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Infections in pregnancy 

Infections in pregnancy

Chapter:
Infections in pregnancy
Author(s):

Lawrence Impey

DOI:
10.1093/med/9780199204854.003.1415_update_001

Update:

HIV—expanded discussion of approaches to reduce the risk of mother-to-child transmission.

Streptococci—comments on recent increase in maternal deaths in the United Kingdom due to group A streptococci.

Updated on 28 Nov 2012. The previous version of this content can be found here.
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date: 28 March 2017

The mother

Maternal illness is often more severe in pregnancy, e.g. varicella, malaria, and the treatment of infections in pregnancy is complicated by potential effects of drugs on the fetus. Peri- and postpartum maternal infection is a major cause of maternal mortality.

The fetus

The effects of infection in pregnancy can be broadly categorized as follows (these are not mutually exclusive): (1) transplacental infection causing fetal malformation, e.g. treponema pallidum, rubella; (2) transplacental infection causing severe in utero illness, e.g. parvovirus; (3) neonatal infection / carrier status as a result of transplacental or intrapartum infection, e.g. HIV, herpes zoster; such neonatal infection may be severe; (4) preterm delivery, late miscarriage, perinatal death and cerebral palsy at term delivery are more common in the presence of in utero and placental infection (chorioamnionitis), e.g. Group B streptococcus.

The baby

Viral—(1) HIV—vertical transmission occurs most frequently during delivery and breastfeeding. Prevention is achieved by the use of antiretrovirals, mode of delivery planned according to the viral load at 36 weeks, and the avoidance of breastfeeding. (2) Parvovirus—transplacental infection can cause fetal anaemia and cardiac failure. (3) CMV—transplacental infection is variable, but severe neurological damage, impaired growth, and deafness may follow. (4) Herpes simplex—intrapartum infection can cause severe neonatal illness following a primary attack. (5) Herpes zoster—chickenpox in early pregnancy is occasionally teratogenic, but severe neonatal illness can follow late pregnancy disease; maternal disease is often severe. (6) Hepatitis B—vertical transmission usually causes chronic carrier status and is reduced by neonatal immunization.

Other—(1) Bacterial vaginosis—associated with preterm delivery. (2) Streptococcal infection—Group A causes puerperal sepsis, a major cause of maternal mortality worldwide, and is also responsible for much of the recent increase in the rare antepartum deaths from sepsis in the United Kingdom; group B can cause severe neonatal illness following intrapartum infection. (3) Chlamydia—associated with preterm delivery and neonatal conjunctivitis. (4) Syphilis—although rare in the West, syphilis is endemic in many countries, with transplacental infection causing congenital syphilis and perinatal death. (5) Toxoplasmosis—transplacental infection can cause severe fetal disease; treatment may prevent transmission and reduce disease severity. (6) Malaria—a major cause of neonatal mortality in parts of Africa; prevention is with nets and chemoprophylaxis.

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