Intrauterine infection. Symptoms and complications of intrauterine infection during pregnancy

14.09.2019

The state of pregnancy imposes a certain responsibility on the woman for the health of the unborn child. Poor nutrition, unhealthy lifestyle and life, bad habits can negatively affect the health of the baby and this is the responsibility of the mother. These risks include intrauterine infections.

Intrauterine infections are caused by pathogens that enter the baby's body from the mother's body. A woman can become infected before pregnancy or during gestation. The consequences of a mother's illness can be different, up to spontaneous abortion or death from an intrauterine infection of a newborn.

In the international community, pathogens of intrauterine infections are called TORCH. Within the disease, they are divided into five groups according to the similarity of symptoms. One group has similar symptoms and consequences.

The name TORCH is an acronym and stands for:

T- denotes toxoplasmosis

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

R- rubella

WITH- cytomegalovirus infection

H- herpes

Intrauterine infections can be divided into 4 groups according to the type of pathogen.

In some cases, the patient may be a carrier of several infections from different groups. Such circumstances complicate the diagnosis and complicate treatment. The risk of unfavorable development of such pregnancy increases significantly.

Fetal infection

The reasons for intrauterine infection of the fetus, due to which the transmission of the pathogen from mother to child occurs, lies in the integrity of the body and the existence of different ways of communication between the mother and child's bodies. This could be:

Placental or hematogenous infection.
Ascending.
Downward.
Contact.

With placental infection, the virus enters the child's body, breaking the placental barrier. Ascending infection is called the penetration of the pathogen through the genital tract, and the descending movement of the infection through the fallopian tubes. Contact infection occurs during the passage of the fetus through the birth canal during childbirth. In this case, the source of infection is the amniotic fluid.

Where does intrauterine infection come from during pregnancy?

The causative agents of many diseases are classified as "conditionally pathogenic" - which means they can live in the human body without showing themselves in anything until the moment the body weakens. Such representatives can be staphylococci, streptococci, enterococci, fungi of the genus Candida and others. In the case of a weakening of the body, these microorganisms are activated, begin to multiply and cause disease.

A woman's pregnancy is accompanied by:

An increase in the load on the woman's body;
Reorganization of the hormonal background;
Increased stress on the excretory organs.

The consequence of all of the above is a weakening of the patient's immunity, and the body's defenses can no longer restrain the reproduction of pathogenic flora.

Other pathogens enter the woman's body from the outside:

If the rules of personal hygiene are not followed.
In case of accidental sexual intercourse.
When visiting potentially dangerous places.
When carrying out cosmetic or medical procedures.

Intrauterine infection during pregnancy, depending on the pathogen, can manifest itself in the following diseases:

HIV infection.
Syphilis.
Staphylococcus aureus.
Herpes.
Rubella.
Gonorrhea.
Candidiasis.
Hepatitis.
Toxoplasmosis.
ARVI.
Chlamydia and other diseases.

Almost any of the infections, once in the mother's body, affects the fetus. This article discusses the most common diseases

HIV infection

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

The consequences of carrying a child by an HIV-positive mother are most likely to be expected:

Risks of spontaneous miscarriage.
Stillbirths.
Hypotrophy.
Lesions of the central nervous system.
Chronic diarrhea.
Oral thrush.
Delays in development.

To prevent intrauterine infection, HIV-positive women are given antiretroviral therapy, which uses didanosine and phosphazide, which replace commonly used zidovudine and nevirapine. These drugs are used to prevent infection of the fetus during the gestation stage.

Syphilis

In the presence of the causative agent of syphilis in the woman's body before pregnancy, the infection of the fetus occurs transplacentally. If the mother is not treated during pregnancy, the disease manifests itself immediately after birth or in the coming weeks.

A newborn may experience the following symptoms:

Skin rashes;
Saddle nose;
An enlarged liver;
Inflamed spleen
Eye lesions (cataract iridocyclitis);
Meningitis;
Damage to the skeletal system.

Laboratory confirmation of the diagnosis is a blood test for RW (Wasserman reaction). In the absence of drug treatment during the period of bearing a child, the mortality rate of newborn children reaches 30%. As a treatment, antibiotics of the penicillin group are used.

Staphylococcus

Refers to conditionally pathogenic flora. Modern science has classified more than 70 types of staphylococci, of which 4 are the main danger during pregnancy.

Golden - causes purulent formations.
Epidermal - causes sepsis, conjunctivitis, endocarditis, purulent urinary tract infections.
Saprophytic - is the cause of urethritis, acute cystitis, inflammation of the bladder, kidneys.
Hemolytic - causes tonsillitis or tonsillitis. Provokes inflammation in the respiratory tract.

To diagnose the presence of staphylococcus, smears are taken from the mucous membranes and a bacterial culture is made.

The presence of staphylococci in a woman's body can manifest itself as pneumonia, various inflammatory processes, tonsillitis, tonsillitis. Lack of treatment can bring any of these processes to sepsis - that is, general blood poisoning, and this is already fraught with death for both the mother and the fetus.

Infection with Staphylococcus aureus often leads to fetal infection, as staphylococcus aureus crosses the placental barrier.

