Intrauterine infections of the fetus and newborn. Intrauterine infections: symptoms, treatment and prevention

When carrying a child, a woman tries to protect him from unfavorable external influences. Health developing baby– this is the most important thing in this period, everyone is aimed at preserving it defense mechanisms. But there are situations when the body cannot cope, and the fetus is affected in utero - most often it is an infection. Why it develops, how it manifests itself and what risks it carries for the child - these are the main questions that concern expectant mothers.

Causes

For an infection to occur, including intrauterine infection, several factors must be present: the pathogen, the route of transmission, and the susceptible organism. The direct cause of the disease is considered to be microbes. 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 caused by microbial associations, i.e., it is mixed in nature, but monoinfections are also common. Among the common pathogens, it is worth noting the following:

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

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

The infection can reach the child in several ways: through the blood (hematogenously or transplacentally), amniotic fluid (amnial), the mother's genital tract (ascending), from the uterine wall (transmural), through the fallopian tubes (descending) and through direct contact. Accordingly, there are certain risk factors for infection that a woman and a doctor should remember:

• Inflammatory pathology of the gynecological sphere (colpitis, cervicitis, bacterial vaginosis, adnexitis, endometritis).
• Invasive interventions during pregnancy and childbirth (amnio- or cordocentesis, chorionic villus biopsy, C-section).
• Abortions and complications in postpartum period(previously transferred).
• Cervical insufficiency.
• Polyhydramnios.
• Feto placental insufficiency.
• Are common infectious diseases.
• Foci of chronic inflammation.
• Early onset of sexual activity and promiscuity in sexual relations.

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

Intrauterine infection develops when infected with microbes, which is facilitated by many factors from the maternal 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 (maturity immune system), duration of microbial aggression. The severity and nature of the lesion are 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 abnormalities. This is due to the biological tropism of microbes, i.e., the tendency to reproduce in embryonic tissues.

Infectious agents have different effects on the fetus. They can provoke an inflammatory process in various organs with the further development of a morphofunctional defect or have a direct teratogenic effect with the appearance of structural abnormalities and malformations. Of no small importance are intoxication of the fetus by products of microbial metabolism, metabolic disorders and hemocirculation with hypoxia. As a result, fetal development suffers and differentiation is disrupted. internal organs.

Symptoms

The clinical manifestations and severity of the infection are determined by many factors: the type and characteristics of the pathogen, the mechanism of its transmission, the 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):

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

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

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

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

Along with the 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 quite sparse, since only symptoms of general intoxication are present, including those already listed above. In addition, the baby is underweight, the umbilical wound does not heal well, jaundice appears, and the liver and spleen are enlarged (hepatosplenomegaly).

In children infected during prenatal period, violations of many vital systems are detected, including nervous, cardiovascular, respiratory, humoral, and immune. Key adaptation mechanisms are disrupted, 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 symptoms.

Cytomegalovirus

Most children infected with cytomegalovirus do not have any visible abnormalities at birth. But later signs emerge neurological disorders: deafness, slow neuropsychic development (mild mental retardation). Unfortunately, these disorders are irreversible. They can progress with development cerebral palsy or epilepsy. In addition, congenital infection can manifest itself:

• Hepatitis.
• Pneumonia.
• Hemolytic anemia.
• Thrombocytopenia.

These disorders disappear within certain period even without treatment. Chorioretinopathy may occur, but 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 chronic illness. Then the child becomes infected through contact, passing through the affected genital tract during childbirth. Intrauterine infection occurs less frequently and occurs before natural conclusion pregnancy, when the membranes burst, or at other times - from the first to the third trimester.

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

• Anemia.
• Jaundice.
• Hypotrophy.
• Meningoencephalitis.
• Hepatosplenomegaly.

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

Rubella

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

• Cataract.
• Deafness.
• Heart defects.

But in addition to these signs, other structural abnormalities may also occur, 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, slows down psychomotor development, autism and diabetes appear.

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 serious consequences for the fetus. Intrauterine infection provokes the death of the child or the occurrence of multiple anomalies, including hydrocephalus, brain cysts, edema syndrome and destruction of internal organs. The congenital disease is often widespread, manifesting itself with the following symptoms:

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

If infected for more than later clinical manifestations are quite scarce and are mainly characterized by decreased vision or unexpressed disorders in the nervous system, which often remain undetected.

Additional diagnostics

It is important prenatal diagnosis infectious lesions of the fetus. To determine pathology, laboratory and instrumental methods are used to identify the pathogen and identify deviations in the development of the child on different terms pregnancy. If intrauterine infection is suspected, the following is performed:

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

After birth, newborns are examined (skin washes, blood tests) and the placenta (histological examination). Comprehensive diagnostics makes it possible to identify pathology at the preclinical stage and plan further treatment. The nature of the measures taken will be determined by the type of infection, its spread and clinical picture. Prenatal prevention also plays an important role correct management pregnancy.

