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

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

Intrauterine infection during pregnancy: what statistics say

1. A timely diagnosed and treated infectious disease in a pregnant woman poses minimal danger to her child.
2. Infectious agents pass from mother to baby in 10 out of 100 pregnancies.
3. 0.5% of infants infected in the womb are born with corresponding signs of the disease.
4. An infection that has settled in the mother’s body does not necessarily pass to the fetus, and the child has a chance to be born healthy.
5. A number of infectious diseases that do not promise anything good for the baby may be present in the mother in a latent form and have virtually no effect on her well-being.
6. If a pregnant woman gets sick with one or another infectious disease for the first time, there is a high probability that her child will also become infected.

Intrauterine infection - ways of infection of the embryo

There are four ways that infectious agents can enter a tiny growing organism:

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

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

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

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

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

• state of shock;
• pneumonia;
• sepsis (blood poisoning).

Some time after birth, acute intrauterine infection in newborns may manifest itself with the following signs:

• excess daily sleep duration;
• poor appetite;
• insufficient physical activity, which decreases every day.

If the congenital infection is chronic, there may be no clinical picture at all. Distant signs of intrauterine infection include:

• complete or partial deafness;
• mental health disorders;
• vision pathologies;
• lagging behind peers in motor development.

Penetration of infection to the fetus through the uterus leads to the following consequences:

• stillbirth of a baby;
• intrauterine embryonic death;
• frozen pregnancy;
• spontaneous abortion.

The following pathological consequences are recorded in children who survived such infection:

• high temperature;
• rash and erosive skin lesions;
• non-immune hydrops fetalis;
• anemia;
• enlarged liver due to jaundice;
• pneumonia;
• pathologies of the heart muscle;
• pathology of the eye lens;
• microcephaly and hydrocephalus.

Intrauterine infection: who is at risk

Every expectant mother runs the risk of being captured by an infectious agent, because during pregnancy her body’s defenses are depleted to the limit. But the greatest danger awaits women who:

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

Symptoms of intrauterine infection in a woman during pregnancy

Doctors identify several universal signs that suggest that the expectant mother has contracted an infectious disease:

• sudden increase in temperature, fever;
• shortness of breath when walking or climbing stairs;
• cough;
• rash on the body;
• enlarged lymph nodes that react painfully to touch;
• painful joints that appear swollen;
• conjunctivitis, lacrimation;
• nasal congestion;
• painful sensations in the chest.

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

Causes of intrauterine infection during pregnancy

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

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

1. Acute and chronic diseases of the mother in the genitourinary system. Among them are inflammatory pathologies such as cervical ectopia, urethritis, cystitis, and pyelonephritis.
2. The mother has an immunodeficiency state or HIV infection.
3. Organ and tissue transplantation that the woman has undergone in the past.

Intrauterine infections: main characteristics and routes of infection

Cytomegalovirus (CMV)

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

During the primary infection of a pregnant woman, the microorganism penetrates the placenta and infects the fetus. In some cases, the baby does not experience any abnormal consequences after infection. But at the same time, statistics say: 10 babies out of 100, whose mothers encountered an infection during pregnancy, have pronounced signs of intrauterine infection.

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

• spontaneous abortion;
• stillbirth;
• hearing loss of sensorineural origin;
• low birth weight;
• hydro- and microcephaly;
• pneumonia;
• lag in the development of psychomotor skills;
• pathological enlargement of the liver and spleen;
• blindness of varying severity.

Cytomegalovirus under a microscope

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

Unfortunately, there are no medications yet that can eliminate the symptoms of CMV in newborns. If a pregnant woman is diagnosed with cytomegalovirus infection, the pregnancy is abandoned because the child has a chance to remain healthy. The expectant mother will be prescribed an appropriate course of treatment to minimize the effect of the disease on her body.

Intrauterine infection - herpes simplex virus (HSV)

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

When a child’s body is affected by a herpes infection, the consequences are severe:

• pneumonia;
• visual impairment;
• brain damage;
• skin rash;
• high temperature;
• poor blood clotting;
• jaundice;
• apathy, lack of appetite;
• stillbirth.

Severe cases of infection result in mental retardation, cerebral palsy and a vegetative state.

Herpes simplex virus under a microscope

Intrauterine infection - rubella

This disease is rightfully considered one of the most life-threatening embryos. The route of transmission of the rubella virus is airborne, and infection is possible even over a long distance. The disease, which poses a particularly great threat before the 16th week of pregnancy, “programs” various deformities in the development of the baby:

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

Intrauterine infection - parvovirus B19

The presence of this virus in the body provokes the development of a disease known as erythema infectiosum. In adults, the disease does not manifest itself in any way because it is latent. However, the consequences of the pathology for the fetus are more than serious: the child may die before birth, and there is also a threat of spontaneous abortion and intrauterine infection. On average, infected children die in 10 cases out of 100. At 13–28 weeks of pregnancy, the fetus is especially defenseless against this infection.

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

• swelling;
• anemia;
• brain damage;
• hepatitis;
• myocardial inflammation;
• peritonitis.

Intrauterine infection - chickenpox

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

Congenital chickenpox is identified by the following characteristics:

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

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

Intrauterine infection - hepatitis B

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

• hepatitis B, which can be treated with the appropriate approach;
• liver cancer;
• indolent form of hepatitis B;
• acute form of hepatitis B, which provokes the development of liver failure in the child and he dies;
• delay in the development of psychomotor functions;
• hypoxia;
• miscarriage.

Intrauterine infection - human immunodeficiency virus (HIV)

HIV infection is a scourge for special immune lymphocytes. In most cases, infection occurs during sexual intercourse with a sick partner. A child can become infected while in the womb or during birth. Intensive complex treatment is recommended for HIV-infected children, otherwise they will not live even two years - the infection quickly “eats” the weak body. Infected children die from infections that do not pose a mortal danger to healthy children.

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

Intrauterine infection - listeriosis

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

• rash and multiple accumulations of pustules on the skin;
• inflammation of the brain;
• refusal of food;
• sepsis;
• spontaneous miscarriage;
• stillbirth of a baby.

