Intrauterine infection in a newborn

August 23, 2021

Infertility due to sexually transmitted infections is a problem, but it can be corrected with proper treatment. The disease can occur unnoticed by the woman and the disease is first suspected during an ultrasound scan of the fetus. A pregnant woman can transmit the pathogen to the fetus, if symptoms of the disease appear in the form of disruption of its development or it dies, then this condition is called intrauterine infection.

If a pathogen is transmitted to a sick expectant mother through the general bloodstream, but no clinical symptoms develop, this will be an intrauterine infection. Such infection after the birth of a child may manifest itself as an intensification of the infectious process. In this case, the pregnant woman’s immunity is strong enough to protect the child developing in the uterus.

The Medicine 24/7 clinic performs a full range of tests to detect all infectious diseases. The examination must be completed before pregnancy, but if a woman has missed the favorable time, this does not mean that she cannot be helped. Contact the Infectious Diseases Center by phone.

Why doesn’t a pregnant woman’s immune system protect?

The immune system is weakened during this period, so nature preserves future offspring that are not entirely identical in genetic makeup. Strong immunity would not allow the fertilized egg to attach. For some viruses, embryonic tissue is ideal for reproduction, where all processes are very active and rapid. When they penetrate the pregnant uterus, they can cause lesions, most often in the initial period resulting in miscarriage, and later developmental arrest or birth defects.

Not only the tropism of the pathogen to tissues can lead to damage, but also the release of toxic products and the breakdown of the mother’s cells; it is very important at what period of organ formation the disease began. It is not always possible to identify pathology using ultrasound; in some cases, clarifying tests are necessary to allow a targeted search.

Disease during different periods of pregnancy

Any infectious disease during pregnancy is dangerous, because an increase in temperature just above 37.7°C already threatens spontaneous miscarriage or premature birth.

• In the first week after fertilization, intrauterine infection will not allow the fertilized egg to attach to the wall of the uterus, and pregnancy simply will not take place.
• In the first two months, infection will destroy the embryo or develop developmental abnormalities.
• By six months, the formation of organs has already occurred, but they are not fully formed, so an infectious disease can lead to the development of pathological changes in them.
• From the 28th week, the fetus acquires its own immunological protection, responding to the introduction of the agent with changes in tissues, which is also manifested by its death, growth retardation, premature birth or congenital infection.

Tactics for managing pregnancy when there is a threat of infection

Management of pregnancy during intrauterine infection is an urgent problem of modern obstetrics and perinatology. Due to the significance of the problem of infectious pathology in obstetrics, special attention is given to infections whose pathogens, penetrating the placental barrier, multiply in the fetoplacental system, causing numerous complications during pregnancy and fetal development. According to various authors, when pregnant women are infected, intrauterine infection develops from 6 to 53%. The last decade has been characterized by significant advances in the study of etiology and pathogenesis, diagnosis and treatment of infection in pregnant women.

We talk about the tactics of managing pregnancy during infection with Asiya Faridovna Subkhankulova, .

— Asiya Faridovna, how relevant is this problem?

— Before talking about the problem of intrauterine infection, it is necessary to emphasize that there are two concepts. They are often confused: intrauterine infection and intrauterine infection of the fetus. These concepts have a significant difference. Intrauterine infection (IUI) is a complex of clinical manifestations of an infectious disease of the fetus and newborn, the source of which is the mother. In turn, intrauterine infection of the fetus is the fact of intrauterine infection of the fetus.

Today, the problem of intrauterine infection of the fetus comes to one of the first places along with the problem of premature birth, extragenital diseases during pregnancy, since it gives a significant number of complications of pregnancy at any stage of its development.

— What infections are dangerous during pregnancy?

- Of course, the absolute pathogens are the “old and good” - syphilis, gonorrhea, toxoplasma infection, brucellosis, transmitted from mother to fetus through the placenta. However, the share of these infections in the structure of perinatal losses is relatively small. Recently, infections that we could not diagnose thirty years ago have come to the fore. With the development of medical science and technology, the equipment of maternity institutions, and the increase in the number of diagnostic centers, it has become possible to diagnose any infection in a timely manner. But among them, the main ones are chlamydial, viral (herpes simplex virus, cytomegalovirus infection), bacterial (mycoplasma genitalium) infections.