How happy parents are when childbirth goes smoothly, without any complications and little man is born healthy. And it seems that nothing else can overshadow the joy of birth. But a couple of days pass and the newborn’s health condition deteriorates sharply. The baby often regurgitates food, he is lethargic, loses his appetite, and there is no weight gain. All this may be a consequence of so-called intrauterine infections in newborns. What is it?

As medical practice shows, the human body always contains microorganisms that are causative agents of all kinds of diseases. And if a man, having become infected with them, is responsible only for himself, then with a representative of the fair sex it is more difficult. Moreover, if at the time of infection she is in interesting position. In this case, there is a real risk of infecting your child while he is still in the womb. Possible ways infections are: shared blood flow between mother and child, accidental ingestion of amniotic fluid by the fetus. Often infection occurs during the birth process.

Depending on which pathogen causes infection of the mother’s body, the baby’s illness will be determined. According to doctors, the disease is caused by:

• Herpes viruses, rubella, influenza, cytomegaly;
• Bacteria – streptococci, Escherichia coli, treponema pallidum, chlamydia;
• Protozoa (Toxoplasma);
• Mushrooms.

Availability expectant mother the following factors will increase the risk of infection in the newborn:

1. A woman’s health is undermined by various chronic illnesses;
2. The female body is influenced by many negative factors such as excessive smoking and alcohol and employment in hazardous work;
3. Constant stress throughout pregnancy;
4. Mom suffers from chronic ailments of the genitourinary system.

In the medical environment, diseases of a newborn received while in the womb of the parent were brought together into one group and given a common name - TORCH. This was due to the fact that, despite the fact that the pathogens are different, the manifestations of the diseases have the same characteristics. This abracadabra can be deciphered quite simply:

T – toxoplasmosis;

O – others. By this we mean almost all ailments of an infectious nature;

R is for rubella. In Latin rubella;

WITH - cytomegalovirus infection newborn;

The degree of influence of the infection on the further development of the baby will depend on the period at which the infection occurred;

• Up to twelve weeks - infection at such an early stage often leads to what happens spontaneous interruption or in the future the development of the little one will be accompanied by major defects;
• The infection occurred between 12 and 28 weeks - usually at this stage infection will lead to developmental delays. The consequence of this will be that the newborn will be born underweight;
• Infection after 28 weeks is dangerous because it has its own Negative influence on the child’s fully formed organs. The brain, heart, liver and lungs are primarily affected. That is, all vital organs.

The most common intrauterine infections

Statistics show that this list includes the following infections in descending order:

• Toxoplasmosis;
• Cytomegalovirus;

Cytomegalovirus in newborns

Let's look at them in more detail:

Experts, in turn, divide staphylococcal infection into two types:

• Purulent-inflammatory processes with a local character;
• Generalized infection or

The most dangerous thing for a child is Staphylococcus aureus. The fact that its causative agent is present in children's body can be recognized by pustules on the skin. This also includes purulent inflammation of the umbilical wound. The consequences of staphylococcal infection are quite severe, including toxicological shock. Therefore, as soon as the first signs appear, you must immediately contact a medical facility.

Who is at risk

Children's doctors have long compiled a list of those who are included in the so-called risk group. In the same list, in addition to living persons, doctors also included subjective reasons. Here is the list:

• Mothers with previously born children. School students and preschool pupils;
• Workers of kindergartens and schools;
• Health workers working directly with children;
• Pregnant women who have inflammatory diseases with a chronic course of the disease;
• Those women who have had repeated abortions for medical reasons;
• Women who have already given birth to infected children;
• Those women who have had children in the past or pregnancy with fetal malformation and fetal death in utero;
• The amniotic fluid broke long before birth.

A pregnant woman should consult a doctor as soon as she feels the following symptoms:

1. A sharp rise in temperature;
2. The lymph nodes have enlarged and become painful to the touch;
3. The skin suddenly broke out in a rash;
4. Cough and shortness of breath appeared;
5. Drowsiness, lacrimation;
6. The joints are swollen and hurt when moving.

It is not necessary that all these signs are dangerous for the little one. But they are required to contact a doctor. It’s better to be safe than to undergo long and difficult treatment later.

Preventive measures

It has long been known that it is better to prevent any illness than to treat it later. TORCH infections are no exception. Preventive measures are divided into two types: before conception and pregnancy.

Measures up to

First of all, this means passing all tests for the presence of immunity to diseases included in the list of intrauterine diseases. If tests show that the titers contain an indicator such as IqG, this will indicate that the woman’s body has the necessary antibodies. If this is not the case, then this means only one thing - the woman’s body is open to infection. Therefore, if pregnancy is planned, then she must first be vaccinated against rubella. In order to avoid toxoplasmosis, you can temporarily remove all animals from the house before giving birth and be examined together with your partner for infection with herpes and cytomegalovirus. If the IqG indicator is very high, then this indicates that there is an acute infection in the female body. And before you plan the birth of your baby, you need to undergo complete treatment.

