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Analysis for the risk of intrauterine infections. Intrauterine infection: consequences for the newborn

Any infectious diseases during pregnancy can cause infection of the fetus. Signs of pathology do not appear immediately, and the consequences can be the most severe. Intrauterine infection (IUI) is difficult to diagnose and difficult to treat. Changes in the fetus are manifested by non-specific symptoms, according to which it is not always possible to suspect an infection.

Etiology and prevalence

The reasons for the development of intrauterine infection of the fetus are associated with infection of the mother during pregnancy or with the activation of a chronic infection. The exact frequency and prevalence has not been established, not all pregnancies with infection end in childbirth, and it is not always possible to determine the causes of early miscarriage. According to various studies, intrauterine infection accompanies up to 10% of all pregnancies.

Etiological factors are various types of microorganisms:

  • rubella, herpes, hepatitis, HIV viruses;
  • bacteria of syphilis, tuberculosis, STIs;
  • protozoa: toxoplasma;
  • fungi of the genus Candida.

A combination of several pathogens is also common.

There is a concept of TORCH-complex. This abbreviation stands for the Latin names of the most common causative agents of fetal diseases. These include:

  • T - toxoplasmosis;
  • O - other pathogens, which include syphilis, hepatitis, mycoplasma, candidiasis and many other infections;
  • R - rubella;
  • C - cytomegalovirus;
  • N - herpes.

Intrauterine infections in newborns in 30% of cases are the cause of death under 1 year, and in 80% of congenital malformations.

Most often, the fetus is affected by viruses, much less often by bacteria and fungi. They can cause disease a second time, after the activation of the viruses.

Consequences depending on the duration of infection

The greatest danger to the unborn child is the primary infection of the mother during pregnancy. Her body must intensively produce protective antibodies, therefore it is not able to protect the fetus. If activation or re-encounter with the pathogen occurs, the consequences are less significant. The mother already has antibodies to the pathogen, so the disease is much easier, and the child is protected by maternal immunity.

The consequences of intrauterine infection for the fetus depend on the period when the infection occurred. In the first 2 weeks of embryo formation, a violation of the laying of the main tissues occurs, therefore, spontaneous occurs. It is more correct to call the outcome of blastopathy a biochemical pregnancy, because. the fetal egg may be at the initial stage of implantation, and the woman will not know about her position. Pregnancy in this case can be registered only by blood tests.

With the penetration of the pathogen in the period of 2-10 weeks of gestation, severe malformations are formed, which are the result of cell damage and impaired organ laying. They are often incompatible with life and end in fetal death, stillbirth or death in the first months of life.

Infection of the fetus in the period of 11-28 weeks of gestation causes fetopathy. The fetal body is already capable of an inflammatory response, only some organs are affected. But the mechanism of inflammation is not complete. After the first phase - alterations, there is no second - exudation, as a result of which there is an influx of leukocytes and the release of substances that are aimed at localizing the infectious agent. The third phase of inflammation is expressed - proliferation, when there is an increased synthesis of connective tissue and delimitation of the pathological focus. Therefore, children infected in this period are born with defects in individual organs, often with fibroelastosis, hydronephrosis, and polycystic disease.

If the infection of the fetus occurs in the late period, 28-40 weeks, then a full-fledged inflammatory reaction occurs, in which several organs are involved. A child is born with encephalitis, nephritis, hepatitis, pneumonia.

Infection can also occur during childbirth. Inflammation of one or two organs develops, most often the lower respiratory tract and liver suffer, pneumonia and hepatitis are diagnosed.

Signs of infection

Clinical signs of an infectious process in the fetus are nonspecific. During pregnancy, some infections can occur in women with minimal symptoms. Signs of intrauterine infection of the fetus include diagnosed fetoplacental insufficiency and (FGR). Inflammatory processes are often accompanied by polyhydramnios, less often oligohydramnios occurs.

Low placentation can also be an indicator of the presence of an infection in the uterus, often these are chronic inflammatory processes like endometritis.