We must not forget about such a problem as bacterial vaginosis (a dysbiotic state of the body) during pregnancy. In unfavorable conditions, bacterial vaginosis can also be a risk factor for IUI. Therefore, it is necessary to eliminate the state of dysbiosis, in particular in the birth canal, and thereby prepare the woman for the normal course of pregnancy and childbirth.

— What are the tactics for managing a pregnant woman with infection?

— Management tactics today are such that if an infection is detected in the initial stages of pregnancy, we, unfortunately, cannot treat it with all possible methods of etiotropic therapy, since there is a risk of teratogenic effects on the fetus in the first trimester of pregnancy (up to 12 weeks). When infected in the early stages of pregnancy, infectious embryopathies or true fetal malformations can form. These women have a high frequency of spontaneous miscarriages, undeveloped pregnancies, and premature births. When infected with intrauterine infections in the 2nd and 3rd trimesters, infectious embryopathies compatible with life are formed. It is necessary to clarify whether infection is the cause of these pregnancy complications? During a screening ultrasound examination (ultrasound) at 11-13 weeks, congenital defects are diagnosed, often incompatible with life. In this case, we are talking about termination of pregnancy, but with mandatory cytogenetic and histological examination of the abortion. When secondary fetopathy develops, during a screening ultrasound in the 2nd trimester (22-23 weeks) of pregnancy, the doctor sees indirect signs of infection. For example, thickening of the placenta, pyelectasis (expansion of the pyelocaliceal system of the fetal kidneys), hepatosplenomegaly, polyhydramnios or, conversely, oligohydramnios. These are all secondary signs of intrauterine infection. Well-known specialist V.E. Radzinsky proposes to divide echographic signs of intrauterine infection into specific and nonspecific. Specific ones include polyhydramnios, hepatosplenomegaly, pyeelectasia and an increase in the size of the fetal abdomen (due to distended intestinal loops, ingestion of infected amniotic fluid). Nonspecific ones include, for example, oligohydramnios, thinning of the placenta, and FGR. These are markers that can be determined by ultrasound.

In patients at risk, we must necessarily confirm or refute the presence of an infectious pathogen. In this case, large diagnostic centers that can identify this range of infections come to our aid.

— What are TORCH complex infections?

— TORCH complex infections were isolated in 1971. This complex includes toxoplasmosis (T), other infections (O-others). At that time, they included about 800 infections. More than 2,500 pathogens have now been described. And every day their number is replenished. Next, R - rubella (rubella), an absolute pathogen, which in most cases gives incompatible malformations when pregnancy must be terminated; C - cytomegalovirus infection (cytomegalovirus) and H - herpes (herpes simplex virus). These infections were classified into one group for the reason that they have much in common: the polyetiological nature of the disease, the difficulty of prenatal diagnosis, the multifactorial impact of pathogens, latency and asymptomatic course of the infectious process.

— Is it possible to prevent infections in pregnant women to avoid complications?

“This is a very correct and timely question, since today the obstetric community is working to ensure that pregnancy is planned and, of course, desired. But the most important thing is that the patient must prepare for pregnancy. During preconception preparation, diagnosis of infectious processes and their timely treatment are necessary.

Unfortunately, our patients often become pregnant first, and then they begin to solve problems, including those related to infection. Therefore, the ideal option is preconception preparation with a search for ways to solve the problem and sanitize chronic foci of infection. Today this is one of the main tasks of our work.

— What are the routes of infection of the fetus?

— There are currently five known ways of fetal infection. Of course, everyone understands that one of the most common routes is the ascending route of infection. Infection of the genital or birth tract leads to the fact that the infection, overcoming the placental barrier, penetrates the amniotic fluid and infects it, and then the fetus swallows these infected fluids and thereby becomes infected itself. This is the most typical route of infection.

Another route of transmission of infection is transplacental. In this case, infections, bypassing the placental barrier, enter the fetal bloodstream and cause generalized diseases in the fetus. This route of infection is typical for most viral infections.

There is also a transdecidual route of transmission of infection. Today, much attention is paid to the development of pregnancy in chronic endometritis. Despite the fact that there is inflammation of the endometrium, pregnancy occurs, but develops against the background of a sluggish infection,

The fourth route of transmission is downward. In a descending manner (from the abdominal cavity and fallopian tubes), the infectious agent penetrates the amniotic cavity.