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

Intrauterine infection - syphilis

If a pregnant woman has syphilis, which she has not treated, the probability of infecting her child is almost 100%. Out of 10 infected babies, only 4 survive, and those who survive are diagnosed with congenital syphilis. The child will become infected even if the mother’s disease is latent. The results of the infection in the child’s body are as follows:

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

Intrauterine infection - toxoplasmosis

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

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

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

Tests for intrauterine infections during pregnancy

Over the course of 9 months, the expectant mother will have to undergo more than one laboratory test so that doctors can make sure that she is healthy. Pregnant women take a blood test for hepatitis B and C, and syphilis. The PRC method is also used for pregnant women, thanks to which it is possible to detect active viruses in the blood, if any. In addition, expectant mothers regularly visit the laboratory to take a vaginal smear for microflora.

Ultrasound examination is of no small importance for successful pregnancy management. This method is absolutely safe for the fetus. And although this procedure is not directly related to the diagnosis of infectious diseases, with its help doctors can detect abnormalities of intrauterine development caused by pathogenic microorganisms. There is every reason to talk about an intrauterine infection if the following symptoms become obvious on an ultrasound:

1. Formed developmental pathologies.
2. Polyhydramnios or oligohydramnios.
3. Swelling of the placenta.
4. Enlarged abdomen and unnaturally enlarged structural units of the kidneys.
5. Enlarged internal organs: heart, liver, spleen.
6. Foci of calcium deposition in the intestines, liver and brain.
7. Enlarged ventricles of the brain.

In the diagnostic program for examining expectant mothers belonging to the risk groups we discussed above, a special place is occupied by the seroimmunological method for determining immunoglobulins. As necessary, doctors resort to amniocentesis and cordocentnesis. The first method of research is to study amniotic fluid, the second involves studying umbilical cord blood. These diagnostic methods are very informative in detecting infection. If the presence of an intrauterine infection is suspected in a baby, then the material for research is the baby’s biological fluids - for example, saliva or blood.

Danger of TORCH infections during pregnancy. Video

beremennuyu.ru

Intrauterine infection during pregnancy, risk of IUI

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

Reasons

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 in recent years there have been certain changes in the structure of intrauterine infections, which is associated with the improvement of diagnostic methods and the identification of new pathogens (for example, listeria).

The infection can 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, cesarean section).
• Abortions and complications in the postpartum period (previous).
• Cervical insufficiency.
• Polyhydramnios.
• Fetoplacental insufficiency.
• 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, heavy physical exertion, 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 of the immune system), and the 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 fetal intoxication with products of microbial metabolism, metabolic disorders and hemocirculation with hypoxia. As a result, fetal development suffers and differentiation of internal organs is disrupted.

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).

Children infected during the prenatal period exhibit disturbances in many vital systems, including the nervous, cardiovascular, respiratory, humoral, and immune systems. 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 of neurological disorders are revealed: deafness, slowing of neuropsychic development (mild mental retardation). Unfortunately, these disorders are irreversible. They may progress to the development of cerebral palsy or epilepsy. In addition, congenital infection can manifest itself:

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

These disorders disappear over a 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 of a chronic disease. Then the child becomes infected through contact, passing through the affected genital tract during childbirth. Intrauterine infection occurs less frequently; it occurs before the natural end of pregnancy, when the amniotic sac bursts, or at other times - from the first to the third trimester.

Infection of the fetus in the first months of pregnancy is accompanied by heart defects, hydrocephalus, anomalies of the digestive system, intrauterine growth retardation, and 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 several systems and organs are involved in the pathological process.

Rubella

A child can become infected from the mother at any stage of pregnancy, and the clinical manifestations will depend on the time of infection. The disease is accompanied by damage to the placenta and fetus, intrauterine death of the latter, or does not 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 disorders, hepatitis, pneumonia. But in many children born infected, no pathology is detected, and in the first five years of life problems begin - hearing deteriorates, psychomotor development slows down, autism and diabetes mellitus 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.

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

Additional diagnostics

Prenatal diagnosis of infectious lesions of the fetus is of great importance. To determine pathology, laboratory and instrumental methods are used to identify the pathogen and identify abnormalities in the development of the child at various stages of 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 and proper management of pregnancy also play an important role.

flovit.ru

Intrauterine infections - symptoms, treatment, forms, stages, diagnosis

Intrauterine infection (IUI) is understood as infectious and inflammatory diseases of the fetus and young children that occur during the antenatal (prenatal) and (or) intranatal (natal) periods with vertical infection from the mother.

It is necessary to distinguish between the concepts of “intrauterine infection” and “intrauterine infection”. Infection implies the penetration of a pathogen into the child’s body without developing a clinical picture, while intrauterine infection is the full implementation of intrauterine infection in the form of a clinical manifestation of an infectious disease.

According to the results of some studies, infection is detected in approximately 50% of full-term and 70% of premature infants. According to more “optimistic” data, every tenth fetus (child) is exposed to pathogenic agents during pregnancy and childbirth.

In 80% of cases, IUI complicates the child’s health with a variety of pathological conditions and developmental defects of varying severity. Based on the results of the autopsy, it is determined that in every third case, perinatal infection was the main cause of death of the newborn, accompanying or complicating the course of the underlying disease.

Long-term studies show that children of the first years of life who have suffered an intrauterine infection have weaker immune capabilities and are more susceptible to infectious and somatic diseases.

In the early 70s of the 20th century, the World Health Organization proposed the name “TORCH syndrome”. This abbreviation reflects the names of the most common intrauterine infections: T - toxoplasmosis, O - others (mycoplasma, syphilis, hepatitis, streptococci, candida, etc.) (Other), R - rubella (Rubella), C - cytomegalovirus (Cytomegalovirus), H – herpes (Herpes). If the etiological factor is not known for certain, they speak of TORCH syndrome.

Causes and risk factors

The main source of infection in IUI, as already noted, is the mother, from whom the pathogen enters the fetus during the ante- and (or) intranatal period (vertical transmission mechanism).

The causative agents of intrauterine infection can be bacteria, fungi, protozoa, and viruses. According to statistics, the first place in the structure of intrauterine infections is occupied by bacterial diseases (28%), followed by chlamydial and associated infections (21%).

