Perinatal Infections

00:01 Now we will discussed perinatal infections.

00:05 So perinatal infections are better known as the TORCHeS.

00:08 That stands for Toxoplasmosis Others Rubella CMV Herpes and HIV and S stands for syphilis.

00:19 Let's talk about those in a little bit more detail.

00:23 So toxoplasmosis is transmitted to the fetus through the cat feces.

00:28 So this is one of the reasons that we tell pregnant moms, they should not deal with their kitty litter.

00:32 The O sites are passing to the kitty litter, and if mom comes in contact with that, she can contract toxoplasmosis that's can pass to the fetus to the placenta.

00:42 The diagnosis is made serologically.

00:46 And what affects it's going to have on the fetus.

00:48 Well the fetus can develop chorioretinitis and hydrocephalus.

00:51 But it is treatable.

00:53 We do give a medication.

00:55 We can either give pyrimethamine or we can give another name for that is Daraprim.

01:01 And we give sulphadiazine along with those medications.

01:07 So varicella also known as chicken pox.

01:10 Transmission is through respiratory droplets.

01:13 So if there is coughing or sneezing and mom comes in contact with that, she can develop varicella.

01:19 The diagnose is again made through blood work.

01:22 And the affects on the fetus where chorioretinitis is one.

01:26 Encephalitis is another one and muscle atrophy.

01:28 Unfortunately there is no treatment if mom contracts varicella during the pregnancy.

01:35 The risk of congenital varicella is highest if mom contracts chicken pox five days or less before delivery.

01:42 Or 1 to 2 days after delivery.

01:44 If a mom think she may have been exposed to varicella and it's not immune she can decrease the risk of congenital varicella by receiving VZIG, A recently approved Varicella Zoster immune globulin.

01:54 Although, best given within 96 hours of exposure, it's used is approved for up to 10 days to prevent or attenuate varicella infection.

02:01 Another infection that belongs to the others group is Hepatitis B.

02:05 It is transmitted parenteral and sexual. A diagnosis is possible via the HB Antigen Test (HBsAg).

02:10 Hepatitis B in the pregnancy can lead to chronic Hepatitis of the child.

02:14 For treatment, we can provide Hepatitis B immunoglobulin and vaccination of the neonate after delivery.

02:19 A cesarian delivery is only necessary if there are obstetric complications.

02:24 Breastfeeding is allowed.

02:26 Hepatitis C is another infection that influences the fetus.

02:29 Again, it is transmitted parenteral and sexual.

02:32 Screenings are not routinely recommended.

02:34 But when suspected, there is the HCV antibody test, followed by HCV nucleic acid testing.

02:40 Within Hepatitis C infection, there's an increased risk for progressing to chronic Hepatitis.

02:44 A cesarean delivery is only necessary if there are obstetric complications, and again breastfeeding is allowed.

02:50 A Group B Hemolytic Streptococcus infection is the last one on the other infections group.

02:56 It is transmitted through delivery after passing through a colonized genital tract.

03:00 It is routinely tested for with vaginal and rectal cultures at 35-37 weeks of gestation.

03:05 Possible effects on the fetus are pneumonia, sepsis, and meningitis.

03:09 As treatment, we can use intrapartum antibiotic prophylaxis with IV penicillin G.

03:15 So Rubella.

03:19 And this is a common appearance of rubella.

03:21 Transmission again is through cough or sneezing though those water droplets.

03:27 We diagnose this serologically as well.

03:29 And as far as the affects on the fetus, congenital hearing loss is one of the biggest ones.

03:35 It's actually one of the most common causes of hearing loss that comes from infection.

03:40 Also babies can develop cataracts or something called a Blueberry Muffin rash.

03:44 And that's what this looks like.

03:46 There is not treatment available during pregnancy.

03:51 This is one of the reasons in our preconceptional labs we screen to see if mom is in fact immune to rubella.

03:58 And if not we give her the vaccine so that she can develop immunity.

04:02 CMV.

04:04 Transmission is through body fluids, such as urine, saliva, blood, tears, semen and breast milk.

04:12 Now fortunately most moms have been exposed to CMV and so they do have immunity.

04:18 However, if you are concerned that the baby may have contracted CMV, the diagnose is made by PCR of amniotic fluid.

04:25 And what are the affects on the fetus.

04:27 Congenital hearing loss, vision loss or seizures.

04:31 Unfortunately there is no treatment available during pregnancy.

04:35 Now this is an example of genital herpes and what it looks like on physical exam.

04:41 Transmission for genital herpes is through sexual transmission via body fluids.

04:47 Again the diagnosis is made serologically.

04:50 And the affect on fetus is life threatening.

04:54 It could be death or they can have CNS abnormalities.

04:58 We do have treatment.

05:00 We give antivirals to moms who have history of genital herpes.

05:03 We administer those at 36 weeks of gestation.

05:07 We want to make sure that the mom is not having an outbreak at the time of delivery.

05:11 If she is, C-section is warranted, to try to prevent transmission to the fetus.

05:16 HIV, transmission is through body fluids.

05:20 And that can be through sexual contact.

05:23 It can be through blood.

05:24 Such as sharing IV needles.

05:26 Now diagnosis is made first by the ELISA test and then confirmed by the Western blot.

05:32 Now at birth, there is no affect on the fetus.

05:36 There are no signs to tell the baby has HIV.

05:38 And the treatment is HAART therapy.

05:41 So we do recommend that during the pregnancy so that mom can keep a low viral load.

05:46 If the viral load is less than a 1000, then the transmission rate is really low.

05:51 It's less than 1%.

05:53 If a mom has a viral load of less than a 1000, she can have a vaginal delivery without worry of transmitting HIV to the fetus.

06:00 However, if the viral load is greater than 1000, we would recommend C-section to again try to decrease that risk of transmission to the fetus.

06:08 This is an example of secondary syphilis.

06:14 Transmission of syphilis is through sexual contact.

06:18 Now let's talk a little bit about the diagnosis.

06:21 So all pregnant women should be screened for syphilis at the initial visit.

06:26 And then again in the 3rd trimester if they live in a high risk area.

06:30 Screening is via RPR or VDRL.

06:33 However, this is non-specific test.

06:35 And there are other things that can make this test positive such as lupus.

06:39 So the confirmation test should be performed, anybody has a positive screen.

06:44 That confirmation test is the antibody test that you can see here, listed here.

06:50 Of note, if a patient has ever been infected with syphilis they will always have positive antibodies.

06:55 In those cases you do have to look at your RPR to determine if they have a new infection based on the titer rate.

07:03 The other way that you can confirm, syphilis is looking for treponemes on dark-field microscopy.

07:09 So with syphilis, what are the affects on the fetus? Hepatomegaly meaning a large liver.

07:15 CNS abnormalities, saddle nose and Hutchinson's teeth.

07:19 The Hutchinson's teeth is pretty diagnostic of syphilis.

07:23 So the treatment is penicillin.

07:26 Even if a patient is allergic, we still give penicillin as a treatment only in pregnancy.

07:32 If a patient is penicillin allergic, they're first desensitize to make the reaction a little bit less severe.

07:39 And then give him penicillin to make sure that they can have their syphilis treated.