Obs Chapter 4: Prenatal Infection

Disease	Pathophysiology	Significance	Prevention	Treatment
Toxoplasmosis	Cat feces First trimester infection risk is low, but infections are serious 3rd trimester infection risk is high, but infections are less serious	Fetal infection: fetal hydrops, microcephaly & intracranial calcifications Neonatal findings: chorioretinitis, seizures, hepatospenomegaly	Avoid cat feces, raw cat meat	Pyrimethamine + sulfadiazine
Varicella	DNA virus, spread via respiratory droplet	Zig-zag skin lesion, microphthalmia, extremity hypoplasia. Rash in mother	VZIG	acyclovir
Rubella	Respiratory droplets	Congenital deafness, cataracts and heart disease. TR is >90% during first 10 weeks of pregnany	Rubella vaccine is made of live attenuated vaccine, pregnancy should be avoided for 1 month after immunization	No specific treatment
CMV	DNA virus spread via body secretion	50% transmition rate irrespective of pregnancy Deafness, periventricular calcifications. Mononucleosis in mothers	Universal precaution while handling body fluid	Ganciclovir
HSV	DNA virus spread via mucocutaneous contact Mostly HSV-2	May cause spontaneous abortion, microcephaly in fetus. 50% mortality in infants. Those who survive may have meningoencephalitis, mental retardation, pneumonia	Perform C-section. If membrane have been rupture >8-12h, C-section is of no value	Acyclovir
HIV	Mostly transmitted due to infected genital secretions during delivery	At birth neonates of HIV-positive will have positive HIV test. Re-test in one month	Prophylaxis via zidovudine. Start at 14 weeks and continue through out pregnancy Do C-section No breast feeding	Women with low CD4 count should be receiving triple drug therapy
Syphilis	Spread via intimate contact between moist membranes	Rate of transmission is highest in secondary syphilis and lowest in tertiary. Fetal death common. Placenta is large. In neonate you find Hutchinson teeth, saddle nose, 8th nerve deafness	You can do vaginal delivery	Penicillin G
Hep B	Body secretions	Mostly 3rd trimester. Neonatal HB develops only in 10% of mother positive for HBsAg but 80% positive for both HbsAg and HbeAg	Vaginal delivery allowed Maternal immunization	No specific treatment