lecture for medical students

1. DR.TARIG MAHMOUD
MD SUDAN
HAIL UNIVERSITY

2. Infectious disease can cause congenital
abnormalities ,increase risk of pregnancy loss
and preterm birth and can lead to serious
neonatal consequences.

3. Rubella:
is a togavirus spread by droplet transmission.
All women should be offered rubella screening
early in their pregnancy, women who are antibody
is not detected, rubella vaccination after
pregnancy should be advised.
Vaccination during pregnancy is contra -indicated

4. Clinical features:
a febrile rash but may be asymptomatic in the
mother in 20–50 per cent of cases.
Features of congenital rubella syndrome include
1)sensorineural deafness.
2)congenital cataracts.
3)blindness.
4)encephalitis .
5)endocrine problems.

5. Management:
If infection occurred prior to 16 weeks gestation,
termination of pregnancy should be offered.
If the infection occurs later in pregnancy the
woman should be given appropriate information
and reassured.

6. Toxoplasmosis:
Toxoplasma gondii is a protozoan parasite found
in cat faeces, soil or uncooked meat.
 Infection occurs by ingestion of the parasite from
undercooked meat or from unwashed hands.

7. Clinical features:
Severely infected infants may have:
1)ventriculomegaly .
2)Microcephaly.
3) chorioretinitis.
4)cerebral calcifi cation.

8. Management:
The diagnosis of primary infection with
toxoplasmosis during pregnancy is made by the
Sabin-Feldman dye test .
Spiramycin treatment can be used in pregnancy(a
3-week course of 2–3 g per day).

9. Cytomegalovirus:
Cytomegalovirus (CMV) is a DNA herpes virus.
transmitted by respiratory droplet and is excreted
in the urine.
about 60 per cent of women are already immune
and the incidence of infection in pregnancy is
estimated to be around 1–2 per cent

10. Clinical features:
 No symptoms or mild non-specific flu-like
symptoms in the mother.
 The diagnosis is made after abnormalities are
seen in the fetus on U/S. The main features seen
in an affected fetus are FGR, microcephaly,
ventriculomegaly, ascites or hydrops.

11. Or after delivery blindness, deafness or
developmental delay.
 The neonate can also be anaemic and
thrombocytopenic,with hepatosplenomegaly,
jaundice and a purpural rash.

12. Management:
diagnosis made by demonstrating CMV
antibodies in a seronegative woman, who initially
develops CMV IgM antibody, and subsequently
IgG antibody.
If there is a suspicion that the fetus may be
infected, amniotic fluid can be tested.
If abnormalities are detected on ultrasound and
these are felt to be due to congenital CMV
infection, termination of pregnancy should be
offered.

13. Chickenpox:
is caused by the varicella zoster virus (VZV), a
herpes virus which is transmitted by droplet
spread.
About 90% of adults are immune to chickenpox
and approximately one in 200 women will
contract chickenpox during their pregnancy.

14. Clinical features:
pregnant women are more vulnerable to
chickenpox and may develop a serious
pneumonia,hepatitis or encephalitis.
It may also cause the fetal varicella syndrome
(FVS) or varicella infection of the newborn.

15. FVS is characterized by one or more of the
following:
1) skin scarring in a dermatomal distribution;
2) eye defects (microphthalmia, chorioretinitis,
cataracts).
3) hypoplasia of the limbs.
4) neurological abnormalities (microcephaly,
cortical atrophy, developmental delay &dysfunction
of bowel and bladder sphincters).

16. Management:
If the pregnant woman is not immune to VZV and
she has had a significant exposure, she should be
given varicella zoster immuno -globulin (VZIG) as
soon as possible.
 VZIG is effective when given up to 10 days after
contact and may prevent or attenuate the disease.

17. Women who have had exposure to chickenpox
should be asked to notify their doctor early if a
rash develops.
oral aciclovir 800 mg five time per day for 7 days
be prescribed for pregnant women with
chickenpox if they present within 24 hours of the
onset of the rash.

18. Parvovirus
Parvovirus is a relatively common infection in
pregnancy, and is spread by droplet infection.
Fifty per cent of women at childbearing age are
immune to PVB19 infection and therefore 50 per
cent are susceptible to infection during pregnancy

19. Clinical features:
mild flu-like illness.
Hydrops fetalis on U/S due to fetal an aplastic
anaemia.

20. Management
diagnosis is made by demonstrating sero -
conversion of the mother, who develops IgM
antibodies to parvovirus, having previously tested
negative.
A hydropic fetus may recover spontaneously as
the mother and fetus recover from the virus, or
may require treatment by in utero transfusion.

21. Listeria
 Listeria monocytogenes is an aerobic and
facultatively anaerobic motile Gram-positive
bacillus.
The incidence of listeria infection in pregnant
women is estimated at 12 per 100 000.
Contaminated food is the usual source of
infection(unpasteurized milk, ripened soft
cheeses and pâté).

22. Clinical features
flu-like illness with fever and general malaise.
Transmission to the via the ascending route
through the cervix, or transplacentally.
Approximately 20 per cent of affected pregnancies
result in miscarriage or stillbirth.
 Premature delivery occur in over 50 %.

23. diagnosis of listeria depends on clinical suspicion
and isolation of the organism from blood, vaginal
swabs or the placenta.
Meconium staining of the amniotic fluid in
apreterm fetus increase clinical suspicion.
For women with listeriosis during pregnancy,
intravenous antibiotic treatment (ampicillin 2 g
given every 6 hours) is indicated.

24. Thank you