An increase in the size of the liver and spleen of the fetus indicates an intrauterine disease. Pathology can be suspected at the birth of a child with dysembryogenesis stigmas. These are minor developmental anomalies that do not significantly affect the general state of health, but indicate diseases that occurred in utero. These include:

  • anomalies in the structure of the skull, low forehead, large brow ridges;
  • changes in the shape of the eyes, the shape of the jaw and chin, the curvature of the nose;
  • excessively protruding ears, lack of natural curvature, tragus;
  • curvature of the neck, folds of skin on it;
  • changes in the shape of the chest, abdominal hernia;
  • short or long fingers, their fusion, transverse groove on the palm, curvature of the fingers;
  • clitoris enlargement, cryptorchidism, small labia;
  • birthmarks and age spots, hemangiomas.

But for the diagnosis of pathologies that have arisen in utero, it is necessary to detect 5 or more stigmas.

The newborn may have respiratory disorders, diseases of the cardiovascular system. Physiological jaundice is more difficult to tolerate, has a longer course. The skin may become covered with a rash, there are neurological disorders, feverish conditions.

But the exact diagnosis can be established only after the diagnosis.

Risk factors

The mechanism of transmission of intrauterine infection can be of three types:

  • ascending - from the genital tract of the mother;
  • transplacental - from foci of chronic or acute infection in the mother's body;
  • descending - through the fallopian tubes;
  • intranatal - during childbirth.

Given the possible ways of infection of the fetus, a woman in the period of preconception preparation needs to sanitize the foci of the existing infection. It is obligatory to achieve remission in chronic infectious pathologies (tonsillitis, sinusitis, cystitis), sanitation of the oral cavity, treatment of carious teeth.

Risk factors that increase the likelihood of developing IUI have been identified. An acute inflammatory process that occurs during pregnancy, especially for the first time, significantly increases the chances of infection of the fetus. In the first trimester, when the placenta has not yet formed, the bacterial flora is more likely to influence. In subsequent trimesters, when the placenta is already able to retain large cells of pathogens, viral pathology often develops.

Chronic foci can lead to the spread of pathogens by hematogenous, lymphogenous or implantation. The risk of disease increases with a decrease in immunity. A little immunosuppression is a natural process. This occurs under the influence of progesterone, which suppresses local defenses to prevent rejection of the fetal egg, which is partly foreign to the mother's body. But long-term chronic diseases, somatic pathologies, hypothermia and overheating, stressful situations can further suppress the immune system.

Violation of placental permeability, which occurs during the pathological course of pregnancy, increases the possibility of the transfer of an infectious agent to the fetus. The placenta itself is also affected, foci of hemorrhages, calcifications and various inclusions may appear in it, which impair blood flow to the fetus. This leads to its chronic and developmental delay.

Poor social and living conditions are also a risk factor. There are conditions for the violation of hygiene, contact with infectious patients is possible. Women from lower social strata are more likely to be infected with sexually transmitted infections.

Characteristics of the main infections

Each disease has its own signs, pathogenesis, features of the course and intrauterine infection.

Toxoplasmosis

Congenital toxoplasmosis develops when infected after 26 weeks, the likelihood of such an outcome increases with the approach of the time of birth. If infection occurs in the initial stages, spontaneous miscarriage or fetal death occurs.

The classic triad of signs is chorioretinitis, microcephaly, and hydrocephalus. But it doesn't always happen. Given the severe fetal malformations and disability, pregnant women who have had toxoplasmosis are offered interruption for medical reasons up to 22 weeks.

Herpes simplex

Herpes simplex viruses are the most common among adults. The first type mainly manifests itself in the form of rashes on the lips, and the second affects the anogenital region. Viruses can remain latent for a long time, appearing only at the time of weakening of the immune system.

The placenta protects the fetus well from infection, so cases of congenital herpes are rare. Intrauterine herpetic infection is possible with viremia in the mother during primary infection during gestation. If this happens in the early stages, spontaneous abortion is possible. In the later stages, IUI is characterized by lesions of various organs.

Late genital herpes can lead to infection during childbirth. If this is a relapse of the disease in the mother, then the child will be protected by her antibodies. With primary infection, severe damage to the newborn occurs.

For a newborn, herpes threatens with neurological complications. Their severity depends on the time of infection. The earlier, the more extensive the damage to the nervous system and the more severe the manifestations. Signs of damage to the nervous system, encephalitis do not appear immediately, but 2 weeks after birth. If left untreated, death occurs in 17%.

With a primary infection of genital herpes (at a later date), a newborn is severely affected, often leading to death.