For the treatment of staphylococcal infection, antibiotics, bacteriophages and immunomodulatory agents are used. From external agents, rinsing with alcoholic antiseptic solutions and quartzing are prescribed. To avoid infection of the fetus, mothers are prescribed toxoid.

Herpes

Herpes comes in four forms:

Generalized (common).
Neurological.
Herpes of mucous membranes and skin.
Multiple (leads to sepsis).

Complications of herpes can lead to deafness, blindness, developmental delay, or disabilities

Herpes simplex is manifested by a rash on the skin, stomatitis, conjunctivitis, jaundice, neurological abnormalities may begin. Virological studies are performed to confirm the diagnosis.

For treatment, interferon, immunoglobulin, detoxification agents are used. Blood transfusion gives a good effect. The mortality rate reaches 50%, but even after rehabilitation it is not always possible to avoid changes in the central nervous system.

Rubella

Rubella, transferred by the mother before pregnancy, does not have a negative effect on the fetus. Whereas infection with rubella in the first one and a half to two months of pregnancy gives 80% of the possibility of infection of the child. Subsequently, the likelihood of infection decreases. Rubella disease provokes prematurity, jaundice and skin rashes.

Developmental abnormalities provoked by the transferred rubella:

Damage to the eye muscles.
Congenital heart defects.
Retinopathy or complete deafness.
Anomaly in the structure of the sky.
Hepatitis.
Deviations in the development of the skeleton.
Physical or mental retardation.

Treatment consists in bed rest, gargling with an antiseptic solution. In the early stages of pregnancy, it may be recommended to terminate the pregnancy, as well as later, if there is evidence of fetal damage.

Gonorrhea

The causative agent of gonorrhea increases the likelihood of spontaneous abortion, or intrauterine fetal death. Possible consequences of fetal infection:

Visual impairment to complete blindness.
Meningitis.
General sepsis.

Diagnostics is carried out by laboratory methods by taking a smear from the vagina, treatment of intrauterine infection with antibiotics of the penicillin group.

Candidiasis (thrush)

Fungi of the genus Candida can be in a woman's body for years without manifesting themselves in any way. Only changes in hormonal levels, weakening of immunity can allow them to be active. Thrush infection can manifest itself:

Spontaneous abortion.
Premature birth.
Accession of a secondary infection.
Early discharge of amniotic fluid.
Inflammation of the placenta (chorionamnionitis).
Endometritis in the postpartum period.
Introducing infection into the birth canal.
Tears of the tissues of the birth canal.

At the site of the ruptures, scars are formed from the connective tissue, which does not have the property of elasticity. Under the influence of the passing fetus, the tissues are torn.

Intrauterine infection is fraught with the following consequences:

Hypoxia.
Stomatitis.
Low weight.

As a treatment for mothers, candles are used, for children, antifungal drugs in the form of capsules and powders.

Hepatitis

Hepatitis is an inflammation of the liver. They come in several varieties and are very dangerous for the health of the mother and child. The most common consequences of intrauterine infection of the fetus are: fetal death due to intoxication of the mother's body and infection of the newborn during childbirth or in utero.

If a healthy child is born to a mother who is a carrier of the hepatitis virus, the child on the first day of life must receive a set of vaccinations against hepatitis, and the first of them is given no later than 12 hours after birth. Viral hepatitis, like other infectious diseases, is diagnosed by laboratory.

Toxoplasmosis

Infection with toxoplasmosis occurs through contact with animals that are carriers of the disease (mainly cats), eating raw vegetables and fruits, or meat and fish that have not undergone appropriate heat treatment. Infection long before the onset of pregnancy does not adversely affect the course of gestation and the fetus. In case of infection with toxoplasmosis during the initial stage of pregnancy, the risk of miscarriage reaches 15%. In later stages, the risk decreases, but the possibility of transplacental infection increases.

This intrauterine infection has the following consequences in a newborn:

Heart defects.
Low weight.
Developmental delays.
Weakening of immunity.
Deviations in the development of the central nervous system.
Meningitis.
Encephalitis.
Jaundice.
Strabismus.
Blindness.

Death is possible. Toxoplasmosis is treated with bacteriostatic drugs. If toxoplasmosis is detected in a pregnant woman for up to 22 weeks, it is recommended to terminate the pregnancy.

ARVI

SARS seems like a harmless common cold, but it also negatively affects a woman's ability to bear a child, like other infections. SARS in the early stages can cause spontaneous abortion, cause intrauterine fetal death. Later (after 12 weeks) infection causes disorders of the central nervous system, hypoxia, and weakens the placental barrier.

Doctors note that ARVI is especially dangerous at the initial stage of pregnancy. It is at the beginning of pregnancy that the main organs, tissues and systems of the child's body are formed. The influenza virus provokes the appearance of some pathologies in the development of the internal organs of the fetus. Therefore, if the infection occurred in the first trimester of pregnancy, the doctor must send the patient for an additional ultrasound examination in order to avoid the consequences of intrauterine infections. To avoid getting the flu during the season, it is best to avoid visiting crowded places and, if possible, avoid contact with sick people.