Infectious agents that are the most common causes of intrauterine infection:

• rubella viruses, herpes simplex, chickenpox, hepatitis B and C, influenza, adenoviruses, enteroviruses, cytomegalovirus;
• pathogenic bacteria (Escherichia, Klebsiella, Proteus and other coliform bacteria, group B streptococci, Haemophylus influenzae, alpha-hemolytic streptococci, non-spore-forming anaerobes);
• intracellular pathogens (toxoplasma, mycoplasma, chlamydia);
• mushrooms of the genus Candida.

Risk factors for intrauterine infection:

• chronic diseases of the urogenital area in the mother (erosive lesions of the cervix, endocervicitis, colpitis, vulvovaginitis, ovarian cyst, urethritis, cystitis, pyelo- and glomerulonephritis, etc.);
• infectious diseases suffered by the mother during pregnancy;
• long waterless period.

Factors indirectly indicating possible intrauterine infection:

• complicated obstetric history (spontaneous abortion, infertility, stillbirth, birth of children with multiple malformations);
• polyhydramnios, the presence of inclusions and impurities in the amniotic fluid;
• fever not accompanied by signs of inflammation in any organ system that developed in the mother during pregnancy or childbirth;
• the birth of a premature baby before the due date;
• intrauterine growth retardation;
• Apgar score 0–4 points in the 1st minute of the child’s life, with unsatisfactory indicators remaining or a deterioration in the score by the 5th minute of life;
• newborn fever of unknown etiology.

Forms of the disease

Depending on the stage of pregnancy at which the infection occurred, there are:

• blastopathy - occurs during the first 14 days of pregnancy;
• embryopathies - appear in the period from 15 days of pregnancy to 8 weeks;
• fetopathy - develops after 9 weeks of pregnancy (early fetopathy - from the 76th to the 180th day of pregnancy, late fetopathy - from the 181st day of pregnancy until the moment of birth).

An intrauterine infection that develops in the first 2 weeks of pregnancy most often leads to the death of the embryo (frozen pregnancy) or the formation of severe systemic malformations, similar to genetic developmental anomalies. Spontaneous termination of pregnancy, as a rule, occurs 2-3 weeks after infection.

Since all organs and systems are formed in the embryonic period, the development of IUI at these stages will lead to the death of the embryo or, as in the previous case, to the formation of malformations of varying severity.

Fetopathies have a number of characteristics:

• congenital defects occur only in those organs whose formation was not completed at the time of the child’s birth;
• infectious processes are more often of a generalized (widespread) nature;
• the infection is often accompanied by the development of thrombohemorrhagic syndrome;
• morphological and functional maturation of organs occurs with a lag.

The World Health Organization (ICD-10) has proposed an extensive classification of intrauterine infections, the main forms of which are:

Symptoms

Often, intrauterine infections do not have characteristic symptoms, so their presence can be suspected by nonspecific signs of an infectious-inflammatory process in a newborn (their similarity is noted in IUI provoked by various pathogens):

• decreased or lack of appetite;
• significant weight loss (decrease in body weight by more than 10% of initial birth weight);
• repeated weight loss, poor restoration of body weight (slow gain, slight gain);
• inflammation of the skin and subcutaneous fat (sclerema);
• lethargy, drowsiness, apathy;
• grayish-pale coloration of the skin, anemic mucous membranes, possible icteric coloration of the skin and mucous membranes, icterus of the sclera;
• edematous syndrome of varying severity and localization;
• respiratory disorders (shortness of breath, short-term episodes of respiratory arrest, involvement of auxiliary muscles in the act of breathing);
• dyspeptic disorders (regurgitation, including heavy regurgitation, unstable stools, enlarged liver and spleen);
• symptoms of involvement of the cardiovascular system (tachycardia, decreased blood pressure, swelling or pastiness, cyanotic staining of the skin and mucous membranes, marbling of the skin, coldness of the extremities);
• neurological symptoms (hyper- or hypotonicity, dystonia, decreased reflexes (including worsening of the sucking reflex);
• changes in the blood count (leukocytosis, accelerated ESR, anemia, decreased platelet count).

Signs of intrauterine infection often manifest in the first 3 days of a newborn’s life.

Diagnostics

When diagnosing IUI, data from anamnesis, laboratory and instrumental research methods are taken into account:

• general blood test (leukocytosis with a neutrophilic shift to the left, accelerated ESR);
• biochemical blood test (for markers of the acute phase reaction - C-reactive protein, haptoglobin, ceruloplasmin, plasminogen, alpha-1-antitrypsin, antithrombin III, C3-fraction of complement, etc.);
• classical microbiological techniques (virological, bacteriological);
• polymerase chain reaction (PCR);
• direct immunofluorescence method using monoclonal antibodies;
• enzyme-linked immunosorbent assay (ELISA) with quantitative determination of specific antibodies of the IgM and IgG classes;
• Ultrasound of the abdominal organs, heart, brain.

Treatment

Treatment of intrauterine infection is complex and consists of etiotropic and symptomatic components:

Pregnancy outcomes with IUI:

• intrauterine fetal death;
• stillbirth;
• the birth of a live viable or live non-viable (with developmental defects incompatible with life) child with signs of intrauterine infection.

Complications of intrauterine infection:

• malformations of internal organs;
• secondary immunodeficiency;
• a child’s lagging behind peers in physical and mental development.

Forecast

With timely diagnosis and comprehensive treatment of intrauterine infection that occurs in later stages, the prognosis is generally favorable (the prognosis improves as the gestational age at which the infection occurs increases), although it is purely individual.

The likelihood of a favorable outcome of the disease depends on many characteristics: the virulence of the pathogen, its type, method of infection, the presence of concomitant pathology and aggravating factors on the part of the mother, the functional state of the pregnant woman’s body, etc.

When IUI occurs in the early stages, the prognosis is usually unfavorable.