Measles

The virus is transmitted by airborne droplets. Pregnancy does not affect the clinical manifestations of pathology. The impact of the measles virus on childbearing is controversial. The risk of teratogenicity is low, but there is evidence of damage to the membranes and the threat of premature birth in women with measles.

A newborn becomes ill only if the mother falls ill 7 days before the birth or within a week after them. The manifestations of the pathology can be different - from a mild course to a lightning-fast one, which ends in death. Infection postnatally leads to mild manifestations of the disease, not dangerous for the child.

Diagnosis is based on a characteristic clinical picture and by detecting antibodies. Treatment is symptomatic.

Measles vaccination during gestation is contraindicated. But this pathology is included in the calendar of preventive vaccinations carried out in childhood.

Numerous types of intrauterine infections are diagnosed during pregnancy only when clinical manifestations of the disease occur. The exception is such dangerous diseases as HIV, syphilis. Also, a woman must be examined for gonorrhea. Smears, which are taken at regular intervals and when there are complaints of discharge, help sanitize the genital tract and prevent infection during childbirth.

Sometimes it happens that the pregnancy seemed to go well, and the birth went well, and the baby immediately screamed after birth, but suddenly on the second or third day of life, the doctor says that the child's condition worsened somewhat. The kid became lethargic, pale, eats badly, spits up, does not gain weight. Sounds like a serious and incomprehensible diagnosis: intrauterine infection. What is intrauterine infection, where does it come from and how to deal with it?

Intrauterine infections are those diseases that occur when the fetus is infected by an infected mother during pregnancy or during childbirth. Predisposing factors for the development of intrauterine infection are various chronic diseases of the mother, especially inflammatory processes of the kidneys and pelvic organs (cystitis, pyelonephritis, vaginitis, inflammation of the uterus, etc.). Occupational hazards, stress, bad habits and improper diet are also of great importance. The causative agents of intrauterine infection can be viruses (herpes, cytomegaly, influenza, rubella), bacteria (streptococci, E. coli, pale treponema, chlamydia), fungi (Candida) and protozoa (toxoplasma). When a pregnant woman encounters an infection for the first time, the chance of the baby being infected increases dramatically.

The period in which infection occurred is crucial and determines the further course of pregnancy. In the 3-12th week of pregnancy, intrauterine infection can lead to abortion or to the formation of fetal malformations. When infected at the 11-28th week of pregnancy, intrauterine growth retardation occurs, the child is born with a low body weight. Infection at a later date affects the already formed internal organs: the central nervous system is the most vulnerable, and the heart, liver, and lungs also often suffer. Intrauterine infection often leads to premature birth, which also affects the condition of the baby.

Also, infection with intrauterine infection can occur during childbirth, for example, by swallowing infected amniotic fluid, the contents of the birth canal and by contact (through the skin and mucous membranes). In this case, the baby will feel good at birth, and signs of infection - lethargy, pallor, decreased appetite, increased regurgitation, respiratory failure, etc. - may appear only after a while, but no later than on the third day of life.

The outcomes of intrauterine infection are different and again depend on the time when the infection occurred and on the specific pathogen. If a child falls ill long before birth, then the entire infectious process occurs in utero, the child can be born healthy, but with low body weight. But long-term consequences are also possible (especially for viral infections): for example, developmental disorders of any organs, tissues; various cysts of the brain, etc. If contact with the infection occurred shortly before childbirth, then the child can be born with the course of the infectious process in the form of pneumonia, enterocolitis, meningitis, etc.

Diagnosis of intrauterine infections difficult due to the lack of specific clinical manifestations. That is, almost all intrauterine infections in a child manifest themselves in the same way: intrauterine growth retardation, enlarged liver and spleen, jaundice, rash, respiratory disorders, cardiovascular failure and neurological disorders. For diagnosis during pregnancy and after the birth of a baby, they use the determination of specific antibodies to a particular pathogen, the search for the pathogen itself in the blood, urine or cerebrospinal fluid of the child and / or mother. Also, many conventional examination methods, such as a complete blood count, urine, biochemical blood test, ultrasound examination of the brain and internal organs, x-rays, help in making a diagnosis.

Treatment of intrauterine infections in newborns, it depends on the pathogen that caused the disease, and the manifestation of the disease. Antibacterial, antiviral, immunostimulating, general strengthening drugs are usually prescribed.