Prevention during

But if the pregnant woman’s tests show an IqG titer, then this clearly indicates infection of the female body. In theory this means: future baby is also in danger. And to rule this out, to the expectant mother It is necessary to undergo some additional tests, by which you can determine the condition of the fetus and develop your further actions.

And keep track of your contacts.

Treatment process

If an infection is detected during pregnancy, this is not a reason to give up. The disease can be easily treated with antibiotics. Representatives of the penicillin group take precedence here. Indeed, despite their venerable “age” among antibiotics, they are still one of the most effective drugs in the treatment of a viral infection. Moreover, they are practically safe for the baby’s health.

At the same time, antimicrobial drugs are actively used. Their use often saves the child’s life and also reduces the negative consequences.

With a viral infection, treatment is a rather difficult process, but if you start it in a timely manner, the consequences can be prevented. But if they have already formed, then antiviral drugs useless. In this case, they often come to the rescue surgical methods. In cases of cataracts or congenital heart disease, the child will have a chance to live his future life independently, with a minimum of outside help. It is not uncommon for such children to need hearing aids many years later.

As mentioned above, acute herpes with rashes on the mother’s labia is definitely an indication for a cesarean section. In other cases natural childbirth nothing interferes.

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

Infection of a child occurs during pregnancy, and its source is the mother. That is why, even at the planning stage, the mother should be attentive to her own health and undergo screening for hidden infections.

Intrauterine infection during pregnancy

Intrauterine infections(VUI) are classified into viral and bacterial. Many viral infections enter the child’s body during 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.

Intrauterine infection is most dangerous in the first three months of pregnancy and causes spontaneous abortion 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 infection.

Symptoms indicating infection

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

During the ultrasound procedure, the following symptoms are noted:

• Fetal growth restriction;
• Polyhydramnios;
• Tachycardia in the fetus;
• Enlarged abdomen and liver in the fetus;
• Thickening of the placenta;

Intrauterine infection can be diagnosed using laboratory tests: blood test for hidden (TORCH) infections, smears 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, CMV, 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’ body. Therefore, it is important for the expectant mother to visit the dentist, ENT specialist and 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 (dilatation of the cervix) and, as a consequence, to premature birth.

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

Main signs

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

With primary infection during pregnancy, the woman experiences symptoms characteristic of of this type diseases.

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

Chronic maternal infection during pregnancy Diagnosed only by laboratory methods and has no obvious symptoms. Any foci of infection in a woman’s body (tonsillitis, sinusitis, caries, pyelonephritis) must be excluded at the planning stage, or subject to treatment and observation from the second trimester of pregnancy. A disease acquired during pregnancy must be treated in a hospital setting.

Early onset of infection

With intrauterine infection in the first trimester of pregnancy, infectious embryopathies which end in spontaneous miscarriage or undeveloped pregnancy.

Primary infection with rubella in the first three months of pregnancy requires its surgical termination. 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.

Danger of ureaplasmosis lies in its asymptomatic course in a pregnant woman; it can only be detected by laboratory diagnostic methods. However, this disease poses a threat to the fetus. In the early stages, ureaplasmosis leads to fading of pregnancy and spontaneous abortion. From the second trimester - provokes a rupture amniotic sac, 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.

Ureaplasmosis is treated with antibiotic therapy from 20 weeks of pregnancy.

Herpes simplex virus in its acute stage causes fetal infection in 80% of cases. If the mother is a carrier of the virus, then the risk of infection of the embryo is reduced to 0.5%. However, when it worsens during childbirth, newborns become infected in 40% of cases.

With 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 surveillance. Antiviral therapy and administration 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 leads to death in 50%, and the remaining 50% experience severe complications, expressed in mental and physical retardation.

More than 90% of the Russian population are carriers of CMV infection. IN THE USA cytomegalovirus is present in the blood of 99% of residents. CMV infection 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 CMV during primary infection of the mother in the early stages leads to spontaneous miscarriage and premature birth in the 2nd and 3rd trimester. In newborns with the acute stage of the virus, developmental defects are noted: hearing loss, dental dystrophy, visual impairment, and mental retardation.

Viral hepatitis B and C

Infection with hepatitis viruses in the perinatal period occurs very rarely, but infection during childbirth and breastfeeding is possible. 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 retarded growth, development and fetal hypoxia.

In 40% of infected newborns, symptoms of chlamydia such as pneumonia, pharyngitis, conjunctivitis, and otitis media are diagnosed. Chlamydia poses the greatest danger to 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 antibacterial therapy.

Gonorrhea

This disease adversely affects the development of pregnancy and childbirth. Diagnosed by ultrasound delayed growth and development of the fetus. 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. Infection with the virus occurs 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 frozen pregnancy. Infection in the 2nd and 3rd trimesters leads to congenital anomalies development: underdevelopment of the eyelids, cleft lip and palate, brain defects.