Prevention

Prevention of the development of IUI is as follows:

• prevention of infectious diseases of the mother (sanitation of foci of chronic inflammation, timely vaccination, screening of pregnant women for the presence of TORCH infections);
• antibacterial or antiviral therapy for pregnant women with the development of acute or exacerbation of chronic infectious inflammation;
• examination of newborns from high-risk mothers;
• early vaccination of newborns.

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Intrauterine infections in newborns

intrauterine infection

Currently, a paradoxical situation has arisen in the Russian Federation, when the emerging trend towards an increase in the birth rate and a decrease in perinatal mortality is combined with a deterioration in the quality of health of newborns, an increase in the proportion of congenital defects and infectious pathology among the causes of infant mortality. High infection of the adult population with viruses, protozoa and bacteria determines the significant prevalence of intrauterine infections in newborns. The source of infection for the fetus is always the mother. The pathogen can penetrate the fetus antenatally and intranatally; the result of this penetration can be two clinical situations, called “intrauterine infection” and “intrauterine infection”. These concepts are not identical.

Intrauterine infection should be understood as the alleged fact of intrauterine penetration of microorganisms into the fetus, in which no signs of an infectious disease of the fetus are detected.

Intrauterine infection should be understood as the established fact of intrauterine penetration of microorganisms into the fetus, in which pathophysiological changes characteristic of an infectious disease occurred in the body of the fetus and/or newborn, detected prenatally or shortly after birth.

Most cases of suspected intrauterine infection are not accompanied by the development of an infectious disease. The frequency of clinical manifestation of intrauterine infection in a newborn depends on the properties of the microorganism, the routes and timing of its transmission from the pregnant woman to the fetus and averages about 10% of all cases of intrauterine infection (varying in the range from 5% to 50%).

The high-risk group for intrauterine infection includes: pregnant women with obstetric pathology (threat of miscarriage, spontaneous miscarriages, premature birth, non-developing pregnancy, antenatal death and fetal development abnormalities); women who suffered acute infections during pregnancy, who have foci of chronic infection, especially in the genitourinary area, as well as those who experienced infectious complications in the early postpartum period.

Risk factors for intrapartum infection are a long anhydrous period, the presence of meconium in the amniotic fluid, fever during labor in the mother, and the birth of a child with asphyxia, requiring the use of artificial ventilation.

The clinical picture of intrauterine infection in a newborn depends on a number of factors. Of great importance is the fact of primary maternal illness during pregnancy, when the primary immune response is significantly reduced. In this case, as a rule, a severe, often generalized form of the disease develops; The pathogen penetrates the fetus transplacentally. If a pregnant woman is immune to infection, then intrauterine infection or a mild form of the disease is possible.

The clinical picture of intrauterine infection in a newborn is significantly influenced by the period of penetration of the infectious agent to the fetus. In the case of viral infection of the fetus in the embryonic period of development, antenatal death or multiple developmental defects are observed. At 3-5 months of intrauterine life, infectious fetopathies develop, characterized by a decrease in fetal body weight, tissue malformations, immaturity of the central nervous system, lungs, kidneys, and degenerative disorders in the cells of parenchymal organs. When an infection of the fetus occurs in the II-III trimesters of pregnancy, both signs of infectious damage to individual organs (hepatitis, myocarditis, meningitis, meningoencephalitis, chorioretinitis, etc.) and symptoms of a generalized infection can be detected.

Clinical manifestations of intrauterine infection also depend on the route of penetration of the infectious agent to the fetus. There are:

1) hematogenous (transplacental) route of penetration; as a rule, it leads to the development of a severe, generalized form of the disease and is characterized by severe jaundice, hepatitis, and multiple organ involvement;

2) ascending route of infection - more often with urogenital infection in the mother (for example, chlamydia); the pathogen penetrates the uterine cavity, affects the membranes of the fetus, and enters the amniotic fluid; the newborn develops conjunctivitis, dermatitis, lesions of the gastrointestinal tract, pneumonia, and generalization of the process is possible;

3) descending route of infection - the infectious agent penetrates through the fallopian tubes, and then - as with the ascending route of infection;

4) contact route - during birth, through the natural birth canal, for example, with genital herpes, candidal colpitis; the disease in a newborn develops in the form of lesions of the skin and/or mucous membranes, although subsequently it can also generalize.

The most typical symptoms of intrauterine infection detected in the early neonatal period are: intrauterine growth retardation, hepatosplenomegaly, jaundice, rash, respiratory distress, cardiovascular failure and severe neurological impairment. Considering that the combination of the above symptoms occurs during intrauterine infections of various etiologies, the term “TORCH syndrome” is used in the English literature to refer to the clinical manifestations of intrauterine infection. In this abbreviation, “T” means toxoplasmosis, “R” means rubella, “C” means cytomegaly, “H” means herpes infectio, and “O” means other infections (other). “Other infections” that manifest themselves in the neonatal period as TORCH syndrome currently include syphilis, listeriosis, viral hepatitis, chickenpox, etc.

In recent years, there has been a trend towards an increase in the frequency of mixed viral-viral and viral-bacterial infections.

Laboratory diagnostics

All newborns with typical manifestations of intrauterine infection, as well as children from a high-risk group, if their condition worsens in the early neonatal period, should undergo a targeted laboratory examination for TORCH infection in order to establish or objectively confirm the etiology of the disease.

The diagnosis of intrauterine infection is always clinical and laboratory. The absence of clinical manifestations of an infectious disease in the perinatal period in most cases makes laboratory testing for TORCH infections inappropriate. An exception may be a routine examination of clinically healthy newborns from mothers with tuberculosis, syphilis and genital herpes (if it worsens shortly before birth).

Based on the ability to identify the causative agent of infection, laboratory diagnostic methods can be divided into two groups: direct, which allows one to detect viruses or microorganisms in biological fluids or tissues of a child (fetus), and indirect ones, which allows one to register a specific immune response of a child (fetus) to viruses or microorganisms.

Direct methods include:

• Microscopy (electronic or direct, e.g. dark field)
• Detection of viral or bacterial antigens (including one-step immunoenzyme and immunochromatographic methods)
• Polymerase chain reaction (PCR)
• Culture method.