The most efficient is prevention of intrauterine infections. Even before the onset of pregnancy, it is worth being examined for some infections, since many of them can have a latent, sluggish course and appear only during pregnancy. If a woman has not had rubella, then when planning a pregnancy (at least 3 months in advance), it is advisable to be vaccinated against this infection, since rubella infection in the early stages can lead to serious malformations in the child. In addition, it is advisable for the expectant mother to follow certain sanitary and hygienic rules: exclude contact with sick relatives, examine pets (cats for the presence of toxoplasmosis), and also be examined and treated in a timely manner if they are carriers of any infections. It is worth paying attention to nutrition: avoid fast food, eat well-done meat and fish and not get carried away with exotic cuisine - these simple measures are an excellent prevention of toxoplasmosis and listeriosis.

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

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

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

Types of intrauterine infections

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

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

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

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

Description of VUI

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

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

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

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

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

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

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

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

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

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

Consequences and danger of IUI

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

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

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

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

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

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

Symptoms of the disease

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

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

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

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

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

How does an infection occur?

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

Treatment

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

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

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

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

Prevention

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

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

Intrauterine infection is the main cause of morbidity and fetal mortality.

Infection of the child occurs during pregnancy, and its source is the mother. That is why, even at the planning stage, mothers should be attentive to their own health and be examined for latent infections.

Intrauterine infection during pregnancy

Intrauterine infections (IUI) are classified into viral and bacterial. Many viral infections enter the child's body in the perinatal period, but are not accompanied by clinical manifestations, thanks to the mother's immunity and protective placenta.

Types of intrauterine infection:

  • Cytomegalovirus and herpetic;
  • Rubella;
  • Syphilis, chlamydia, gonorrhea;
  • Hepatitis A and B, etc.

The intrauterine infection carries the greatest danger in the first three months of pregnancy and causes spontaneous abortions and fetal death. From the age of 6 months, the baby develops its own immunity, which allows it to specifically respond to the introduction of the infection.

Symptoms indicating infection

Signs of infection of the embryo in the first trimester of pregnancy is placental insufficiency, which leads to fading of pregnancy and miscarriage. When infected in the second trimester, the placental circulation is disturbed, the fetus develops anomalies, mainly from the central nervous system.

During the ultrasound procedure, the following symptoms are noted:

  • Fetal growth retardation;
  • polyhydramnios;
  • Tachycardia in the fetus;
  • Enlargement of the abdomen and liver in the fetus;
  • Thickening of the placenta;

Intrauterine infection can be diagnosed using laboratory tests: blood test for latent infections (TORCH), swabs from the vagina and cervix for bacterial culture.

Main reasons

Infection of the fetus in the perinatal period occurs from mother to child if: the mother becomes ill for the first time (rubella, CMVI, hepatitis), or she is already a carrier of the infection (herpes, chlamydia, gonorrhea).

If there are foci of infection in a woman's body - caries, tonsillitis, pyelonephritis, then there is a risk of bacteria (staphylococci, streptococci) entering the fetus. Therefore, it is important for the expectant mother to visit the dentist, ENT and take urine tests every trimester for early detection of the disease and timely treatment.

Infection of the mother with an infectious disease in the first months of pregnancy almost always leads to its termination, since embryo infection occurs in 90% of cases.

In the later stages, intrauterine infection leads to rupture of the membranes, isthmic-cervical insufficiency (opening of the cervix) and, as a result, to premature birth.

A child is born with numerous diseases: pneumonia, meningitis, encephalitis, otitis, vulvovaginitis. Intrauterine infection is very dangerous for the fetus and causes congenital malformations: impaired hearing, central nervous system, digestive system and liver, splitting of the lip, palate (cleft palate).

Main features

Signs of infection of the fetus with IUI can be diagnosed during the ultrasound procedure: numerous fetal malformations, placental insufficiency, polyhydramnios. A woman, being a carrier of a latent infection, as a rule, does not feel severe symptoms.

With a primary infection during pregnancy, a woman experiences symptoms characteristic of this type of disease.

Visible signs of intrauterine infection are diagnosed during the ultrasound procedure, which are expressed in pathologies of fetal development. A child infected in the womb is born with congenital diseases that often lead to his disability, in severe cases - to death.

