An overview of infections in pregnancy

1. Infections In Pregnancy
Dhammike Silva

2. Bacterial Infections in Pregnancy
 Bacterial infections can affect pregnant
women from implantation of the fertilized
ovum through the time of delivery and
peripartum period.
 They may also affect the fetus and newborn.
Many women with these infections are
asymptomatic, necessitating both a high
degree of clinical awareness and adequate
screening.

3. 1. Group B Streptococcus
• GBS; Streptococcus agalactiae is the most
common cause of life-threatening infections in
newborns and can also affect the mother.
• Found as part of normal vaginal, rectal, and
oral flora
• Intrapartum transmission occurs via ascending
spread or at the time of delivery

6. Urinary tract infections
• Asymptomatic bacteriuria develops in 10-15% of
pregnant women.
• Lead to complications such as pyelonephritis and
premature labor.
• All pregnant women should undergo screening
with urine culture at least once during early
pregnancy
• Significant bacteriuria is defined as >100,000
colony-forming units (CFU) of a single organism in
a clean-catch specimen.

7. causative organisms
• Escherichia coli
• Klebsiella species
• Enterobacter species
• Enterococcus species
• Group B Streptococcus (GBS)
• Staphylococcus saprophyticus
• Proteus mirabilis

8. Listeriosis
• One third of all reported cases of listeriosis occur during pregnancy, typically
during the third trimester
• Mode of transmission-
• ingestion of contaminated food,
• contact with infected animals and
• nosocomial transmission
• Clinical presentation –
• with listeriosis is bacteremia, often asymptomatic; CNS Listeria infections are rare
• Symptomatic pregnant patients - fever, muscle aches, and, occasionally, nausea or
diarrhea during the bacteremic phase of the disease
• Maternal complications-
• amnionitis
• spontaneous septic abortion
• premature labor with delivery of an infected baby
• stillbirth
• Fetal complications-
• septicemia, meningoencephalitis, or disseminated granulomatous lesions with microabscesses

9. disseminated granulomatous lesions
with microabscesses

10. Syphilis
• Untreated primary or secondary syphilis in pregnancy leads to a fetal infection rate
of almost 100%
• Maternal Signs & symptoms
– In primary syphilis- a hard, painless red ulcer typically forms on the vulva, cervix, or vagina
– Secondary syphilis -predominantly manifests as a nonpruritic rash that may involve the palms
and soles; fever, lymphadenopathy, and joint pain
– The latent stage causes no symptoms and is still transmissible to the fetus
– Tertiary syphilis can result in cardiovascular or gummatous disease
– Neurosyphilis can occur at any stage, resulting in CNS or ophthalmic presentations
• Complications –
– Stillbirth
– late abortion
– neonatal death
– latent infection

12. Congenital syphilis

13. Chlamydia
• Approximately 75% of women with C trachomatis infection are
asymptomatic
• The usual mode of transmission to the fetus is vertical during the
second stage of labor
• Maternal complications –
– Endometritis
– Cervicitis
– acute PID, and acute urethral syndrome
– Chorioamnionitis
– postpartum endometritis
– gestational bleeding in pregnant women
• In neonates- commonly causes conjunctivitis (ophthalmia
neonatorum) and pneumonia

15. Gonorrhea
• Gonococcal infections are second only to chlamydial
infections in the number of cases of bacterial STDs
• Gonococcal infections cause no symptoms in
approximately 50% of patients
• Pregnancy is a predisposing factor to the development
of disseminated gonococcal infection
• presents as an arthritis-dermatitis syndrome
• Newborns exposed to gonorrhea during vaginal
delivery can develop an acute conjunctivitis
(ophthalmia neonatorum), sepsis, arthritis, and
meningitis

16. ophthalmia neonatorum

17. viral Infections in Pregnancy
• RUBELLA: ( German Measles).
– Risk of fetal transmission:
• 50-60% of fetuses are affected if maternal primary
infection is in the first month of gestation.
• 22% in the second month,
• 6-10% in the third to fourth month.

18. congenital rubella syndrome includes
• -Neuropathic changes:
• 1.microcephaly.
• 2.mental& motor retardation.
• 3.meningoencephalitis
• 4.cerebral palsy.
• 5.cerebral calcification
• -Cardiovascular lesions:
• 1.persistent ducats arteiosis
• 2.pulmonary artery stenosis
• 3.atrioventricular septal defects
• -Ocular defects:
• 1.cataract
• 2.microphthalmia
• 3.retinal changes, retinitis
• 4.blindness

19. Congenital rubella with hemorrhagic
lesions in the skin
CYTOMEGALOVIRUS (CMV)

20. CYTOMEGALOVIRUS (CMV)
• Transmission:
– direct: person to person contact ( saliva, milk,
urine, semen, tears, stools, blood, cervical and
vag. Secretion.).
– indirect: contaminated fomites.
• in primary CMV infection –
– 30-40% of fetuses will be infected,
– 2-4% of them will develop severe malformations
at birth.

21. Complications of fetal CMV infection
include:
• 1. micro & hydrocephaly
• 2. chorioretinitis
• 3. cerebral calcification
• 4. mental retardation
• 5. heart block
• 6. petechiae

22. chorioretinitis

23. Varicella Zoster
• If infection occurs in first trimester 4.9% risk of
congenital varicella .
• Congenital Syndrome
– Limb hypoplasia -
– Ocular abnormalities
– CNS abnormalities ( convulsive disorders )
– Dermatomal scarring

24. Varicella-Zoster Infections Figure 3. Congenital varicella with short-limb
syndrome and scarring of the skin. The mother had varicella during the
first trimester of pregnancy.

25. Herpes Simplex virus
• Primary
– Fetal loss
– Congenital Syndrome
• Recurrent
– Mucocutaneous lesions
– Disseminated disease
– Encephalitis
• Transmission occurs at time of delivery in 90-95% of
cases( vaginal delivery).
• Prevention:If lesions present at time of delivery,
recommend caesarean section.

26. VIRAL HIBATITIS
• Most common cause of jaundice during
pregnancy.
• HepatitisB transmitted by contaminated blood
,saliva, breast milk, semen .
• Hepatitis B - pregnant women who are
infected transmit the virus transplacentally to
the fetus and at birth.

27. TOXOPLASMOSIS
• Causative agent: by protozoan toxoplasma gondi.
• Risk of fetal infection:
– First Trimester - 15 % ( less incidence of fetal infection but
serious disease is most common ).
– Second Trimester - 25 % .
– Third Trimester - 65 % ( but almost 90% of newborns are
without clinical signs of disease ).
• 40% of fetuses are affected if the mother has the illness.
• the earlier in pregnancy the more damage.
• Maternal symptoms: usually asymptomatic, fever, rash &
eosinophelia If symptomatic ( the CNS prognosis is poor