Intrauterine infection with toxoplasmosis can be diagnosed using an 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 of the disease begin to appear: rashes, enlarged lymph nodes, inflammation of the mucous membranes of the eyes and nose. Treatment of syphilis during pregnancy is carried out in accordance with established standards.

The body of a pregnant woman has an increased susceptibility to listeriosis pathogens. 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 more late period pregnancy, IUI manifests itself in the fetus in the form of sepsis. In newborns, the hearing organs, liver and central nervous system are affected, and pneumonia occurs.

Infections acquired by a child during intrauterine life, make a significant contribution to the statistics of morbidity, infant mortality and further disability. Today there are frequent cases when it would seem healthy woman(does not smoke, does not drink, has no chronic diseases) an unhealthy child is born.

What explains this? During pregnancy, a woman's immunity decreases, and some hidden (latent) infections that do not manifest themselves before pregnancy become more active (this is especially dangerous in the 1st trimester).

Important facts about IUI

• Up to 10% of all pregnancies are accompanied by transmission of infection from mother to fetus
• 0.5% of children born have some symptoms of infection
• Infection of the mother does not necessarily lead to infection of the fetus
• Many infections that are dangerous to the fetus are mild in the mother or have no symptoms at all.
• Infection of the fetus most often occurs when the mother has a new infection
• Timely treatment of a pregnant woman can reduce or eliminate risks to the fetus.

How does a fetus become infected?

There are three main ways of transmitting intrauterine infection during pregnancy:

• Transplacental (hematogenous) - viruses (CMV, herpes, etc.), syphilis, toxoplasmosis, listeriosis

The pathogen enters from the mother's blood through the placenta. If this happens in the 1st trimester, then malformations and deformities often occur. If the fetus becomes infected in the 3rd trimester, the newborn will show signs of acute infection. Direct entry of the pathogen into the baby’s blood leads to generalized damage.

• Ascending - mycoplasma, chlamydia, herpes

The infection ascends from the genital tract of the mother to the child. This usually occurs after rupture of the membranes, at the time of birth, but sometimes it also happens during pregnancy. The main reason intrauterine infection is its entry into the amniotic fluid, and as a result, damage to the skin, respiratory and digestive tract of the fetus.

• Descending

The infection descends to the fetus through the fallopian tubes (with adnexitis, oophoritis).

Frequent causative agents of intrauterine transplacental infection

Most viruses and bacteria known to man can penetrate the fetus and cause various damage. But some of them are particularly contagious or represent increased danger for a child. Some viruses (almost all that cause ARVI) are not transmitted to the baby, but are dangerous only when the pregnant woman’s temperature rises greatly.

Consequences of intrauterine infection for a child

Congenital infection can develop in 2 scenarios: acute and chronic. Acute infection is dangerous with severe sepsis, pneumonia and shock. Signs of ill health in such babies are visible almost from birth: they eat poorly, sleep a lot, and become less and less active. But often the disease acquired in the womb is sluggish or has no obvious symptoms. Such children are also at risk for long-term consequences: hearing and vision impairment, delayed mental and motor development.

Common symptoms of intrauterine infections

With intrauterine penetration of infectious agents, miscarriages, miscarriages, antenatal fetal death and stillbirths quite often occur. Surviving fetuses may exhibit the following symptoms:

• Intrauterine growth restriction
• Micro- and hydrocephalus
• Chorioretinitis, cataracts (eye damage)
• Pneumonia
• Jaundice and enlarged liver
• Anemia
• Hydrops fetalis (edema)
• Skin rash
• Fever

At what stage of pregnancy is infection dangerous?

Infecting a baby before birth can be dangerous at any stage of pregnancy. But some infections carry big threat life and health in the first trimester (rubella virus, for example), and some diseases are terrible if infected a couple of days before birth (chickenpox).

Early infection often leads to miscarriages and severe malformations. Late infection is usually associated with a rapidly progressing infectious disease in the newborn. More specific risks and the degree of danger are determined by the attending physician based on test results, ultrasound, gestational age and the characteristics of a particular infection.

Risk groups for diseases dangerous to the fetus

• Women with older children attending school and preschool institutions
• Workers of kindergartens, nurseries, schools
• Medical workers
• Pregnant women with chronic inflammatory diseases
• Indication of repeated medical abortions
• Women with a history of giving birth to infected children
• Malformations and antenatal fetal death in the past
• Untimely rupture of amniotic fluid

Signs of infection in a pregnant woman

• Temperature rise
• Enlarged and painful lymph nodes
• Cough, shortness of breath, chest pain
• Runny nose, lacrimation, conjunctivitis
• Pain and swelling of the joints

The above symptoms may be signs of allergies, non-infectious diseases, or infections that are not dangerous for the baby. But any signs of ill health should be noticed by the pregnant woman and are a reason to consult a doctor.