Chlamydia

Chlamydia refers to the so-called STDs - previously they were called venereal. Such infections are transmitted during intercourse, so careful choice of mate can help avoid infection. In the first stage of pregnancy, chlamydia can cause:

Spontaneous termination of pregnancy.
Oxygen starvation of the fetus.
Intrauterine growth arrest.

Fetal infection can occur during gestation or during childbirth. Diagnostics is performed in the laboratory, by examining a smear from the vagina. Possible pathologies:

Conjunctivitis.
Rhinitis.
Colpitis.
Pneumonia.
Liver damage.
Kidney.
Stomach.
Lungs.

Treatment is carried out by prescribing a course of antibiotics.

Cytomegaly

Depending on the period of infection, there may be the following consequences of the infection entering the body in the first trimester:

Spontaneous miscarriage.
Pathology of the development of the internal organs of the fetus.

In the second trimester:

Delayed development
Pathology of internal organs.

In the third trimester:

Diseases of the central nervous system develop.
Affects the cardiovascular system.
Liver.
Vision.
Respiratory system.

The consequences of infection resulting from labor can lead to immunodeficiency, purulent formations on the baby's skin, an inflammatory process in the lungs or liver. There are also possible manifestations of jaundice, hemorrhoids, pneumonia and other diseases both immediately after childbirth and after some time.

Hearing and vision can be affected. For treatment, drugs are used:

Isoprinosine.
Various preparations containing interferon.
Antivirus Acyclovir and Panavir.

As a prevention of infection, vaccines are now being developed to form active immunity. Passive immunity can be obtained by taking immunoglobulin.

Methods for diagnosing intrauterine infections

What are the symptoms of intrauterine infection in the fetus during pregnancy and in the newborn? Determining an intrauterine infection in a fetus during pregnancy can be quite difficult. Very often, the clinical picture of the child's condition is blurred by the visible well-being of the mother's health. That is why planning of pregnancy and childbirth should be approached with the utmost responsibility. Before pregnancy, you should visit the antenatal clinic, undergo an examination and exclude all possible infections. If the test results are positive for any virus, treatment should be done.

During the entire period of gestation, patients are repeatedly tested for intrauterine infections. They include blood tests for the TORCH complex of infections, syphilis, HIV. To be sure that there is no intrauterine infection, you should trust the complex of ultrasound and analysis of intrauterine infections (amniocentesis, chorionic biopsy, cordocentesis). After the birth of the child, it will be possible to conduct tests and examine the afterbirth, take a blood test from the newborn, examine the abdominal organs using ultrasound.

These are the main causes of intrauterine infections. Of course, there are many more infections themselves and the number of those affected by them is simply enormous. Nearly 10 percent of newborns are born with the infection or acquire it during childbirth. And nearly 10 percent of those infected get sick within the first four weeks of life. The causes of intrauterine infection of the fetus are known and the consequences are predictable. An infection untreated during the neonatal period, if it does not provoke death during the neonatal period, will become chronic. Long-term presence in the body of the causative agent of the disease becomes the cause of chronic diseases of the liver, kidneys, rheumatism, diabetes mellitus, lesions of the nervous system and others.

Common clinical symptoms of intrauterine infections

When talking about the symptoms of intrauterine infections, they recall prematurity, intrauterine growth retardation, immaturity, congenital malformations and other severe pathologies. In this case, it is worth mentioning about minimal tissue malformations, hypoxia, respiratory distress syndrome, hyaline membrane disease, edema syndrome. You can talk about other lighter consequences: regurgitation, refusal to eat, pathological weight loss, skin lesions (rash, erosion, pyoderma), high temperature in the first days of life.

On any forum devoted to intrauterine infections, you can read messages about severe and persistent hyperbilirubinemia, neurological symptoms, infectious lesions of various organs and systems (conjunctivitis, otitis media, pneumonia, myocarditis, endocarditis, enterocolitis, meningoencephalitis, generalized infection).

Prevention of intrauterine infections

As a prophylaxis of intrauterine infections, only one remedy can be advised: In order not to infect her unborn child, the mother should not get sick herself. Those diseases that used to be called sexually transmitted diseases (and now they are STDs) - in order to avoid becoming infected with them, a woman should responsibly choose a partner for sex or insist on using a condom.

To avoid hepatitis A, you should wash your hands more often, avoid drinking raw water, and wash fruits and vegetables thoroughly before eating. Adequate vaccination will help to avoid congenital rubella, and the same is true for hepatitis B.

Before deciding on the birth of a child, it is imperative to be examined and tested for the presence of syphilis, toxoplasmosis, hepatitis B, HIV infection, mycoplasmosis, chlamydia. It is necessary to check before conception for the presence of streptococci in the birth canal and if pathogens of certain infections are found, the mother must undergo treatment before pregnancy.

Risk factors for intrauterine infection

An intrauterine infection can develop in any pregnancy, but there are indications that significantly increase the risk. Some of them are listed below.

Chronic illness in the mother - infection of the genitourinary system
Miscarriages, stillbirths, children born with pathologies noted in the medical history
The course of this pregnancy - the presence of threats of termination, previous infections, polyhydramnios
The course of labor - pathology of the placenta, weak labor, the smell of amniotic fluid, fever

In custody

So, you can reduce the risk of developing an intrauterine infection if you follow some recommendations:

Pregnancy should be planned after being examined by doctors and passing all the necessary tests.
During gestation, a woman must follow the rules of hygiene and be attentive to her body.
If tests show the presence of pathogenic microflora, treatment should be performed.