And the last, fifth route of transmission is intranatal, when the fetus becomes infected while passing through the infected birth canal.

An infectious factor is proven if an infectious lesion of the fetus or newborn is confirmed by laboratory methods and by histological examination of the placenta, when its lesions are detected.

Today, the search for ways to solve problems of possible infection is going in the following direction: 1-2 smear tests are taken (PCR diagnostics). To accurately establish a diagnosis, an additional method (ELISA) of examining the pregnant woman’s blood is required.

Many foreign researchers see ways to solve the problem of diagnosing IUI using cordo- and amniocentesis with subsequent isolation of pathogens in the fetal blood and amniotic fluid.

I would like to emphasize once again that the best solution to the problem of intrauterine infection, in my opinion, is prevention and preconception preparation for married couples, including examination for perinatal infections and sanitation of foci of infection, if any.

Gulnara Abdukaeva

What are the most common infections during pregnancy?

• Chicken pox without complications is not dangerous for the mother and does not lead to miscarriage, but a third of newborns die if the pregnant woman gets sick a week and a half before giving birth. Chickenpox at the beginning of pregnancy in every twentieth person leads to atrophy or disfiguring changes in the limbs, underdevelopment of the cerebral cortex. If a woman has been in contact with an infectious patient, immunoglobulin is administered.
• Viral hepatitis increases the risk of prematurity; they do not cause developmental abnormalities, but lead to congenital hepatitis.
• Influenza is dangerous for the woman herself, since a decrease in immune defense contributes to the introduction of pneumococcus and the development of severe pneumonia with a fatal outcome. The virus passes through the placenta and a miscarriage or premature birth may occur, but the child does not have any abnormalities. But taking amantadine by a pregnant woman can lead to abnormalities in the development of systems and organs. Vaccinations against influenza and pneumococcus help prevent severe pneumonia.
• Rubella in a pregnant woman is no more severe than in others, but the frequency of miscarriage and death increases many times over; if this does not happen, the infection will result in numerous defects. In the third trimester, a favorable outcome for the child is possible. All young women should be vaccinated before pregnancy.
• Measles before childbirth threatens congenital infection, the rest of the time it leads to spontaneous abortion and prematurity, but developmental anomalies are not typical. However, if a woman has not had measles, she needs to be vaccinated at the stage of pregnancy planning.
• Cytomegalovirus infection allows you to carry a child to term, but with intrauterine infection, death or underdevelopment of the brain is possible. Asymptomatic infection in a pregnant woman leads to neurological pathology with visual and hearing impairment in every tenth newborn.
• Mumps causes complications in women; early in pregnancy it can cause miscarriage, but developmental anomalies are not typical.
• Chlamydia can lead to intrauterine infection, but clinical symptoms will appear at birth in the form of mild damage to the eye mucosa or pneumonia.
• Borreliosis or Lyme disease increases the likelihood of fetal death and miscarriage, but pregnant women tolerate it without any special features.

What needs to be done?

In case of spontaneous abortion due to a “childhood” disease, subsequent pregnancies are not in danger. But to avoid trouble, it is necessary to undergo an examination. When a developmental pathology is identified, it is necessary to do tests for the presence of antibodies to certain pathogens of infectious diseases; however, it will not be possible to turn back the clock, but it is possible to reduce adverse manifestations in relation to the female body.

With chronic infections, you can also safely carry and give birth to a healthy child, but for this you need to undergo an examination in advance and the entire period of gestation is under the supervision of an infectious disease specialist. Medicine specialists 24/7 are able to correct a bad pregnancy history, sign up for a consultation by phone +7 (495) 230-00-01

What can cause intrauterine infections?

Doctors identify several main ways of infecting the fetus with infectious diseases:

• Rising. This means that pathogens enter the uterine cavity from the genital tract. There they penetrate into the tissues of the embryo itself. In this way, infection with chlamydia most often occurs, as well as diseases that are caused by enterococci.
• Descending. This is the name for infection when pathogenic microorganisms enter the uterine cavity from the fallopian tubes.
• Transplantental (also called hematogenous). In this way, the infection enters the fetal tissue through the placenta. In this way, a child can become infected with toxoplasmosis and a number of viral diseases.
• Contact, or intrapartum. In this case, pathogens of infectious diseases enter the baby’s mucous membranes during the process of swallowing amniotic fluid.