Direct laboratory diagnostic methods can detect the presence of the pathogen in biological fluids or tissue biopsies of an infected child. However, their sensitivity and specificity significantly depend on the type of pathogen being detected, the quality of laboratory equipment and reagents. Therefore, the results of a child’s examination conducted in different clinical and research laboratories may be different.

Despite the fact that in recent years the PCR method has been rapidly developing as a highly sensitive and specific method, the “gold standard” for diagnosing all bacterial and a number of viral infections (including rubella and herpes) is the cultural method. The most reliable method for diagnosing syphilis to date remains the detection of treponemal antigen by the immune fluorescence reaction and the immobilization reaction of treponema pallidum.

Indirect (indirect) methods include the so-called serological methods, of which the most informative is the enzyme immunoassay method for determining specific IgG, IgM, IgA (ELISA). The sensitivity and specificity of serological methods for detecting infections in newborns is significantly worse than in older children and adults, which is associated with the characteristics of the immune response and the presence of maternal antibodies in their blood. However, from a technical point of view, these methods are quite simple, which makes it possible to use them for primary screening for intrauterine infection.

When using serological diagnostic methods, you should remember:

1) the examination must be carried out before the use of donor blood products in the treatment of a child;

2) the results of the examination of the child must always be compared with the results of the examination of the mother;

3) the presence of specific immunoglobulins of the IgG class in a titer equal to or less than the titer of the corresponding maternal antibodies does not indicate intrauterine infection, but the transplacental transfer of maternal antibodies;

4) the presence of specific immunoglobulins of the IgM class in any titer indicates the primary immune response of the fetus or newborn to the corresponding bacterial/viral antigen and may be an indirect sign of infection;

5) the absence of specific immunoglobulins of the IgM class in the blood serum of newborns in a number of diseases (including neonatal herpes) does not exclude the possibility of intrauterine (intrapartum) infection.

Emergency care for asphyxia of a newborn

– a group of diseases of the fetus and newborn that develop as a result of infection in the prenatal period or during childbirth. Intrauterine infections can lead to fetal death, spontaneous abortion, intrauterine growth retardation, premature birth, the formation of congenital defects, damage to internal organs and the central nervous system. Methods for diagnosing intrauterine infections include microscopic, cultural, immunoenzyme, and molecular biological studies. Treatment of intrauterine infections is carried out using immunoglobulins, immunomodulators, antiviral and antibacterial drugs.

General information

Intrauterine infections are pathological processes and diseases caused by antenatal and intrapartum infection of the fetus. The true prevalence of intrauterine infections has not been established, however, according to generalized data, at least 10% of newborns are born with congenital infections. The relevance of the problem of intrauterine infections in pediatrics is due to high reproductive losses, early neonatal morbidity, leading to disability and postnatal death of children. Issues of preventing intrauterine infections lie in the area of ​​consideration of obstetrics and gynecology, neonatology, and pediatrics.

Causes of intrauterine infections

Intrauterine infections develop as a result of infection of the fetus in the prenatal period or directly during childbirth. Typically, the mother is the source of intrauterine infection for the child, i.e., there is a vertical transmission mechanism, which in the antenatal period is realized by transplacental or ascending (through infected amniotic fluid) routes, and in the intranatal period by aspiration or contact routes.

Iatrogenic infection of the fetus occurs less frequently during pregnancy when a woman undergoes invasive prenatal diagnostics (amniocentesis, cordocentesis, chorionic villus biopsy), the introduction of blood products to the fetus through the vessels of the umbilical cord (plasma, red blood cells, immunoglobulins), etc.

In the antenatal period, infection of the fetus is usually associated with viral agents (rubella, herpes, cytomegaly, hepatitis B and Coxsackie viruses, HIV) and intracellular pathogens (toxoplasmosis, mycoplasmosis).

In the intranatal period, microbial contamination more often occurs, the nature and extent of which depends on the microbial landscape of the mother’s birth canal. Among the bacterial agents, the most common are enterobacteria, group B streptococci, gonococci, Pseudomonas aeruginosa, Proteus, Klebsiella, etc. The placental barrier is impermeable to most bacteria and protozoa, however, if the placenta is damaged and fetoplacental insufficiency develops, antenatal microbial infection can occur (for example, with the causative agent of syphilis ). In addition, intrapartum viral infection cannot be ruled out.

Factors in the occurrence of intrauterine infections are a burdened obstetric and gynecological history of the mother (nonspecific colpitis, endocervicitis, STDs, salpingophoritis), unfavorable course of pregnancy (threat of miscarriage, gestosis, premature placental abruption) and infectious morbidity of the pregnant woman. The risk of developing a manifest form of intrauterine infection is significantly higher in premature infants and in cases where a woman is primarily infected during pregnancy.

The severity of clinical manifestations of intrauterine infection is influenced by the timing of infection and the type of pathogen. So, if infection occurs in the first 8-10 weeks of embryogenesis, pregnancy usually ends in spontaneous miscarriage. Intrauterine infections that occur in the early fetal period (before 12 weeks of gestation) can lead to stillbirth or the formation of gross malformations. Intrauterine infection of the fetus in the second and third trimester of pregnancy is manifested by damage to individual organs (myocarditis, hepatitis, meningitis, meningoencephalitis) or a generalized infection.

It is known that the severity of the manifestations of the infectious process in a pregnant woman and in the fetus may not coincide. An asymptomatic or minimally symptomatic course of infection in the mother can cause severe damage to the fetus, including its death. This is due to the increased tropism of viral and microbial pathogens towards embryonic tissues, mainly the central nervous system, heart, and organ of vision.

Classification

The etiological structure of intrauterine infections suggests their division into:

To designate the group of the most common intrauterine infections, the abbreviation TORCH syndrome is used, combining toxoplasmosis, rubella, cytomegalovirus, and herpes simplex. The letter O (other) denotes other infections, including viral hepatitis, HIV infection, chicken pox, listeriosis, mycoplasmosis, syphilis, chlamydia, etc.).