The implementation of these simple rules will help a woman safely bear her child and enjoy the happiness of motherhood for many years.

What is intrauterine infection?

The diagnosis of intrauterine fetal infection (IUI) is now widespread. Many mothers have to deal with this diagnosis during pregnancy, or in the first days of a baby's life. Even more often, according to ultrasound, laboratory tests and the nature of amniotic fluid and the time of their discharge, a diagnosis is made "The risk of intrauterine infection in a child."

"Intrauterine infection" means the process of spreading infectious agents in the fetus and the resulting changes in various organs and systems, characteristic of an infectious disease that occurs during pregnancy or childbirth and is detected during pregnancy or after birth.

The outcome of intrauterine infection can be early miscarriages, stillbirths, multiple fetal malformations, intrauterine growth retardation, premature birth and low birth weight, infectious lesions of the placenta (membranitis, deciduitis, placentitis), premature aging of the placenta and premature detachment, as well as various infectious complications of the child: intrauterine pneumonia, meningitis, sepsis.

The severity of the infectious process is not always directly related to the mother and child. A mild, little or asymptomatic infection of the mother, caused by various infectious agents, may be accompanied by severe damage to the organs and systems of the fetus or its death. At the same time, an acute and sufficiently pronounced infection in the mother is not necessarily fatal to the fetus.

Dangers and causes of intrauterine infections

Is this diagnosis a real threat to the child's health and where do the infectious agents come from?

The first part of the question cannot be answered unequivocally, here a lot depends on the mother's immunity, the type of infectious agent and the baby's condition. Premature babies are most at risk of intrauterine infections. But even full-term babies can develop complications such as pneumonia, if the child swallowed infected amniotic fluid during childbirth, there was fetal hypoxia (, green waters,), or the waters left early and there was a long anhydrous period (over 12 hours), during which infectious agents through the birth canal reach the uterine cavity.

"The causative agents of intrauterine infection can be any types of infectious agents, these are viruses, bacteria, mycoplasmas, yeast fungi, any microorganisms that somehow entered the mother's body and then descending (from the abdominal cavity) or ascending (vagina and cervical canal) by penetrating into the uterine cavity.

TORCH syndrome

The term is used to refer to the most common infections "TORCH syndrome", where:

"T" - Toxoplasmosis - toxoplasmosis;
"O" - other - other infections (syphilis, chlamydia, viral hepatitis, listeriosis, chickenpox, HIV, infections caused by parvovirus B19, enteroviruses, etc.);
"R" - Rubella - rubella;
"C" - Cytomegalia - cytomegaly;
"H" - Herpes simplex virus - herpes.

During pregnancy planning, the expectant mother needs to be tested for the presence of these infections in the body, if this analysis was not done in advance, then it is important to perform it before the 12th week of pregnancy in order to take timely measures for the treatment and prevention of intrauterine infection in the fetus.

Herpes, cytamegalovirus

Often a woman is a carrier herpes virus or cytomegalovirus. Should I pay attention to this? Viruses easily penetrate the fetoplacental barrier and therefore can have a negative effect on the fetus. At the same time, fetal cells are damaged, especially those that are in a state of division, which can lead to congenital malformations and serious illnesses in the newborn. It is important to check the titer of antibodies to these viruses, namely the level of IgM (immunoglobulins of class M) is a marker of an acute viral infection that must be treated immediately.

"An increase in the level of IgG (class G immunoglobulin) indicates that the mother had contact with this infection, and an immune response was formed to her (the presence of immunity).

Influenza, ARVI

In addition to these viruses, women are often exposed to influenza viruses, acute respiratory viral infection... The main danger of these pathogens is in the first trimester of pregnancy, when the embryo is developing rapidly. Mom can tolerate a slight cold on her legs, but at the same time, severe intrauterine malformations (most often of the brain, heart, kidneys) form in the embryo. This should not be forgotten when planning, for example, planning the beginning of pregnancy in the summer, when there are no massive flu epidemics.

Chronic sexually transmitted infections(chlamydia, ureaplasma, mycoplasma, trichomonas) can also cause significant harm to the health of the baby. An infection that rises along the genital tract first affects the fetal membranes, which can cause negative changes in the placenta (premature detachment in the early stages, rapid aging of the placenta and the associated malnutrition of the fetus) and only then reach the amniotic fluid, which, as you know, are swallowed by the fetus.

"When aspiration (inhalation) of infected amniotic fluid, the fetus may develop intrauterine pneumonia. If the ingestion of infected fluid occurs during childbirth, pneumonia of the newborn develops.

Descending infection

Intrauterine a descending infection is much less common. As a rule, its source is chronic inflammatory processes in the small pelvis and abdominal cavity. Chronic inflammation in the uterine cavity and appendages not only prevents the onset of pregnancy, but can be a source of infection for the fetus in the future.

“At the same time, the placenta and fetal membranes are a fairly reliable barrier against the penetration of infectious agents into the uterine cavity.