Chronic maternal infection during pregnancy diagnosed only by laboratory methods and has no apparent symptoms. Any foci of infection in a woman's body (tonsillitis, sinusitis, caries, pyelonephritis) should be excluded at the planning stage, or be treated and monitored from the second trimester of pregnancy. The disease acquired during pregnancy is subject to treatment in a hospital setting.

Early onset of infection

With intrauterine infection in the first trimester of pregnancy, there are infectious embryopathies, which end in spontaneous miscarriage, non-developing pregnancy.

Primary infection with rubella in the first three months of pregnancy requires its surgical interruption. Viral infections (herpes) in early pregnancy lead to spontaneous abortion or congenital malformations of the fetus.

The danger of IUI in early pregnancy is due to the impossibility of treatment, the absence of a placental barrier between mother and child, and the underdevelopment of the immune system in the embryo.

The danger of ureaplasmosis It consists in its asymptomatic course in a pregnant woman, it can be detected only by laboratory diagnostic methods. However, this disease poses a threat to the fetus. In the early stages, ureaplasmosis leads to pregnancy fading and spontaneous abortion. From the second trimester - provokes rupture of the fetal bladder, isthmic-cervical insufficiency, which lead to miscarriage.

A child infected with ureaplasmosis in the womb is born with reduced immunity, and is at risk of acquiring pneumonia, neonatal meningitis and other diseases.

Treatment of ureaplasmosis is carried out with the help of antibiotic therapy from the 20-week gestation period.

Herpes simplex virus in the acute stage causes infection of the fetus in 80% of cases. If the mother is a carrier of the virus, then the risks of infection of the embryo are reduced to 0.5%. However, with its exacerbation during childbirth, newborns become infected in 40% of cases.

With the primary infection with herpes in the early stages, the question of termination of pregnancy is raised. If infection occurs from the second trimester, the pregnant woman is at risk and is under constant supervision. Antiviral therapy and the introduction of immunoglobulins are prescribed.

Infection with herpes in the third trimester leads to the birth of a child with lesions of the skin, eyes and central nervous system. The manifestation of herpetic infection in newborns in 50% leads to death, and the remaining 50% experience severe complications, expressed in mental and physical retardation.

More than 90% of the Russian population are carriers of CMVI. IN THE USA cytomegalovirus is present in the blood of 99% of the population. CMVI in the chronic stage is asymptomatic, and the risk of infection of the fetus is reduced to zero. An exacerbation can occur in 1-2% of pregnancies, the probability of infection of the fetus is 20%.

Asymptomatic carriage of the virus is detected in 90% of newborns. Infection of the fetus with CMVI during the primary infection of the mother in the early stages leads to spontaneous miscarriage and premature birth in the 2nd and 3rd trimesters. In newborns with an acute stage of the virus, malformations are noted: hearing loss, dental dystrophy, visual impairment, mental retardation.

Viral hepatitis B and C

Infection with hepatitis viruses in the perinatal period is very rare, but infection during childbirth and breastfeeding is not excluded. In infected newborns, hepatitis occurs in a latent, asymptomatic phase. The danger of hepatitis lies in the fact that newborns, being carriers of the virus, in 85% of cases can infect other children.

Chlamydia in the acute stage is diagnosed in 10% of pregnant women, in the chronic phase - in 50%. Infection with chlamydia in utero leads to growth retardation, development and fetal hypoxia.

40% of infected newborns are diagnosed with such symptoms of chlamydia as pneumonia, pharyngitis, conjunctivitis, otitis. The greatest danger of chlamydia is for premature babies, it leads to severe forms of encephalitis and meningitis.

Treatment of women is carried out from the second trimester with the help of antibiotic therapy.

Gonorrhea

This disease adversely affects the development of pregnancy and childbirth. Ultrasound is diagnosed fetal growth and developmental delay. Newborns with gonococcal infection develop jaundice and purulent conjunctivitis, which often leads to complete blindness. Premature babies are at risk of developing gonorrhea.

Treatment of the disease is carried out with antibiotics from the first trimester of pregnancy.

Toxoplasmosis poses a serious danger to a pregnant woman. The virus is transmitted through contact with infected pets. The risk of infection of the fetus from the mother through the placenta is almost 100%.

In the first months of pregnancy, infection with toxoplasmosis leads to miscarriage. Infection in the 2nd and 3rd trimesters leads to congenital malformations: underdevelopment of the eyelids, splitting of the lip and palate, and brain defects.