Symptoms of intrauterine infections

The presence of intrauterine infection in a newborn may be suspected already during childbirth. Intrauterine infection may be indicated by the discharge of turbid amniotic fluid, contaminated with meconium and having an unpleasant odor, and the condition of the placenta (plethora, microthrobosis, micronecrosis). Children with intrauterine infection are often born in a state of asphyxia, with prenatal malnutrition, enlarged liver, malformations or stigmas of dysembryogenesis, microcephaly, hydrocephalus. From the first days of life, they have jaundice, elements of pyoderma, roseolous or vesicular rashes on the skin, fever, convulsions, respiratory and cardiovascular disorders.

The early neonatal period with intrauterine infections is often aggravated by interstitial pneumonia, omphalitis, myocarditis or carditis, anemia, keratoconjunctivitis, chorioretinitis, hemorrhagic syndrome, etc. During instrumental examination, congenital cataracts, glaucoma, congenital heart defects, cysts and brain calcifications may be detected in newborns .

In the perinatal period, the child experiences frequent and profuse regurgitation, muscle hypotension, central nervous system depression syndrome, and gray skin color. In the later stages, with a long incubation period of intrauterine infection, the development of late meningitis, encephalitis, and osteomyelitis is possible.

Let us consider the manifestations of the main intrauterine infections that make up the TORCH syndrome.

Congenital toxoplasmosis

After birth in the acute period, intrauterine infection manifests itself as fever, jaundice, edematous syndrome, exanthema, hemorrhages, diarrhea, convulsions, hepatosplenomegaly, myocarditis, nephritis, pneumonia. In the subacute course, signs of meningitis or encephalitis dominate. With chronic persistence, hydrocephalus with microcephaly, iridocyclitis, strabismus, and optic nerve atrophy develop. Sometimes monosymptomatic and latent forms of intrauterine infection occur.

Late complications of congenital toxoplasmosis include mental retardation, epilepsy, and blindness.

Congenital rubella

Intrauterine infection occurs due to rubella during pregnancy. The probability and consequences of fetal infection depend on the gestational age: in the first 8 weeks the risk reaches 80%; The consequences of intrauterine infection can include spontaneous abortion, embryo- and fetopathy. In the second trimester, the risk of intrauterine infection is 10-20%, in the third – 3-8%.

Babies with intrauterine infection are usually born premature or at low birth weight. The neonatal period is characterized by a hemorrhagic rash and prolonged jaundice.

Congenital herpetic infection

Intrauterine herpes infection can occur in a generalized (50%), neurological (20%), mucocutaneous form (20%).

Generalized intrauterine congenital herpetic infection occurs with severe toxicosis, respiratory distress syndrome, hepatomegaly, jaundice, pneumonia, thrombocytopenia, hemorrhagic syndrome. The neurological form of congenital herpes is clinically manifested by encephalitis and meningoencephalitis. Intrauterine herpes infection with the development of skin syndrome is accompanied by the appearance of a vesicular rash on the skin and mucous membranes, including internal organs. When a bacterial infection develops, neonatal sepsis develops.

Intrauterine herpes infection in a child can lead to the formation of developmental defects - microcephaly, retinopathy, limb hypoplasia (cortical dwarfism). Late complications of congenital herpes include encephalopathy, deafness, blindness, and delayed psychomotor development.

Diagnostics

Currently, prenatal diagnosis of intrauterine infections is an urgent task. For this purpose, in the early stages of pregnancy, smear microscopy, bacteriological culture of the vagina for flora, PCR examination of scrapings, and examination for the TORCH complex are performed. Invasive prenatal diagnostics (chorionic villus aspiration, amniocentesis with examination of amniotic fluid, cordocentesis with examination of umbilical cord blood) are indicated for pregnant women at high risk for the development of intrauterine infection. detects signs.

Treatment of intrauterine infections

General principles for the treatment of intrauterine infections involve immunotherapy, antiviral, antibacterial and syndromic therapy.

Immunotherapy includes the use of polyvalent and specific immunoglobulins, immunomodulators (interferons). Targeted antiviral therapy is carried out mainly with acyclovir. For antimicrobial therapy of bacterial intrauterine infections, broad-spectrum antibiotics (cephalosporins, aminoglycosides, carbapenems) are used; for mycoplasma and chlamydial infections, macrolides are used.

Syndromic therapy of intrauterine infections is aimed at relieving individual manifestations of perinatal damage to the central nervous system, hemorrhagic syndrome, hepatitis, myocarditis, pneumonia, etc.

rubella vaccinations, must be vaccinated no later than 3 months before the expected pregnancy. In some cases, intrauterine infections may be the basis for artificial

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Intrauterine infections

Intrauterine infections of newborns(IUI) are infectious diseases in which pathogens from an infected mother penetrate to the fetus during pregnancy or childbirth.

In newborns, IUI manifests itself in the form of severe damage to the central nervous system, heart, and organs of vision.

The time of infection of a pregnant woman, as well as the type and virulence of the pathogen, the severity of infection, the route of penetration of the pathogen, and the nature of the course of pregnancy are important in the development of the disease.

Infection of the mother occurs from Toxoplasma-infected domestic animals and birds (cattle, pigs, horses, sheep, rabbits, chickens, turkeys), wild animals (hares, squirrels). The mechanism of transmission is fecal-oral through unwashed hands after contact with soil contaminated with animal feces, consumption of unpasteurized milk, raw or undercooked meat; hematogenous - during transfusion of infected blood products. A person infected with toxoplasmosis for others not dangerous.

Infection from mother to fetus is transmitted through the placenta only once in a lifetime if she was first infected during this pregnancy. During a subsequent pregnancy or in the event of an illness before pregnancy, the fetus is not infected. This is due to the fact that the mother’s body has already developed high immunological activity to this pathogen.

Damage to the fetus in the first trimester of pregnancy leads to miscarriages, stillbirths and severe organ damage. When infected in the third trimester of pregnancy, the fetus is less likely to become infected, and the disease manifests itself in a milder form. Toxoplasmosis can be asymptomatic for a long time and can be detected in children at an older age, even at 4-14 years of age.