Therefore, a "bad" vaginal smear or cold is not a reason for panic, but requires timely treatment under the supervision of a doctor. During pregnancy, it is possible to prescribe antibacterial drugs in order to eliminate infectious agents (in the II and III trimesters). This reduces the risk of intrauterine infection and infection of the baby during labor.

Developing in the mother's belly, the child is relatively safe. In relative terms, since even in such sterile conditions there is a risk of developing an infectious disease. This large group of diseases is called intrauterine infections. During pregnancy, a woman should especially carefully monitor her health. A sick mother can infect her child during intrauterine development or during childbirth. We will discuss the signs and methods of diagnosing such diseases in the article.

The danger of intrauterine infections is that they unceremoniously interfere in the formation of a new life, which is why babies are born weak and sick - with mental and physical defects. Such infections can cause the greatest harm to the fetus in the first 3 months of its existence.

Intrauterine infection during pregnancy: what the statistics say

A timely diagnosed and treated infectious disease in a pregnant woman poses minimal danger to her child.
The causative agents of infection pass from mother to baby in 10 cases of pregnancy out of 100.
0.5% of babies infected in utero are born with the corresponding signs of the disease.
An infection that has settled in the mother's body does not necessarily pass to the fetus, and the baby has a chance to be born healthy.
A number of infectious diseases that do not promise anything good to the baby can be present in the mother in a latent form and practically do not affect her well-being in any way.
If a pregnant woman gets sick with this or that infectious disease for the first time, it is highly likely that the child will also be infected from her.

Intrauterine infection - ways of infection of the embryo

There are four ways in which infectious agents can enter tiny growing organisms:

hematogenous (transplacental) - from the mother, harmful microorganisms penetrate to the fetus through the placenta. This route of infection is typical for viruses and toxoplasma;
ascending - infection occurs when the causative agent of infection through the genital tract rises to the uterus and, having penetrated into its cavity, affects the embryo. So the baby may develop chlamydial infection and enterococci;
descending - the focus of infection is the fallopian tubes (with adnexitis or oophoritis). From there, the causative agents of the disease penetrate into the uterine cavity, where they infect the child;
contact - the baby is infected during childbirth, when he moves along the birth canal of a sick mother. Pathogens enter the baby's body after he has swallowed infected amniotic fluid.

Intrauterine infection at different stages of pregnancy: consequences for the child

The outcome of an infectious infection of the fetus depends on at what stage of intrauterine development it was attacked by dangerous microorganisms:

gestation period 3 - 12 weeks: spontaneous termination of pregnancy or the appearance of various developmental anomalies in the fetus;
gestation period 11 - 28 weeks: the fetus is noticeably behind in intrauterine development, the child is born with insufficient body weight and various malformations (for example, congenital heart disease);
gestational age after 30 weeks: developmental anomalies affect the organs of the fetus, which by this time have already formed. The greatest danger of infection is for the central nervous system, heart, liver, lungs and organs of vision.

In addition, congenital infection is acute and chronic. The following consequences indicate an acute infection of a child at birth:

shock state;
pneumonia;
sepsis (blood poisoning).

Some time after childbirth, an acute intrauterine infection in newborns can manifest itself with the following signs:

exceeding the norm of daily sleep duration;
poor appetite;
insufficient physical activity, which decreases every day.

If the congenital infection is chronic, the clinical picture may be absent altogether. Distant signs of intrauterine infection are considered:

complete or partial deafness;
deviations in mental health;
pathology of vision;
lagging behind peers in motor development.

The penetration of infection to the fetus through the uterus leads to the following consequences:

the birth of a dead baby;
intrauterine embryo death;
frozen pregnancy;
spontaneous abortion.

In children who survived such infection, the following pathological consequences are recorded:

heat;
rash and erosive skin lesions;
non-immune dropsy of the fetus;
anemia;
an enlarged liver with jaundice;
pneumonia;
pathology of the heart muscle;
pathology of the eye lens;
microcephalus and hydrocephalus.

Intrauterine infection: who is at risk

Every expectant mother is at risk of being captured by the pathogen, because during pregnancy the defenses of her body are depleted to the limit. But the biggest danger lies in wait for women who:

already have one or more children attending kindergarten, school;
are related to the field of medicine and are in direct contact with people who may be potential carriers of infection;
work in a kindergarten, school and other children's institutions;
have had 2 or more medical abortions in the past;
have inflammatory diseases in a sluggish form;
faced with untimely discharge of amniotic fluid;
have had a pregnancy with abnormal development of the embryo or intrauterine fetal death in the past;
have already given birth in the past to a baby with signs of infection.

Symptoms of intrauterine infection in a woman during pregnancy

Doctors identify several universal signs by which it can be assumed that the expectant mother has contracted an infectious disease:

a sharp rise in temperature, fever;
shortness of breath when walking or climbing stairs;
cough;
rash on the body;
enlarged lymph nodes that are painful to touch;
tenderness in joints that look swollen;
conjunctivitis, lacrimation;
nasal congestion;
painful sensations in the chest.

