Dangerous infections during pregnancy - Causes, symptoms and treatment. MF.
Infectious process is a pathological process caused by microorganisms: protozoa, bacteria and viruses, they are also called "infections".Most diseases are somehow related to microorganisms and their effect on the human body. The most dangerous infection for the body with reduced immunity, since in this case, even a minor infectious lesion can lead to serious consequences.
Immunity can be reduced for many reasons, in particular, reducing immunity during pregnancy is a physiological process necessary for the normal development of the fetus and preventing its rejection by the mother. Consequently, during pregnancy, the mother's body is extremely vulnerable and susceptible to the action of various microorganisms.
However, the infection is dangerous not only for the mother's body. Neither more nor less, and sometimes more dangerous to the fetus. Unsorted infections can lead to: infertility, interruption of pregnancy and chronic miscarriage, the formation of malformations and anomalies, fetal death. The mother needs to know what kind of infection is dangerous and how to deal with this or that disease, whether to prolong the pregnancy or interrupt it, what it is necessary to be ready, what can and what can not be treated. To do this, it is necessary to be under constant supervision of an obstetrician-gynecologist.
Bacterial infections that can be the most dangerous for the mother and fetus:
1. Chlamydia trachomatis( Chlamydia) - is found in 40% of women, in pregnant women and not. The most frequent manifestation is urethritis. In addition, women can cause: bartholinitis, endocervicitis, endometritis, salpingitis, pelvioperitonitis. Sometimes it can cause ectopic pregnancy( in the case of a long-standing sluggish process that caused adhesions in the fallopian tubes and their obstruction).May lead to termination of pregnancy in the early stages;in the absence of treatment, can give quite serious complications: fetal hypotrophy( delay in its development), premature discharge of amniotic fluid, chorionamionitis. Rarely can cause fetal death. In children born to chlamydia-sick mothers, conjunctivitis( chlamydial blenorrhea) occurs in 20% of cases, pharyngitis, vulvovaginitis and urethritis, proctitis, bronchitis and pneumonia.
2. Neisseria gonorrhoeae( gonorrhea) is an infectious disease that primarily affects the mucous membranes of the urogenital tract caused by the gonococcal and transmitted mainly through the sexual route. The disease manifests itself on the 3rd-7th day after infection;can occur acutely or chronically. It is characterized by the release of mucus, pus, burning sensation and pain in the terminal section of the urethral canal, which are very frequent in painful urination. At half of infected can not be observed symptoms, especially at the very beginning of the disease. The most prone to such a course of the disease are women. Infection of the fetus occurs most often in utero. The second possible way is during labor. Possible manifestations of fetus and newborn: gonococcal sepsis in a newborn, chorioamnionitis;gonococcal conjunctivitis, otitis externa and vulvovaginitis, neonatal ophthalmia is highly contagious and prognostically dangerous to the newborn, which can lead to blindness. Less common in children born from sick with gonorrhea of mothers, meningitis and arthritis.
3. Trichomonas vaginalis( trichomoniasis) - it is estimated that 180 million people fall ill every year! It is usually transmitted sexually, and is not rarely combined with gonococci, chlamydia, ureaplasma, fungal lesions. In women, it causes lesions of the urogenital organs, causing: vaginitis, vulvitis, urethritis, endocervicitis. In children, infection from sick mothers is possible, more often during childbirth. They are characterized by vulvovaginitis and urethritis, which do not have specific signs.
4. Mycoplasma hominis( mycoplasma) and Ureaplasma urealyticum( ureaplasma) - are microorganisms without a cell wall, which makes them resistant to antibiotics. Often they are isolated in a separate group, standing between viruses, bacteria and protozoa. Immunity to them is not persistent, it occurs in pregnancy not more often than outside of pregnancy. Mycoplasmas in women can be the cause of vaginitis, urethritis and endocervicitis. They can cause interruption, delay in development, formation of malformations of the fetus - most often with a massive infection and an acute current process. Ureaplasmosis in women is characterized by clear secretions from the genital tract, if the inflammation of the uterus and appendages, a characteristic clinical manifestation of which are pain in the lower abdomen. For the fetus and newborn is especially dangerous at a titer above 104, contributing to the interruption of pregnancy in the early stages, the retardation of intrauterine fetal development( VZRP), the development of reactive ureaplasmosis in newborns.
5. Streptococus agalactiae( Streptococcus group B) is a representative of the flora of the vagina in most women, most often it flows asymptomatically. However, during pregnancy they can play quite a serious, negative role. Although, it is necessary to mention that in most cases this infection does not lead to any serious pathological processes. It can be transmitted to the fetus and the newborn. A specific vaccine does not exist. May be the cause of severe illness, up to sepsis. For the mother are dangerous: endometritis, sepsis and urinary tract infection, meningitis, abdominal abscesses, endocarditis and necrotizing fasciitis. For a newborn: stillbirth, impaired respiratory functions, sepsis without a primary focus, meningitis.
6. Lysteria monocytogenes( Listeria) - can give serious complications to the newborn's body, as it can pass through the fetoplacental barrier( the barrier between the mother's body and the baby, preventing the passage of damaging agents to the fetus).
7. Treponema pallidum( pale spirochete is the causative agent of lyuis( syphilis)) - in pregnant women it occurs not more often than in not pregnant women. It is quite dangerous for the fetus. In the absence of observation, women during pregnancy can occur in 89% of newborns. Transmission to the fetus can pass through the transplant, can occur during childbirth( vertical transmission).With the formation of a congenital syphilis, early and late, characterized by a large number of complications is possible.