Frequent causative agents of intrauterine infection

Viruses

	Maternal infection	Consequences for the child
Rubella	Airborne path	Fetal rubella syndrome
Cytomegalovirus	Through biological fluids: blood, saliva, semen, urine	Congenital CMV infection (with or without symptoms)
Herpes simplex virus 2	Predominantly sexual route	Congenital herpetic infection
Parvovirus B19	Airborne path	Anemia, hydrops fetalis
Chicken pox	Airborne, contact and household route	Developmental defects during early infection, congenital chickenpox during infection before birth
	Airborne path	Spontaneous abortion, congenital measles
Hepatitis B, C	Sexual tract	Neonatal hepatitis, chronic carriage of the virus
	Sexual route, injection route	Congenital HIV infection

Bacteria

Protozoa

CMV

CMV, which belongs to the herpesovirus group, is transmitted sexually and through blood through transfusions and other interventions, as well as through close household contacts. It is believed that half of European women have encountered this virus at least once in their lives. It more often penetrates the placenta during primary infection of the mother.

But activation of a dormant infection can also harm a child (see). The likelihood of infection of the fetus is greatest in the 3rd trimester, and the consequences for the baby are more severe if infected at the beginning of pregnancy. It is believed that the risk of fetal infection is 30-40%. Of these, 90% of children will not have any symptoms or consequences. And 10% of newborns will be born with various signs of intrauterine infection.

Consequences for the child:

• miscarriage, stillbirth
• low birth weight
• ( varying degrees)
• (insufficient brain size)
• (accumulation of fluid in the brain cavities)
• hepatosplenomegaly (damage to the liver and spleen with an increase in their size)
• pneumonia
• optic nerve atrophy (various degrees of blindness)

With severe combined damage, a third of children die in the first months of life, and some patients develop long-term consequences (deafness, blindness, mental retardation). With mild infection, the prognosis is much more favorable.

There is currently no effective treatment for CMV symptoms in newborns. It is believed that the use of ganciclovir somewhat mitigates pneumonia and eye damage.

CMV is not an indication for termination of pregnancy, since the outcome for the newborn may be good. Therefore, it is recommended to treat pregnant women in order to reduce the risks of complications.

HSV

Herpes simplex virus, especially type 2 (genital), can cause congenital herpes infection kids. It manifests itself during the first 28 days after birth (see).

Children from mothers who were diagnosed with herpes during pregnancy for the first time in their lives often become ill. In most cases, infection occurs when the child passes through the birth canal, but transplacental transmission is also possible.

Consequences of congenital herpes:

• miscarriage, stillbirth
• lethargy, poor appetite
• fever
• characteristic skin rashes (sometimes they do not appear immediately)
• jaundice
• bleeding disorder
• pneumonia
• eye damage (chorioretinitis)
• brain damage (with seizures, apnea, increased intracranial pressure)

Typically, the severity of the condition is maximum 4-7 days after birth, when many organs are affected and there is a risk of death from shock. If the virus attacks the brain, then encephalitis, meningitis and atrophy of the cerebral cortex are likely to develop. Therefore, severe congenital herpes makes a large contribution to the number of children with disabilities (cerebral palsy, mental retardation, vegetative state). Despite the danger of the disease, there are often cases when a child is born without symptoms of herpes, or has minor damage to the eyes and skin.

Treatment of pregnant women is most often carried out in the 3rd trimester with antiviral drugs (acyclovir, valacyclovir and others). Since with severe rashes on the woman’s genitals there is a risk of infection of the baby during childbirth, doctors may recommend a caesarean section. A child with signs of herpes should also be treated with acyclovir.

Rubella

One of the most dangerous viruses that causes deformities in the fetus is the rubella virus. The risk is especially high during pregnancy up to 16 weeks (more than 80%). Symptoms of the disease depend on the period at which the virus penetrated the fetus (see).

Congenital rubella syndrome:

• miscarriage, stillbirth
• low birth weight
• microcephaly
• cataract
• deafness (up to 50% of children)
• heart defects
• skin like “blueberry pie” - bluish foci of hematopoiesis in the skin
• meningitis and encephalitis
• hepatosplenomegaly
• pneumonia
• skin lesion

Signs of rubella in a pregnant woman are classic: fever, rash, swollen lymph nodes, joint pain and general malaise. Since the rubella virus is extremely contagious, all women are recommended to take an immunoglobulin test for it before planning a pregnancy. If it turns out that there is no immunity to the disease, then you must be vaccinated at least three months before pregnancy. There is no treatment for rubella during pregnancy or in newborns.

Parvovirus B19

The virus that causes erythema infectiosum usually goes undetected in adults. There are often no symptoms of infection. But during pregnancy, this disease can lead to miscarriages, stillbirths and intrauterine infection. The mortality rate for children is 2.5-10%. The virus is most dangerous from 13 to 28 weeks of pregnancy.