Such a set of indications may also indicate the development of allergies in a pregnant woman. In this case, there is no threat of infectious infection of the fetus. Be that as it may, the expectant mother should go to the hospital as soon as at least one of these symptoms appears.

The reasons for the development of intrauterine infection during pregnancy

The activity of ubiquitous pathogens is the main cause of morbidity among women who are preparing to become mothers. Many bacteria and viruses, entering the mother's body, are transmitted to the child, provoking the development of serious anomalies. Viruses that are responsible for the development of acute respiratory viral diseases do not pose a danger to the fetus. The threat to the condition of the child appears if only the pregnant woman has a high body temperature.

One way or another, but intrauterine infection of a baby comes exclusively from a sick mother. There are several main factors that can contribute to the development of infectious pathology in the fetus:

Acute and chronic diseases of the mother in the genitourinary system. Among them are such inflammatory pathologies as ectopia of the cervix, urethritis, cystitis, pyelonephritis.
The mother has an immunodeficiency state or HIV infection.
An organ and tissue transplant that a woman has undergone in the past.

Intrauterine infections: main characteristics and routes of infection

Cytomegalovirus (CMV)

The causative agent of the disease is a representative of the herpes viruses. You can get an ailment through sexual and close household contact, through blood (for example, through a transfusion from an infected donor).

With the initial infection of a woman in position, the microorganism enters the placenta and infects the fetus. In some cases, no abnormal consequences are observed in the baby after infection. But at the same time, statistics say: 10 out of 100 babies whose mothers encountered an infection during pregnancy have pronounced signs of intrauterine infection.

The consequences of such an intrauterine infection during pregnancy are as follows:

spontaneous abortion;
the birth of a dead baby;
hearing loss of neurosensory origin;
being underweight at birth;
hydro- and microcephaly;
pneumonia;
lag in the development of psychomotor skills;
pathological enlargement of the liver and spleen;
blindness of varying severity.

Cytomegalovirus under a microscope

If the infectious lesion has a general combined character, more than half of the babies die within 2 to 3 months after birth. In addition, the development of such consequences as mental retardation, hearing loss and blindness is likely. With a slight local lesion, the consequences are not so fatal.

Unfortunately, there are still no medications that could help eliminate the symptoms of CMV in newborns. If a woman in a position has been diagnosed with cytomegalovirus infection, the pregnancy is left as the child has a chance to stay healthy. The expectant mother will be prescribed an appropriate course of treatment in order to mitigate the effect of the disease on her body as much as possible.

Intrauterine infection - herpes simplex virus (HSV)

A newborn baby is diagnosed with a congenital herpes infection if his mother is diagnosed with herpes simplex virus type 2, which in most cases is infected during unprotected sexual intercourse. Symptoms of the disease will appear in a child almost immediately, during the first month of life. Infection of a baby occurs mainly during childbirth, when it moves along the birth canal of an infected mother. In some cases, the virus enters the fetus through the placenta.

If the child's body is affected by herpes infection, the consequences are severe:

pneumonia;
violation of visual function;
brain damage;
skin rash;
heat;
poor blood clotting;
jaundice;
apathy, lack of appetite;
stillbirth.

Severe infections result in oligophrenia, cerebral palsy and a vegetative state.

Herpes simplex virus under a microscope

Intrauterine infection - rubella

This disease is rightfully considered one of the most dangerous for the life of the embryo. The route of transmission of the rubella virus is airborne, and infection is possible even at a great distance. The disease, which poses a particularly great threat before the 16th week of pregnancy, "programs" various deformities in the development of the baby:

underweight at birth;
spontaneous abortion, intrauterine death;
microcephaly;
congenital anomalies in the development of the heart muscle;
hearing loss;
cataract;
various skin diseases;
pneumonia;
unnatural enlargement of the liver and spleen;
meningitis, encephalitis.

Intrauterine infection - parvovirus B19

The presence of this virus in the body provokes the development of a disease known as infectious erythema. In adults, the disease does not manifest itself in any way, since it proceeds latently. However, the consequences of the pathology for the fetus are more than serious: the child can die before birth, and there is also a threat of spontaneous abortion and intrauterine infection. On average, infected children die in 10 cases out of 100. At 13 - 28 weeks of gestation, the fetus is especially vulnerable to this infection.

When infected with parvovirus B19, the following consequences are noted:

swelling;
anemia;
brain damage;
hepatitis;
inflammation of the myocardium;
peritonitis.

Intrauterine infection - chickenpox

When the expectant mother is infected with chickenpox, the infection also affects the child in 25 cases out of 100, but the symptoms of the disease are not always there.

Congenital chickenpox is identified by the following features:

brain damage;
pneumonia;
skin rash;
delayed development of eyes and limbs;
optic nerve atrophy.

Newborn babies infected in the womb are not treated for chickenpox, since the clinical picture of the disease does not progress. If a pregnant woman "caught" the infection 5 days before delivery and later, the child will be given an injection of immunoglobulin after birth, since there are no maternal antibodies in his body.