8. Mycobacterium tuberculosis( mycobacterium tuberculosis, "Koch's stick") - is most often activated in a pregnant woman who has tuberculosis or is a carrier.
Infections caused by the simplest microorganisms and fungi:
1. Candida albicans - fungal infection, is detected in 36% of pregnant women. Most often occur in the presence of the patient's diabetes, after the application of broad-spectrum antibiotics and in cases of immunodeficiency caused by HIV infection. As a rule does not affect the development of the fetus. Infection is possible when the newborn passes through the birth canal.
2. Toxoplasma gondii( toxoplasmosis) is a common and widespread infection. The urgency of this infection lies in the possibility of severe fetal damage, in view of easy penetration through the placental barrier of the fetus. In this case, intrauterine fetal death occurs, the death of a newborn as a result of generalization of the infection;the surviving children with congenital toxoplasmosis are diagnosed with severe defects of the nervous system, retina and choroid coat of the eye.
3. Malaria, especially Plasmodium Falciparum, is especially dangerous for young primiparous women who have not previously had contact with this infection. It is difficult for pregnant women, often with a fatal outcome for the mother.
Infections caused by viruses:
1. Rubella - with primary pregnancy in more than 65% of cases, the fetus is transmitted, causing severe fetal malformations, often incompatible with life. The risk to the fetus depends on the period of pregnancy at which the mother was infected. If the infection occurred in the first trimester of pregnancy, the fetal damage rate is 80%, with infection at 13-14 weeks - already 70%, with infection in 26 weeks.- 25%.When a mother is infected after 16 weeks of pregnancy, the risk to the fetus is minimal, manifested by a rare development of deafness. Symptoms of congenital rubella syndrome are divided into three groups: 1. Conditions directly associated with a viral infection, manifested during the first weeks of life: low weight, bone damage, enlarged liver and spleen, generalized lymphadenopathy and meningoencephalitis;2. Defects manifested much later - deafness, cataracts, congenital glaucoma, congenital heart defects( non-opening of the Batal duct, defects of the interventricular septum), mental retardation and microcephaly;3. Remote disorders - deafness, insulin-dependent diabetes mellitus, mental retardation.
2. Cytomegalovirus( CMV) is dangerous, mainly for the fetus, causing birth defects. The frequency and clinical severity of congenital CMV infection depends on the frequency and nature( primary or reactive) of CMV infection during pregnancy. Sensingural hearing loss is the most common consequence of congenital CMV infection. In addition, about 7% of cerebral palsy are the result of congenital CMV infection. It can also cause a multiorganic disease, the clinical manifestations of which include: enlargement of the liver and spleen, thrombocytopenia, chorioretinitis, microcephaly, etc. It should be noted that less than 10% of newborns have congenital CMV infection with mothers with it, but more than 50% are sick quite heavily.
3. Herpes simplex virus - the infection is caused by the herpes simplex virus 1 st( HSV-1) and 2-nd( HSV-2) types. As a rule it has a hidden character. It is dangerous in terms of transmission to a newborn, especially genital herpes during childbirth. In rare cases, the transmission of herpes is possible through the placenta, often in the third trimester of pregnancy. When lesions of HSV1 viruses in newborns usually process is asymptomatic, or the infection does not flow heavily, without giving serious complications. When lesions of HSV2 type develop severe neurological complications in children. The most characteristic manifestation is encephalitis, which can be extremely difficult to cause a neonatal death or the development of severe neurological complications in survivors.
4. Hepatitis - characterized by damage to liver tissue, as well as other organs and systems, is usually caused by the hepatitis A, B, C, D, E, G and F virus. Of these, B, C and D are the most dangerous and common, among themthe hepatitis D virus, as a rule, accompanies and complicates the course of the previous two. In the case of the hepatitis B virus, many newborns and children may be asymptomatic. Children with chronic viral hepatitis B are threatened by the development of exacerbation of chronic hepatitis, liver cirrhosis and primary hepatocellular carcinoma. The course of viral hepatitis C in children is poorly understood. Possible liver enlargement in size, the development of symptoms of liver failure, as well as in rare cases of symptoms of multiple organ failure and hepatocellular cancer.
5. HIV infection - the topic is so vast that it requires a separate article. It can only be noted that nonspecific symptoms are observed in HIV-infected children at an early age. About a quarter of them develop AIDS.The course of HIV in children is prone to more rapid progression than in adults. It must necessarily be said that with proper management of pregnancy and childbirth it is possible to completely exclude or minimize the possibility of infecting HIV children from infected mothers.
6. Chickenpox - as a rule, it recovers from childhood, acquiring immunity to infection. Severe cases of the course of the disease during pregnancy are observed in women who carry this infection for the first time. The frequency of deaths is significant. It can be the cause of malformations of the fetus and intrauterine fetal death, since the virus is able to penetrate the placental barrier.
7. SARS( acute respiratory viral infections) is a large group of viral pathogens that, in one way or another, can complicate the course of pregnancy, produce unwanted complications and affect the fetus and its health. The most dangerous is the flu. When infected in the first trimester of pregnancy, it is possible to form gross developmental anomalies. Up to 12 weeks of infection with the influenza virus can cause malformations by the "all or nothing" principle - either a group of vices incompatible with life will form or nothing will happen and the pregnancy will proceed normally. In the period after 12 weeks there can not be serious complications, but there is a possibility of developing fetoplacental insufficiency, hypoxia of the fetus, and a risk of premature birth. Despite what has been said above, one thing should be remembered: the absolute majority of women suffer ARVI during pregnancy and for further development of the fetus, as well as on the health of the mother, this does not affect in any way.
Doctor obstetrician-gynecologist Kupatadze D.D.