Consequences of intrauterine infection:

• anemia
• swelling
• myocarditis
• hepatitis
• peritonitis
• brain damage

In pregnant women, parvovirus infection manifests itself as pain in small joints, rash and fever. If such signs were noted, or the woman was in contact with a patient with parvovirus, then it is necessary to conduct laboratory diagnostics.

In cases of confirmed infection and fetal anemia, intrauterine administration of red blood cells is recommended. This technique often increases the level of red blood cells and saves the child's life.

Chicken pox

Chickenpox that occurs during pregnancy can cause severe damage to the fetus (congenital syndrome). chickenpox). Infection of a child a few days before birth leads to classic chickenpox of severe form with high mortality. The overall risk of infection to a fetus is 25%, although not all will develop symptoms.

Symptoms of congenital chickenpox:

• rash, zigzag scars
• underdevelopment of limbs (shortening and deformation)
• optic nerve atrophy, eye underdevelopment
• brain damage (underdevelopment)
• pneumonia

During pregnancy, if you come into contact with a patient with chickenpox, it is possible to administer immunoglobulin or antiviral treatment (acyclovir). Treatment of newborns is not advisable, since chickenpox symptoms do not progress after birth. Only if the mother is infected 5 days before birth or less does it make sense to administer immunoglobulin to the child, since the mother did not have time to transfer her antibodies to him.

Hepatitis B

The hepatitis B virus, spread primarily through sexual contact, can penetrate the placenta to the fetus at any stage of pregnancy. However, the maximum danger to the child occurs when the mother becomes infected with hepatitis in the 3rd trimester.

Consequences of intrauterine hepatitis infection:

• miscarriage, stillbirth
• light weight,
• psychomotor development delay
• acute form of hepatitis with liver failure and death
• carriage and chronic hepatitis B
• liver cancer
• hepatitis B with subsequent recovery

To diagnose hepatitis in the mother, the level of HBsAg is determined, which increases 1-2 months after infection. In case of chronic illness or carriage of the virus, this antigen does not disappear. Severe forms of hepatitis are treated with interferon-A. But even in the absence of symptoms, a pregnant woman can transmit the disease to her child, so special monitoring is required for such newborns.

HIV infection

Human immunodeficiency virus, which attacks specific immune lymphocytes Lately conquers new territories. Most adult women become infected with it through sexual contact, while almost all children under 13 years of age acquired the disease during fetal life or at the time of birth.

Many children with HIV do not survive even two years without appropriate treatment, since their virus multiplication rate is very high. Subsequently, babies die from opportunistic infections that healthy person not scary.

Among the methods for diagnosing HIV in a newborn, it is better to use PCR. Determination of antibodies may be uninformative in the first 3-6 months of life. It is very important to detect HIV in pregnant women. Taking antiretroviral drugs throughout the entire period (zidovudine from 4 weeks of pregnancy) together with refusal of breastfeeding increases the chances of birth healthy child up to 90%. If the blood test results for HIV in a child are still positive, there is still a chance to slow down the disease for a long time. Recently, there has been more and more data on cases of complete recovery of children who regularly took medications from birth.

Listeriosis

Listeria is one of the few bacteria that can penetrate placental barrier. Women become infected with listeriosis by eating meat, cheeses, vegetables and contact with animals. A pregnant woman may not notice any symptoms, but sometimes vomiting and diarrhea occur, the temperature rises, and a flu-like condition appears.

Manifestations of intrauterine infection:

• stillbirth, spontaneous abortion
• fever, refusal to eat
• meningitis
• sepsis
• multiple purulent foci, rash

If signs appear in a child in the first week, the mortality rate is extremely high - about 60%. Therefore, all pregnant women with confirmed listeriosis are treated with ampicillin for 2 weeks. The same treatment for intrauterine infection is also necessary for sick newborns.

Syphilis

Primary syphilis (the formation of a hard chancre - an ulcer at the site of penetration of the bacterium), which occurs during pregnancy and is not treated, is transmitted to the child in almost 100% of cases, resulting in the death of 6 out of 10 children, the rest suffer from congenital syphilis.

After the primary ulcer, the mother’s disease enters a latent phase with periodic exacerbations. The fetus can become infected even in the absence of significant symptoms in the mother, starting from the 4th month of pregnancy.

Consequences of syphilis infection:

• stillbirth
• anemia, jaundice of a child
• cracks in the skin, rashes of various shapes
• damage to the eyes, ears, limbs, teeth (“Hutchinson’s teeth”)
• deafness
• impaired mental function

At positive results analysis for intrauterine infection and treatment with penicillin. Treatment for a pregnant woman is mandatory, as it helps prevent or treat syphilis in the fetus before birth. If a newborn has a positive reaction to syphilis, penicillin is also indicated. Due to effective diagnosis and simple therapy, the number of children with late congenital syphilis is currently insignificant.