Intrauterine infection - hepatitis B

You can get a dangerous virus during intercourse with an infected person in the absence of barrier methods of contraception. The causative agent of the disease enters the baby through the placenta. The most dangerous period in terms of infection is from 4 to 9 months of pregnancy. The consequences of infection for a child are as follows:

hepatitis B, which, with the appropriate approach, is treatable;
oncological diseases of the liver;
a sluggish form of hepatitis B;
an acute form of hepatitis B, which provokes the development of liver failure in a child and he dies;
delay in the development of psychomotor functions;
hypoxia;
miscarriage.

Intrauterine Infection - Human Immunodeficiency Virus (HIV)

HIV infection is a scourge for special immune lymphocytes. In most cases, infection occurs during intercourse with a sick partner. A child can become infected while in the womb, or during childbirth. Intensive complex treatment is shown to HIV-infected children, otherwise they will not live even two years - the infection quickly "eats up" the weak body. Infected babies die from infections that are not fatal to healthy babies.

To confirm HIV in an infant, a polymerase chain reaction diagnostic method is used. It is also very important to timely detect an infection in the body of a pregnant woman. If the baby is lucky enough to be born healthy, the mother will not breastfeed him so that the infection is not transmitted to him through milk.

Intrauterine infection - listeriosis

The disease develops as a result of the vital activity of the bacterium listeria. The microorganism easily penetrates the fetus through the placenta. Infection of a pregnant woman occurs through unwashed vegetables and a number of food products (milk, eggs, meat). In a woman, the disease may be asymptomatic, although in some cases, fever, vomiting and diarrhea are noted. An infected baby has the following signs of listeriosis:

rash and multiple accumulations of pustules on the skin;
inflammation of the brain;
refusal to eat;
sepsis;
spontaneous miscarriage;
the birth of a dead baby.

If signs of listeriosis become apparent in the first week after birth, babies die in 60 cases out of 100. After confirmation of listeriosis in a pregnant woman, she is prescribed a two-week course of treatment with Ampicillin.

Intrauterine infection - syphilis

If a woman in a position is sick with syphilis, which she has not treated, the chance of infection in her child is almost 100%. Of the 10 infected babies, only 4 survive, and the survivors are diagnosed with congenital syphilis. The child will become infected even if the mother's disease is latent. The results of the activity of the infection in the child's body are as follows:

tooth decay, damage to the organs of vision and hearing;
damage to the upper and lower extremities;
the formation of cracks and rashes on the skin;
anemia;
jaundice;
mental retardation;
premature birth;
stillbirth.

Intrauterine infection - toxoplasmosis

The main carriers of toxoplasmosis are cats and dogs. The causative agent of the disease enters the body of the expectant mother when she takes care of her pet or, out of habit, tastes meat with an insufficient degree of heat treatment during the preparation of dinner. Infection during pregnancy poses a great danger to the intrauterine development of the baby - in 50 cases out of 100, the infection overcomes the placental barrier and affects the fetus. The consequences of infection in a child are as follows:

damage to the organs of vision;
hydrocephalus;
microcephaly;
an abnormally enlarged liver and spleen;
inflammation of the brain;
spontaneous abortion;
delay in the development of psychomotor functions.

Cytomegalovirus, rubella, toxoplasmosis, herpes, tuberculosis, syphilis and some other diseases are combined into the group of so-called TORCH infections. When planning a pregnancy, expectant parents take tests that help identify these pathological conditions.

Tests for intrauterine infections during pregnancy

Within 9 months, the expectant mother will have to undergo more than one laboratory test so that the doctors are convinced that she is healthy. Women in position take a blood test for hepatitis B and C, syphilis. In relation to pregnant women, the OCP method is also practiced, thanks to which it is possible to identify active viruses in the blood, if any. In addition, expectant mothers regularly visit the laboratory to take a smear from the vagina for microflora.

Ultrasound is of great importance for the successful management of pregnancy. This method is absolutely safe for the fetus. And although this procedure is not directly related to the diagnosis of infectious diseases, with its help doctors can detect abnormalities of intrauterine development caused by pathogenic microorganisms. There is every reason to talk about an intrauterine infection if the following symptoms became apparent on an ultrasound scan:

Formed developmental pathologies.
Polyhydramnios or low water.
Swelling of the placenta.
Enlarged abdomen and abnormally enlarged structural units of the kidneys.
Enlarged internal organs: heart, liver, spleen.
Foci of calcium deposits in the intestines, liver and brain.
Enlarged ventricles of the brain.

In the diagnostic program of examination of expectant mothers belonging to the risk groups, which we spoke about above, a special place is occupied by the seroimmunological method for the determination of immunoglobulins. As necessary, physicians resort to amniocentnesis and cordocentesis. The first method of research is to study the amniotic fluid, the second involves the study of umbilical cord blood. These diagnostic methods are highly informative in detecting infection. If the presence of an intrauterine infection is suspected in an infant, then the biological fluids of the baby - for example, saliva or blood - serve as the material for the study.

Danger of TORCH infections during pregnancy. Video

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 non-lysed 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 in 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, it is possible for the pathogen to 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 pass without a trace.

The concept of "intrauterine infection" is conditional, it supplements the clinical diagnosis with the presupposing the birth of a child in the future 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 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 to minimize the likelihood of having a child with an acute infectious process and to 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 decreased 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 unreasonable.