It is possible to diagnose intrauterine infection with toxoplasmosis during the ultrasound procedure. Treatment of infected women is carried out at any stage of pregnancy.

Syphilis

Intrauterine infection of the fetus with syphilis occurs after 20 weeks of pregnancy through the umbilical cord vein. Children are usually born healthy, but after a few days, symptoms begin to appear: rash, swollen lymph nodes, inflammation of the mucous membranes of the eyes, nose. Treatment of syphilis during pregnancy is carried out in accordance with established standards.

The organism of a pregnant woman has an increased susceptibility to pathogens of listeriosis. Infection occurs through animal products and vegetables. Infection of the fetus occurs through the placenta after its formation.

Infection in the early stages leads to fetal death and miscarriage. In the later period of pregnancy, IUI manifests itself in the fetus in the form of sepsis. In newborns, the organs of hearing, liver and central nervous system are affected, pneumonia occurs.

During the intrauterine life of a child, the infections he receives leave a tangible contribution to the statistics of neonatal mortality, disease or further disability. To date, cases have become more frequent when a healthy woman (without chronic diseases and bad habits) has a not quite healthy baby.

How can this phenomenon be explained? The course of pregnancy in women is characterized by a decrease in immunity and the activation of certain latent (latent) infections that did not manifest themselves before pregnancy (especially dangerous in the 1st trimester).

Important information about intrauterine infection (IUI)

Every woman who is preparing to become a mother should be aware of the potential dangers that intrauterine infections carry for the fetus:

  • Timely treatment of a pregnant woman can reduce or eliminate the occurrence of risks to the fetus.
  • About 10 percent of all pregnancies are transmitted from mother to child.
  • Infection of the fetus often occurs when the mother first becomes infected.
  • Infection of the mother with an infection may not always result in infection of the fetus.
  • Most infections that are dangerous to the fetus do not show their symptoms when they occur in the mother.
  • 0.5% of newborns have some symptoms of infection.

How does infection occur in the fetus?

There are three main routes of intrauterine infection during pregnancy:

  • Descending - the infection enters the fetus through the fallopian tubes in the presence of oophoritis or adnexitis in the mother.
  • Ascending - intrauterine infections in children enter the fetus through the mother's genital tract. Often this process occurs during childbirth (when the amniotic bladder ruptures), but it can also happen during pregnancy. When microorganisms enter the amniotic fluid, intrauterine infection can have serious consequences for the baby - improper development of the respiratory and digestive organs, skin lesions. Such infections include herpes, chlamydia and mycoplasma.
  • Hematogenous (transplacental)- syphilis, listeriosis, toxoplasmosis, viruses (herpes, CMV, etc.). Penetration of the pathogen occurs through the placenta from maternal blood. Infection of the fetus in the 1st trimester very often affects the formation of developmental defects or deformities. Infection in the 3rd trimester of a newborn is accompanied by a clear manifestation of signs of acute infection. Direct penetration of the pathogen into the blood of the child leads to the spread of infection.
Common pathogens of intrauterine transplacental infection

Many viruses and bacteria that are familiar to modern medicine are able to penetrate the fetus and harm it. Most infections can be highly contagious or pose a great health risk to your baby. Some types of viruses cannot infect a child (almost all that cause SARS), their danger arises only with a strong rise in temperature.

The result of intrauterine infection on a child

Infection of the fetus can occur in chronic and acute form. The danger of an acute form of infection can cause pneumonia, sepsis and shock. The consequences of intrauterine infection in newborns are manifested almost from birth, the child does not eat well, sleeps a lot, and the activity of the baby decreases. There are frequent cases when infection in the womb is not active, and there are no obvious symptoms. Such babies are at risk due to certain consequences: delayed motor and mental development, visual and hearing impairments.

Clinic of intrauterine infections

During infection through the mother's genitals (intrauterine penetration), miscarriages, antenatal fetal death, pregnancy failure and stillbirth very often occur. Symptoms of intrauterine infections that occur in surviving babies:

  • Fever
  • Intrauterine growth retardation
  • Micro- and hydrocephalus
  • Edema in the fetus (dropsy)
  • Damage to the heart muscle (myocarditis)
  • Low hemoglobin in the blood (anemia)
  • Chorioretinitis, eye damage ()
  • Inflammation of the lungs (pneumonia)
  • Enlargement of the liver and

Who is at risk?