There are acute, subacute and chronic phases of the disease. Clinical symptoms of an infectious disease are varied and not always specific. For acute phase(generalization stage) is characterized by a general serious condition, fever, jaundice, enlarged liver and spleen, maculopapular rash. Possible dyspeptic disorders, interstitial pneumonia, myocarditis, intrauterine growth retardation. Damage to the nervous system is characterized by lethargy, drowsiness, nystagmus, and strabismus. The fetus becomes infected shortly before the birth of the child, and a severe infection that begins in utero continues after birth.

IN subacute phase(stage of active encephalitis) a child is born with symptoms of central nervous system damage - vomiting, convulsions, tremors, paralysis and paresis, progressive micro-, hydrocephalus are detected; changes in the eyes are observed - vitreous opacification, chorioretinitis, iridocyclitis, nystagmus, strabismus.

IN chronic phase Irreversible changes in the central nervous system and eyes occur - micro-, hydrocephalus, calcifications in the brain, delayed mental, speech and physical development, epilepsy, hearing loss, optic nerve atrophy, microphthalmia, chorioretinitis. Infection of the fetus occurs in the early stages, the child is born with manifestations of chronic toxoplasmosis.

Treatment. IN pyrimitamine preparations are used in treatment (chloridine, daraprim, tindurine) in combination with sulfonamides ( bactrim, sulfadimezin). Combination drugs are used fansidar or metakelfin. Effective spiramycin (rowamycin), sumamed, rulid. For active inflammation, corticosteroids are indicated. Multivitamins are a must.

To prevent toxoplasmosis, it is important to carry out sanitary educational work among women of childbearing age, identify infected women among pregnant women (screening test at the beginning and end of pregnancy), and prevent contact of pregnant women with cats and other animals;

Wash your hands thoroughly after handling raw meat. Identified infected women are treated in the first half of pregnancy spiramycin or terminate the pregnancy.

Congenital cytomegalovirus infection. The causative agent of the disease belongs to DNA viruses from the herpes family. The disease is characterized by damage to the salivary glands, central nervous system and other organs with the formation of giant cells with large intranuclear inclusions in their tissues.

The source of infection is only a person (patient or virus carrier). The virus is released from an infected body in urine, saliva, secretions, blood, and less often with feces. Shedding the virus in urine can last for several years. The transmission mechanism is predominantly contact, less often airborne, enteral and sexual.

The source of infection for newborn children is mothers who are carriers of the cytomegaly virus. Viruses penetrate to the fetus through the placenta, ascending or during childbirth, to the newborn - with infected milk, through transfusion of infected blood. Infection during childbirth occurs through aspiration or ingestion of infected amniotic fluid or secretions from the mother's birth canal.

Signs of the disease may be absent in pregnant women. asymptomatic form). If a latent infection is activated in a pregnant woman, a less intense infection of the placenta is observed. Due to the presence of specific IgG antibodies in the mother, less pronounced damage to the fetus is observed.

Damage to the fetus in early pregnancy leads to miscarriages and stillbirths. A child is born with malformations of the central nervous system, cardiovascular system, kidneys, lungs, thymus, adrenal glands, spleen, and intestines. Organ damage is fibrocystic in nature - liver cirrhosis, biliary atresia, kidney and lung cysts, cystic fibrosis. Viremia and release of the virus into the external environment are not observed, since it is in a latent state.

If infection occurs shortly before birth, during labor, the child is born with generalized form disease or it develops soon after birth. It is characterized by clinical symptoms from the first hours or days of life, involvement of many organs and systems in the process: low birth weight, progressive jaundice, enlarged liver and spleen, hemorrhages - petechiae, sometimes resembling “blueberry pie” on the skin, melena, hemolytic anemia, meningoencephalitis and small cerebral calcifications around the ventricles. Chorioretinitis, cataracts, and optic neuritis are detected. When the lungs are affected, children experience persistent cough, shortness of breath and other signs of interstitial pneumonia.

Localized form develops against the background of isolated damage to the salivary glands or lungs, liver, or central nervous system.

Diagnostics. Laboratory diagnosis is based on the results of cytological, virological and serological studies. The virus is isolated in urine sediment, saliva, and cerebrospinal fluid. Serological methods - RSK, PH, RPGA - confirm the diagnosis. ELISA, PCR and D NK hybridization are used.

Treatment. During treatment, you should make sure that there are no pathogens in the mother's milk. A specific anti-cytomegalovirus 10% immunoglobulin solution is used - cytotect, sandoglobulin(IgG). Use pentaglobin - IgM, KIP, antiviral drugs (cytosine arabinoside, adenine arabinoside, iododeoxyuridine, ganciclovir, foscarnet). Syndromic and symptomatic therapy is carried out.

It is important to observe the rules of personal hygiene when caring for newborns with jaundice and toxic-septic diseases. All pregnant women are examined for the presence of cytomegaly.

Good afternoon Using my resource, I want to congratulate and support my good friend Yulechka, who became a mother yesterday. Unfortunately, the newborn baby was diagnosed with an infectious disease and the girls will not leave the hospital anytime soon. To keep abreast of events, I made an analysis of the main childhood diseases that can be encountered immediately after childbirth. The main problem of newborn children is diseases. Both the mother and the medical staff should help the baby adapt in the first days of life. However, there are frequent cases of a child contracting infections in the maternity hospital that arise due to illness or underexamination of the mother, lack of sterility and improper behavior of doctors during childbirth.

Therefore, it is so important that from the first minutes of life the baby receives first colostrum, and then breast milk. Both products, as is known, contain a lot of substances that are useful for the child’s immunity and can protect the baby from infection in the maternity hospital.

There are also intrauterine and congenital infections. Intrauterine ones arise from disturbances in the interaction between the fetus and the placenta, and congenital ones arise from rubella, hepatitis, AIDS and herpes.

Most diseases occur in the fetus due to these viruses. In particular, cytomegalovirus infection appears due to herpes. That is why it is so important to undergo tests (including additional ones) for these diseases in the early stages of pregnancy.

Danger in the first days of life

Infections in newborns can be early or late. Early diseases include those that appear in a child in the first 72 hours of life. Late ones occur in the baby after 72 hours (or more) during his stay in the maternity hospital. Children born prematurely are especially at risk of infection.

Infections of premature babies include:

• pneumonia;
• meningitis;
• bacteremia;
• genitourinary infection.