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 the 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 observed 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 pregnancy 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 due to 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 fetal blood 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 only 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 the signs of the infectious state of the fetus itself are difficult to interpret.

In this regard, the conclusion of the 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-chambered 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 undirected 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 vasodilatation, 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 level of screening.

The consequence of the inflammatory state of the placenta is always the accumulation and deposition of fibrin in the lacunae and MEP, which determines the 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 the adsorption function of the amniotic membranes are disturbed.

When 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 of concern to expectant mothers.

Causes

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 believed to be the immediate 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, the following are worth noting:

Bacteria: staphylo-, strepto- and enterococci, Escherichia coli, Klebsiella, Proteus.
Viruses: herpes, rubella, hepatitis B, HIV.
Intracellular agents: chlamydia, mycoplasma, ureaplasma.
Fungi: candida.
The simplest: Toxoplasma.

Separately, a group of infections was identified, which, 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 under the abbreviation TORCH: Toxoplasma, rubella, cytomegalovirus, herpes, and others. It must 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 penetrate the child in several ways: through the blood (hematogenous or transplacental), amniotic fluid (amnial), the mother's genital tract (ascending), from the wall of the uterus (transmurally), 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 (amniocentesis or cordocentesis, chorionic biopsy, cesarean section).
Abortions and complications in the postpartum period (postponed earlier).
Insufficiency of the cervix.
Polyhydramnios.
Placental insufficiency.
Common infectious diseases.
Focuses 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 case of metabolic and hormonal processes in the female body: hypovitaminosis, anemia, heavy physical exertion, psychoemotional stress, endocrine disorders, exacerbation of chronic diseases. Those who have identified such factors are at high risk of intrauterine infection of the fetus. He is also shown regular monitoring of the condition and preventive measures aimed at minimizing the likelihood of the development of pathology and its consequences.

Intrauterine infection develops when infected with microbes, which is facilitated by many factors on the part of the mother's body.

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 (the maturity of the immune system), 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, latent infection caused by chlamydial, viral or fungal agents leads to intrauterine death or the birth of a child with serious disabilities. This is due to the biological tropism of microbes, i.e., the tendency to multiply 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. Of no small importance are fetal intoxication with products of microbial metabolism, metabolic disorders and hemocirculation with hypoxia. As a result, fetal development suffers and the differentiation of internal organs is impaired.

Symptoms

Clinical manifestations and the severity of the infection are determined by many factors: the type and characteristics of the pathogen, the mechanism of its transmission, the strength 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, this can be represented as follows (table):

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

Weakening of reflexes.
Muscle hypotension.
Refusal to feed.
Frequent regurgitation.
Pale skin with periods of cyanosis.
Change in the rhythm and frequency of breathing.
Muffled heart tones.

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:

Vesiculopustulosis: a rash on the skin in the form of blisters and pustules.
Conjunctivitis, otitis media and rhinitis.
Pneumonia: shortness of breath, cyanosis of the skin, wheezing in the lungs.
Enterocolitis: diarrhea, bloating, sluggish sucking, regurgitation.
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 scarce, since there are only symptoms of general intoxication, including those already listed above. In addition, the baby is underweight, the umbilical wound does not heal well, jaundice appears, the liver and spleen increase (hepatosplenomegaly).

In children infected during the prenatal period, violations of many vital systems are detected, 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 babies infected with cytomegalovirus do not have any 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 can 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 period of time, 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 through the affected genital tract during childbirth. 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, abnormalities of the digestive system, intrauterine growth retardation, and spontaneous abortions. In the second and third trimesters, pathology leads to the appearance of the following deviations:

Anemia.
Jaundice.
Hypotrophy.
Meningoencephalitis.
Hepatosplenomegaly.

And herpes infection in newborns is diagnosed by vesicular (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 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. For children born with an infection, rather specific anomalies are characteristic:

Cataract.
Deafness.
Heart defects.

But in addition to these signs, there may be other structural abnormalities, for example, microcephaly, cleft palate, skeletal disorders, 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, diabetes mellitus appears.

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

Toxoplasmosis

Infection with toxoplasmosis in early pregnancy can be accompanied by severe consequences for the fetus. An intrauterine infection provokes the death of a child or the occurrence of multiple abnormalities, including hydrocephalus, brain cysts, edema and destruction of internal organs. Congenital disease is often common, manifesting itself with the following symptoms:

Anemia.
Hepatosplenomegaly.
Jaundice.
Lymphadenopathy (swollen lymph nodes).
Fever.
Chorioretinitis.

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

Additional diagnostics

Of great importance is the prenatal diagnosis of an infectious lesion of the fetus. 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:

Biochemical blood test (antibodies or microbial antigens).
Analysis of smears from the genital tract and amniotic fluid (microscopy, bacteriology and virology).
Genetic identification (PCR).
Ultrasound (fetometry, placentography, Doppler ultrasound).
Cardiotocography.

After birth, newborns are examined (skin washings, blood tests) and the placenta (histological examination). Comprehensive diagnostics allows detecting pathology at the preclinical stage and planning further treatment. The nature of the activities carried out will be determined by the type of infection, its spread and clinical picture. An important role is also played by prenatal prevention and the correct management of pregnancy.