Toxoplasmosis

Timely detection and treatment of toxoplasmosis in pregnant women reduces the risk of infection of the baby by 60%.

What are TORCH infections?

Toxoplasmosis, rubella, cytomegalovirus, herpes and some other diseases (syphilis, tuberculosis, etc.) are combined under the term TORCH for a reason. All of these infections are extremely dangerous when infected intrauterinely, some of them are asymptomatic or have few symptoms, and therefore require careful prevention and diagnosis.

When planning a pregnancy

Before conception, it is necessary to take tests for immunity to TORCH. The presence of IgG in the required titers indicates stable immunity to a previous infection. The absence of these is a sign of a woman’s vulnerability to infection. Therefore, vaccination against rubella is recommended, as well as careful care of cats (to avoid toxoplasmosis), and screening of the partner for herpes and cytomegalovirus. A high IgM titer indicates an acute infection. Such women are advised to postpone planning pregnancy.

During pregnancy the appearance

During pregnancy, IgM may indicate infection, which theoretically leads to intrauterine infection of the fetus. Such women will have to undergo additional tests to determine the condition of the child and further tactics.

Diagnosis of intrauterine infection

Blood tests for all pregnant women

• syphilis, hepatitis B and C, regular vaginal smears for microflora
• PCR to detect viruses in blood

Ultrasound

Ultrasound examination of the fetus is simple, safe, although not absolutely exact method diagnosis of infection. Based on its results, you can evaluate intrauterine growth retardation and see some defects that are a consequence of infection. In addition, cordocentesis is performed under ultrasound guidance. Signs of a possible infection on ultrasound:

• enlargement of the ventricles of the brain
• multiple calcium deposits in the brain, liver, intestines
• enlargement of the heart, liver and spleen
• enlargement of the abdomen and expansion of the renal collecting system
• intrauterine growth retardation syndrome
• swelling of the placenta, amniotic bands
• high or low water
• formed developmental defects

All of the above signs may be a consequence of non-infectious diseases or a variant of the norm (see).

Seroimmunological method

Determination of immunoglobulins is necessary for women at risk. The appearance of IgM indicates infection or reactivation of the infection. This may be an indication for invasive diagnostics: cordocentesis.

In domestic healthcare there is mandatory serological screening for rubella, syphilis, hepatitis, and in risk groups - for HIV. But often the doctor recommends taking additional tests for infections of the TORCH group and others. The results of some tests (for toxoplasmosis, for example) are easier to interpret if a similar study was carried out before pregnancy.

The essence of the definition of immunoglobulins:

• There is IgM, no IgG - most likely there is an acute infection
• There is IgG, no IgM – the infection was in the past, immunity is formed
• There is neither IgM nor IgG in sufficient titers - the woman has not encountered the infection, or has encountered it for a very long time, there is no immunity
• There are IgM and IgG – there is an infection to which immunity has already begun to form, or a reactivation of a previously existing infection has occurred. Most likely, the fetus is not in danger.

Serological testing of a newborn's blood is difficult, since it contains maternal antibodies, which distort the picture.

Cordocentesis and amniocentesis

Cordocentesis is a puncture of the skin and drawing blood from the umbilical cord, a fairly accurate method for determining infection. Cord blood may contain DNA of the pathogen, as well as immune complexes against it.
Amniocentesis is the study of amniotic fluid.

Tests of blood, saliva, urine, cerebrospinal fluid of a newborn

They make it possible to detect intrauterine infection in children with varying degrees of symptom severity.

Treatment and observation for intrauterine infection

Timely detection of viral or bacterial disease extremely important, as some infections respond well to treatment with early stages, and the risk severe consequences for the baby is reduced.

Drug treatment

Bacterial diseases in pregnant women can and should be treated with antibiotics. Penicillin drugs are used quite often - they are safe and effective for many diseases. Newborn baby with signs bacterial infections Antimicrobial drugs are also administered, which often saves lives and prevents complications.

Viral infections are less easily treated in both pregnant women and newborns. Some drugs (acyclovir, valacyclovir and others) are used for herpetic rashes and some other diseases. If treatment helps quickly, serious developmental defects can be prevented and congenital infections. Formed consequences in the form of defects of the heart, brain and other organs are treated antiviral agents are not subject to

Choosing a method of delivery

Many diseases with rashes on the genitals require careful management of childbirth; acute herpes with blisters on the labia can be dangerous for the baby when passing through the birth canal. In such cases, a caesarean section is often recommended. But in most infectious lesions of the mother, childbirth can be carried out through natural means.

Monitoring infected children

Even in the absence of symptoms of CMV and rubella in the first months of life, infected children need to have their hearing checked before the age of 5-6 years.