On the one hand, these diseases still occur quite rarely, but on the other hand, they are very difficult and with complications, which in some cases leads to death. , as a rule, resolves with the use of strong antibiotics and is an inevitable option. Refusal to treat with strong medications will only worsen the situation.

Late period diseases occur due to fungi and microorganisms. In the first place are staphylococcal infection and intestinal infection, i.e., in fact, diseases of dirty hands. The symptoms of these infections are approximately the same: children sleep poorly, eat poorly and are generally quite lethargic.

Antibiotics are used for treatment, and as preventive measures - careful hygiene, when communicating with the baby - treating hands with an antiseptic.

What else should moms worry about?

Not as scary, but still unpleasant, are newborn jaundice and umbilical infection. Yellow skin in a baby indicates a high level of bilirubin in the blood. This is a natural manifestation, especially in premature babies, but here it is very important to track the increase in this pigment in tests, since the consequences are very serious - from cerebral palsy to mental retardation.

The main solution to the problem is to place the child under a so-called blue lamp, the light of which destroys bilirubin pigments.

Until now, I knew only physiological jaundice, however, it turned out that there is also breast milk jaundice, pathological jaundice and hemolytic disease. And if the pigmentary reaction to breast milk is almost natural and can be corrected (while maintaining breastfeeding), then pathological variants require serious intervention due to their strong influence on the nervous system and brain of the child.

Among children's problems, infection of the baby's navel is also noted - these are various types of suppuration that arise due to non-compliance with sterility during and after childbirth, often accompanied by staphylococcus.

The newborn may develop suppuration, swelling or ulcers at the site of the umbilical wound. Only doctors should treat such problems, since self-medication can lead to a significant deterioration in the child’s condition.

If your baby has such problems, you must agree to hospitalization, because strong remedies, in particular immunotherapy, may be needed to get rid of the infection.

Today’s post turned out to be completely sad, but I hope it will make expectant mothers think about prevention, getting rid of bad habits, timely treatment and continuity during pregnancy. After all, the same cytomegalovirus infection can be detected in the early stages, and by finding out when it occurred, you can help yourself and your unborn child.

Dear readers! I wish that you, your friends and loved ones will avoid all the troubles that I wrote about. Let the babies come into this world healthy and full of strength! I send rays of goodness to everyone, I hope for a repost.

Intrauterine infection is a viral, bacterial, or fungal infection of the embryo, fetus or newborn during gestation or childbirth. Depending on the type and severity of infection, this condition can lead to severe mental and physical developmental defects, hypoxia, death of the unborn child and, as a consequence, premature birth.

Causes of intrauterine fetal infection

The pathological process can be caused by the following microorganisms:

bacteria (damage to staphylococcus, streptococcus, tetanus, diphtheria bacillus);

viruses (rubella, chickenpox, influenza, cytomegalovirus, herpes);

fungi (for example, the genus Candida);

less often – protozoa (Toxoplasma).

All these microorganisms can disrupt the normal development of the unborn baby during the period of acute or chronic illness of the mother, by:

transplacental penetration (herpes virus, cytomegalovirus, toxoplasmosis);

ascending infection (STD, chlamydia, vaginal candidiasis);

descending infection (any inflammatory diseases of the ovaries and fallopian tubes);

direct contact (HIV/AIDS, hepatitis B, C).

Symptoms of intrauterine infection

Intrauterine infection is always a consequence of a mother's disease, which can be pronounced or hidden. For example, a fetus can receive a small amount of rubella virus even if the mother is not sick but has been in contact with someone who is sick.

The same picture is typical for an embryo affected by toxoplasma - the mother is only a carrier of the protozoan, which at the initial stage of the disease is very dangerous for the unborn child. In this case, there is a threat of intrauterine infection in the newborn.

Congenital infection can be indicated either by individual facts or by their combination:

during pregnancy up to 12 weeks: threat of miscarriage, uterine hypertonicity, miscarriage, embryo freezing, diagnosis of pathologies based on ultrasound results (malformations of the neural tube);

during gestation from 13-40 weeks: uterine hypertonicity, fetal death, threat of premature birth, diagnosis of pathologies based on ultrasound results (heart defects, myocarditis, brain malformations, congenital pyelonephritis and pneumonia, the level of development of internal organs does not correspond to the gestational age).

In some cases, a child may be born on time and be considered healthy, however, after some time he may show signs of intrauterine infection - sepsis, osteomyelitis, progressive cataracts, hepatitis.

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This is due to the possibility of transmission of microorganisms during childbirth or the so-called delayed pathology, the cause of which lies in infection during gestation.

How does intrauterine infection affect preterm birth?

Premature birth - delivery that began between 22 and 37 completed weeks of pregnancy; such a process can be early (22-27 weeks), middle (23-33 weeks) and late (33-37 weeks). The presence of an infection in the fetus can provoke this pathology for 2 reasons:

any deviations in the development of the unborn child are a process that contradicts the basic law of nature about the survival of the fittest. A woman’s body often reacts violently to abnormalities in the unborn child caused by intrauterine infection, and therefore tries in every possible way to get rid of the defective fetus, and in this case a premature baby may be born;

if the unborn child is infected due to the fact that the pregnant woman has suffered an acute or chronic form of a sexually transmitted disease (syphilis, gonorrhea), premature birth can cause a violation of the muscle tone of the uterus or loss of elasticity

Diagnosis and treatment

Intrauterine infection of a child can only be assumed based on the combination of the following indicators:

data on specific diseases suffered by a pregnant woman at a certain stage of pregnancy;

results of laboratory tests of maternal physiological fluids, including amniotic fluid and blood tests for TORCH infections (detection of rubella viruses, herpes, cytomegalovirus, toxoplasma and pallidum spirochete - the causative agent of syphilis);

ultrasound examination data that indicate pathologies of fetal development;

results of examination of parts of the umbilical cord and placenta, as well as the blood and cerebrospinal fluid of the child (if the newborn is infected by contact).

Therapeutic tactics for various intrauterine infections are different and depend on the period of gestation, the condition of the woman, the condition of the fetus, the nature and severity of the disease.