There are certain groups of women who have a significantly increased risk of developing intrauterine infections. These include:

  • Women who have already had infected newborns
  • Employees of preschool institutions and schools
  • Medical workers
  • Mothers with older children who go to nurseries, kindergartens and schools
  • Pregnant women with chronic diseases with an inflammatory process
  • Having multiple abortions in the past
  • Developmental disorders and antenatal fetal death
  • Untimely rupture of the bladder with amniotic fluid

During what period of pregnancy is the infection dangerous?

Intrauterine infections in pregnant women are dangerous at any time. Certain infections pose a great threat to health and life in the 1st trimester (rubella), but there are other diseases that can be very dangerous a few days before childbirth ().

Infection at an early stage often entails negative consequences (severe disturbances in the development of the fetus, miscarriage). Infection in the third trimester indicates a rapid course of an infectious disease in a newborn. The degree of danger and the establishment of risks for the fetus is determined by the attending physician based on the results of tests for infection, which are often prescribed for pregnant women, ultrasound, gestational age and symptoms of infection.

Signs of infection

There are certain symptoms that may indicate the presence of an infection in pregnant women:

  • Swelling and pain in the joints
  • Enlargement and pain of the lymph nodes
  • Chest pain, cough and shortness of breath
  • , runny nose and lacrimation

Similar symptoms may also indicate other diseases that do not pose a danger to the baby, but still, at the first signs of malaise, you should immediately consult a doctor.

Common causative agents of intrauterine infection

The table below shows the most common carriers of intrauterine infections, which the analysis will help to detect.

Viruses
Maternal infection Consequences for the child
HIV Injection and sexual contact Congenital HIV
Rubella Airborne Embryonic rubella syndrome
Hepatitis B, C sexually Chronic carrier of hepatitis
Herpes simplex 2 Most often through sexual intercourse congenital herpes
Measles Airborne miscarriage, congenital measles
Parvovirus B19 Airborne Dropsy and anemia in the fetus
Chickenpox Contact-household and airborne Inhibition in the development of the fetus with early infection, congenital chickenpox with infection before childbirth
Cytomegalovirus Through body fluids: blood, saliva, urine, semen Congenital CMV (with or without symptoms)
bacteria
Protozoa

Cytomegalovirus (CMV)

CMV belongs to the group of herpes viruses, it is transmitted through sexual intercourse, blood transfusions and other interventions, and through close household contacts. About half of the women in all of Europe have been infected with the virus at least once in their lives. The penetration of CMV to the placenta most often occurs during the first infection of the mother.

But the presence of CMV during pregnancy can cause undesirable consequences for the fetus. The highest risk of contracting an infection is observed in pregnant women in the third trimester, but severe consequences are caused by infection in the initial stages.

Statistics say that approximately 30-40 percent of pregnant women are at risk, but only 10 percent of newborns are born with obvious signs of intrauterine infection, while for the rest it is hidden.

The effects of CMV on the newborn include:

  • Delayed mental development and motor skills;
  • Stillbirth, miscarriages;
  • Blindness due to atrophy of the optic nerve;
  • Low birth weight;
  • Pneumonia;
  • Poor hearing or deafness (sensory hearing loss);
  • Damage and enlargement of the liver and spleen;
  • Underdevelopment of the brain;
  • Accumulation of fluid in the cavities of the brain.

If the infection in pregnant women has not been treated, and the consequences are combined, a third of newborns die in the first few months of life. The rest develop negative consequences: blindness, deafness or mental retardation. Mild infection has practically no consequences for the baby.

At the moment, there is no drug that would completely eliminate the manifestations of CMV in newborns. Only ganciclovir preparations can mitigate pneumonia and blindness. However, the presence of CMV is not an indication for termination of pregnancy, since with the correct treatment, negative consequences for the fetus can be avoided.

Herpes simplex virus (HSV)

Infection with HSV, especially the sexual form, causes congenital infection of the child and manifests itself during the first month of life. Most often, children become infected from mothers who have herpes for the first time. The child becomes infected with herpes when passing through the birth canal, but in some cases there is infection through the placenta.