Treatment of formed defects and damage due to intrauterine infections in newborns

Many congenital defects (CHD, cataracts) can be reduced or eliminated surgically. In such cases, the child gets a chance to live and independent activity. Children often require hearing aids many years after an infection, since hearing loss is quite common among those infected.

Prevention of fetal infection

• Vaccination of children and adult women before planning pregnancy
• Taking care of women's health
  • limiting contact with children, especially in educational institutions
  • restriction of visiting crowded places
  • careful contact with pets, avoiding cleaning cat litter
  • eating thermally processed foods, excluding soft cheeses and semi-finished products
  • an adequate way to protect against infection during sexual intercourse
• Determination of the level of immunoglobulins for the main intrauterine TORCH infections before planning a pregnancy

What to do if you come into contact with infected people?

If a woman during pregnancy communicated or spent a long time near an infected adult and child, she should consult her doctor. For example, when exposed to rubella, the presence of IgG is immediately checked. Their presence indicates strong immune protection for both the pregnant woman and the baby. The absence of such antibodies requires further tests 3-4 and 6 weeks after exposure. Negative results give a reason to calm down. Positive test or presence clinical symptoms– a reason for additional examinations (ultrasound, cordocentesis and others).

Intrauterine infection is a whole group of ailments of both the fetus and the baby who has already been born. Reason for development similar diseases consists of infection that occurred either during pregnancy or during childbirth. As of today, there are no specific and clear statistics regarding intrauterine infections, but it is believed that at least 10% of newborns come into our world with this problem.

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

What can cause intrauterine infections?

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

• Rising. This means that pathogens enter the uterine cavity from the genital tract. There they penetrate into the tissues of the embryo itself. In this way, infection with chlamydia most often occurs, as well as diseases that are caused by enterococci.
• Descending. This is the name for infection when pathogenic microorganisms enter the uterine cavity from the fallopian tubes.
• Transplantental(it is also called hematogenous). In this way, the infection enters the fetal tissue through the placenta. In this way, a child can become infected with toxoplasmosis and a number of viral diseases.
• Contact, or intrapartum. In this case, pathogens of infectious diseases enter the baby’s mucous membranes during the process of swallowing amniotic fluid.

The main symptoms of intrauterine infection of the fetus in pregnant women

You can select following signs, suggesting that a pregnant woman has developed an intrauterine infection:

• High body temperature.
• The appearance of a rash on the skin (regardless of where on the body).
• Enlarged lymph nodes painful sensations when pressing on them.
• The appearance of shortness of breath, cough, pulling sensations in the chest.
• Development of conjunctivitis or excessive tearing of the eyes.
• Problems with joints (aching pain, swelling).

It’s worth noting right away that the cause of such symptoms is not always an intrauterine infection. However, due to the fact that it poses a serious danger to the child, if you detect the slightest suspicion, you should immediately consult a doctor for a more detailed diagnosis. Better once again visit the clinic rather than not start timely treatment of the disease.

Signs of intrauterine infection in a newborn

If the disease was not diagnosed during pregnancy, the following symptoms may indicate its presence after the birth of the child:

• jaundice, enlarged liver;
• intrauterine growth retardation;
• cataract;
• dropsy, accompanied by the formation of edema;
• skin rash;
• pneumonia;
• fever;
• myocarditis.

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

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

Who is at greater risk of becoming infected than others?

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

In other words, the main prevention of intrauterine infections is the extremely attentive and vigilant attitude of the pregnant woman to her health and to the health of the fetus. There are several categories of women for whom this can be especially difficult:

1. Employees in the healthcare industry, especially those who have direct contact with patients.
2. Children's employees educational institutions(schools, kindergartens, nurseries). This also includes women who already have children attending such institutions. It is not for nothing that sick children are advised not to be brought to kindergarten or school under any circumstances - in these institutions infectious diseases spread instantly.
3. Women who have chronic inflammatory diseases.
4. Pregnant women who have repeatedly resorted to abortion.
5. Women who have previously been pregnant and given birth to children with intrauterine infections.
6. Patients who have had incidents in the past with antenatal fetal death or the birth of a baby with developmental defects.
7. Pregnant women with untimely rupture of amniotic fluid.

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

How are intrauterine infections treated?

Whatever the causes of this disease, with timely diagnosis you can fight for the health of the fetus. Typically, treatment of the disease is carried out in the following areas:

• Taking medications. We are talking about antibiotics, and of the penicillin series, since they are the safest during gestation. If we are talking about treating an already born child, then he may be given antimicrobial drugs and a number of other medications, depending on the identified deviations from the normal state.
• Competent choice of method of childbirth. If an intrauterine infection has been diagnosed in advance, the doctor managing the patient's pregnancy will have time and enough information to choose the most appropriate method of delivery and prepare the expectant mother for it.
• Observation and treatment of children. Babies born with an intrauterine infection are monitored until the age of 5-6 years, with corrective treatment prescribed if necessary. Sometimes we even talk about performing operations that can correct a number of congenital defects.

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