection is not always the cause of the appearance of such symptoms. However, due to the fact that it poses a serious danger to the child, if the slightest suspicion is found, you should immediately consult a doctor for a more detailed diagnosis. It is better to visit the clinic once again than not to start timely treatment of the disease.

Signs of intrauterine infection in a newborn

If the disease was not diagnosed during pregnancy, the following symptoms can tell about its presence after the baby is born:

jaundice, an increase in the size of the liver;
intrauterine growth retardation;
cataract;
dropsy, accompanied by the formation of edema;
skin rash;
pneumonia;
fever;
myocarditis.

In addition, as already noted, intrauterine infection can cause miscarriage, stillbirth, antenatal death of the baby or pregnancy fading.

It is also worth noting that the consequences of congenital infection do not always proceed according to the acute type, in which the resulting health problems are visible immediately after the birth of the child (in addition to the discovered ailments, such babies do not eat well, constantly sleep, do not show proper activity, etc.) ... There are also chronic consequences of intrauterine infections that are not characterized by the presence of obvious symptoms. However, such children may experience long-term consequences of intrauterine infection: delayed physical and mental development, vision and hearing problems.

Who is more at risk of being infected than others?

If you are wondering where this disease comes from, the answer is - from almost everywhere. In fact, the overwhelming majority of bacteria and viruses that, in principle, can infect the human body, are theoretically capable of penetrating the fetus. However, some of them are especially contagious and have a particularly negative effect on the baby. It is also worth noting that almost all viruses that cause SARS are not transmitted directly to the fetus. They can worsen his condition only if the mother of the unborn child has a very high temperature.

In other words, the main prevention of intrauterine infections is an extremely attentive and vigilant attitude of a pregnant woman to her health and to the health of the fetus. There are several categories of women who find it especially difficult to do this:

Healthcare professionals, especially those in direct contact with patients.
Employees of children's educational institutions (schools, kindergartens, nurseries). This also includes women who already have children attending such institutions. It is not for nothing that sick children are advised not to bring them to kindergarten or school under any circumstances - infectious diseases spread instantly in these institutions.
Women who have chronic inflammatory diseases.
Pregnant women who have previously had multiple abortions.
Women who were previously pregnant and gave birth to children with intrauterine infections.
Patients who have had incidents of antenatal fetal death or the birth of a baby with developmental defects in the past.
Pregnant women with untimely discharge of amniotic fluid.

Unfortunately, not all women from these risk groups can somehow neutralize the likelihood of developing intrauterine infections. We can only advise you to visit the doctor regularly, take care of yourself and your baby, and also make it the first priority for the next nine months. You should be prepared for the fact that you may be faced with a choice: to continue working and create the likelihood of infection of the baby, or go on maternity leave early and are more likely to give birth to a healthy baby.

How are intrauterine infections treated?

Whatever the reasons for this ailment, with timely diagnosis, you can fight for the health of the fetus. Usually, the treatment of the disease is carried out in the following directions:

Taking medications. We are talking about antibiotics, moreover, of the penicillin type, since they are the safest during the period of gestation. If we are talking about the treatment of an already born child, then antimicrobial drugs and a number of other drugs can be administered to him, depending on the identified deviations from the normal state.
Competent choice of the method of delivery. If an intrauterine infection was diagnosed in advance, the doctor conducting the patient's pregnancy will have time and enough information to choose the most appropriate method of delivery and prepare the expectant mother for it.
Observation and treatment of children. Babies born with an intrauterine infection are led up to 5-6 years of age, prescribing corrective treatment if necessary. Sometimes we are even talking about operations that can correct a number of congenital defects.

Take care of yourself and your unborn child. And if you still encounter such a problem, do not panic and strictly follow the recommendations of your doctor. An intrauterine infection cannot be called a sentence, and with a competent approach to it, you can still become a mother of a healthy and cheerful baby.