The consequences of congenital herpes for an infant include:

  • Disorders of the brain (convulsions, apnea, increased intracranial pressure);
  • miscarriages and stillbirths;
  • Eye diseases, in particular chorioretinitis;
  • Poor appetite and constant lethargy;
  • Pneumonia;
  • A strong increase in temperature;
  • Impaired blood clotting process;
  • Herpetic rash on the skin;
  • Jaundice.

Often, the most negative manifestations of congenital herpes appear in the first week of a child's life. It was at this time that the disease affects many organs and the baby can simply die from shock. If the virus infects the brain, the risk of developing encephalitis, meningitis, or atrophy of the substance in the cerebral cortex increases. It is the herpes virus that often causes mental retardation.

Despite the high risk of the disease, very often in newborns the disease manifests itself with only small lesions of the eyes or skin.

Pregnant women who have been diagnosed with herpes are prescribed a course of antiviral drugs (Acyclovir) in the third trimester, and if the disease is accompanied by a rash on the genitals, they may recommend a caesarean section to prevent infection during childbirth.

Rubella

The rubella virus during pregnancy is considered one of the most dangerous, as it can cause physical deformities in newborns. The greatest danger is infection in the first trimester of pregnancy. Manifestations of rubella directly depend on the period of penetration of the virus to the fetus.

Amniocentesis and cordocentesis

Cordocentesis is a puncture of the mother's abdomen to collect cord blood. This is a very accurate method of diagnosing an infection because the blood from the umbilical cord may contain the infection's DNA or immune cells against it.

Amniocentesis is the study of amniotic fluid.

Seroimmunological method

This analysis is necessary primarily for women who are at risk. The presence of IgM indicates acute infection or activation of latent infection. Such data may be an indication for cordocentesis.

Modern medicine conducts a mandatory seroimmunological analysis for causative agents of syphilis, rubella, hepatitis and HIV. Often, a pregnant woman is recommended to additionally be tested for TORCH infection. In addition, if preparation for pregnancy is being carried out, it will be much easier to decipher the data obtained if there are results of such analyzes before conception.

Immunoglobulins are defined as follows:

  • Acute infection is diagnosed in the presence of IgM and the absence of IgG;
  • Formed immunity against infection shows the presence of IgG and the absence of IgM;
  • The absence of both IgM and IgG indicates immature immunity;
  • The presence of IgG and IgM indicates the presence of infection and the process of formation of immunity. In this case, the fetus is not in danger.

Conducting this study in a newborn is not informative, since mother's antibodies are still present in his blood.

Analysis of saliva, urine, blood and cerebrospinal fluid in a newborn

These tests can detect intrauterine infection even with hidden symptoms.

Treatment Methods

Timely diagnosis and treatment of intrauterine infections will significantly reduce the risk of malformations in the fetus.

IUI therapy includes:

Taking medications

If a bacterial infection has been diagnosed in a pregnant woman, antibacterial drugs are often prescribed (most often penicillins, as the most effective and safe). Newborns are also given similar medications to prevent complications.

Viral diseases are much more difficult to treat in both infants and pregnant women. Acyclovir preparations are often prescribed, and if the treatment works quickly, the risk of malformations in the fetus is significantly reduced. The consequences of viral infections (brain disorders, heart defects) are not treated with antiviral drugs.

Method of delivery

If a woman has a rash on her genitals (for example, with an acute form of herpes), doctors recommend a caesarean section so that the baby does not become infected when passing through the birth canal. But most infectious diseases still do not interfere with natural childbirth.

Newborn care

When infected with rubella or CMV, even in the absence of symptoms, children should be regularly examined and have their hearing checked until about six years of age.

Treatment of consequences

Some consequences of intrauterine infections (for example, heart disease) are eliminated by surgery. In this case, the chance to raise a healthy child increases. However, it is very common for children to wear hearing aids years after surgery due to the spread of hearing loss.

Prophylactic

To prevent the development of intrauterine infections, you should adhere to some recommendations of doctors:

  • Timely vaccinate children and women at the planning stage of conception;
  • Conduct analysis for TORCH infection at the planning stage;
  • To protect the health of the future mother, namely, to limit her contact with preschool children, to be less likely to be in crowded places, to minimize contact with pets and their feces, to eat only high-quality products that have undergone heat treatment and to be protected during sexual intercourse.
Actions upon contact with an infected person

If during pregnancy a woman was forced to contact a sick person for a long time, she must definitely consult a doctor.