1. Infectious diseases in pregnancy
Dr Khalid Sait

2. HIV in pregnancy
• USA 1-5% Canada 1/5000
• Risk to the baby 25 %
• Risk increase in HIV patient with low CD4
count and high viral load.

3. HIV in pregnancy
• Prenatal care:
Counseling
CD4 count in first and second trimester
Torch and STD screen in first and third
trimester
Pap smear twice eight week apart Watch
for IUGR Zidovudine ( ZDV)
during pregnancy and labor and to the infant
reduce the risk to 7.2 %

4. HIV in pregnancy
• Intrapartum management:
Avoid scalp PH , Internal scalp electrode
and ARM.
May be there is benefit from C.S.

5. HIV in pregnancy
• Post partum:
No breast feeding Encourage
contraception

6. Hepatitis in pregnancy
• Exposed pregnant women should be immunize with
immunoglobulin 0.02 ml/kg IM
Neonatal infection in HBsAg positive mother:
Maternal status Neonatal infection rate
HBeAg positive 90 %
HBe Ag negative 10-20 %
Anti Hbe positive 0-10 %
Acute HBV in ist trimester 10-20 %
Acute HBVin third trimester
or with in 1 month of
delivery
80-90 %
Infant required HBIG and HBV with in 12 hours of delivery

7. Parvovirus in pregnancy
• Fifth disease , childhood exanthum
( slapped cheeks)
• Can cause intrauterine infection and lead to
fetal hemolysis and fetal anemia and then
non immune hydrops
• IgG immune
• IgM acute infection(watch the baby )

8. Rubella in pregnancy
• Rubella specific IgM that present for four
weeks or rise fourfold in IgG
• Congenital rubella syndrome
1st
month 50 % risk
Second month 25 % risk
Third m 10 % risk
Second trimester 1 % risk

9. Toxoplasmosis in pregnancy
• Four fold rise in IgG
• IgM be present for many years
• Non pregnant infected women should delay
pregnancy for 6 months
• Congenital infection can occur but often is a
symptomatic
• 90 % of symptomatic neonate will be
neurologically impaired
• Treatment with 3 g spiramycin daily apparently
reduced the severity of congenital toxoplasmosis

10. Varicella in pregnancy
• Pneumonia associated with 10 % mortality
• Fetal risk 2-5 % (rare in second half pf pregnancy)
• Neonatal risk:
mild if maternal infection was 5-20 days before
delivery
30 % risk of neonatal disseminated VZV if
maternal infection was less than 5 days before
delivery or 2 days post partum they need VZIG
• Maternal exposure:
Check for immunity if not immune give VZIG 125
iu/10 kg with in 96 hours of exposure

11. CMV and pregnancy
• Four fold rise in CMV titer considered
evidence of acute infection
• Fetal risk of congenital CMV:
40 % in first trimester
30 % in second trimester
25 % of children have squeal
Third trimester infection is
usually with out squeal

12. Listeria infection and pregnancy
• High risk of preterm labor and
Choriamnioties
• Treatment:
Iv ampicillin and gentamycin

13. Group B streptococcal infection
and pregnancy
• Most common cause of neonatal sepsis in USA
• Vaginal colonization in 5-40 % of pregnant women
• Only 1-2 % of neonate develop sepsis
• Early onset infection ( first 2 days of life) mortality up to
37 % majority in preterm infant
• Late onset infection
Onset 6-90 days after delivery
mortality up to 25 %
Frequently cause endomytrities
A symtomatic bacturia is cause of pyelonephritis and
preterm labor

14. Group B streptococcal infection
and pregnancy
• Prevention:
1- Intrapartum antibiotic prophylaxsis to
all women with positive culture
2- If no culture is available we should treat
risk factors:
1- preterm labor
2- ROM > 18 H
3- previous baby with GBS
disease 4- Maternal fever