VUI risk in newborns. Infections of newborns

04.11.2019 -

Intrauterine infection refers to viral, bacterial, fungal infection embryo, fetus or newborn during gestation or childbirth. Depending on the type and severity of infection, this condition can lead to severe mental and physical developmental defects, hypoxia, death of the unborn child and, as a consequence, premature birth.

Causes of intrauterine fetal infection

The pathological process can be caused by the following microorganisms:

bacteria (damage to staphylococcus, streptococcus, tetanus, diphtheria bacillus);

viruses (rubella, chickenpox, influenza, cytomegalovirus, herpes);

fungi (for example, the genus Candida);

less often – protozoa (Toxoplasma).

All these microorganisms can disrupt normal development the unborn baby during the period of acute or chronic illness of the mother, by:

transplacental penetration (herpes virus, cytomegalovirus, toxoplasmosis);

ascending infection (STD, chlamydia, vaginal candidiasis);

descending infection (any inflammatory diseases ovaries and fallopian tubes);

direct contact (HIV/AIDS, hepatitis B, C).

Symptoms of intrauterine infection

Intrauterine infection is always a consequence of a maternal illness, which can be pronounced or hidden. For example, a fetus can receive a small amount of rubella virus even if the mother is not sick but has been in contact with someone who is sick.

The same picture is typical for the infection of the embryo by toxoplasma - the mother is only a carrier of the protozoan, which initial stage The disease is very dangerous for the unborn child. In this case, there is a threat of intrauterine infection in the newborn.

Congenital infection can be indicated either by individual facts or by their combination:

during pregnancy up to 12 weeks: threat of miscarriage, uterine hypertonicity, miscarriage, embryo freezing, diagnosis of pathologies based on ultrasound results (malformations of the neural tube);

during gestation from 13-40 weeks: uterine hypertonicity, fetal death, threat of premature birth, diagnosis of pathologies based on ultrasound results (heart defects, myocarditis, brain malformations, congenital pyelonephritis and pneumonia, level of development internal organs does not correspond to the gestational age).

In some cases, a child may be born on time and be considered healthy, however, after some time he may show signs of intrauterine infection - sepsis, osteomyelitis, progressive cataracts, hepatitis.

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This is due to the possibility of transmission of microorganisms during childbirth or the so-called delayed pathology, the cause of which lies in infection during gestation.

How does intrauterine infection affect preterm birth?

Premature birth - delivery that began between 22 and 37 completed weeks of pregnancy; such a process can be early (22-27 weeks), middle (23-33 weeks) and late (33-37 weeks). The presence of an infection in the fetus can provoke this pathology for 2 reasons:

any deviations in the development of the unborn child are a process that contradicts the basic law of nature about the survival of the fittest. A woman’s body often reacts violently to abnormalities in the unborn child caused by intrauterine infection, and therefore tries in every possible way to get rid of the defective fetus, and in this case a premature baby may be born;

when an unborn child becomes infected due to the fact that the pregnant woman has suffered an acute or chronic form sexually transmitted diseases (syphilis, gonorrhea), premature birth can cause disruption of the muscle tone of the uterus or loss of elasticity

Diagnosis and treatment

Intrauterine infection of a child can only be assumed based on a combination of the following indicators:

data about specific diseases suffered by a pregnant woman at a certain stage of pregnancy;

results of laboratory tests of maternal physiological fluids, including amniotic fluid and blood tests for TORCH infections (detection of rubella viruses, herpes, cytomegalovirus, toxoplasma and spirochete pallidum - the causative agent of syphilis);

ultrasound examination data that indicate pathologies of fetal development;

results of examination of parts of the umbilical cord and placenta, as well as blood and cerebrospinal fluid child (if a newborn is infected by contact).

Therapeutic tactics for various intrauterine infections are different and depend on the period of gestation, the condition of the woman, the condition of the fetus, the nature and severity of the disease.

A calm pregnancy, easy childbirth and the birth of a healthy baby are in some cases overshadowed by a sudden deterioration in the baby’s condition on the 2-3rd day of his life, which is manifested by frequent regurgitation, lethargy, and lack of weight gain. All this may be a consequence intrauterine infections in a newborn. Let's talk about what these infections are and how they can be avoided?

What are intrauterine infections in newborns?

Often, the expectant mother’s body contains certain pathogens that lead to various inflammatory processes, often in the genitals. The result of such an infection may be subsequent infection of the fetus during its intrauterine development.

In most cases, infection of a child occurs through the single bloodstream of the woman and the fetus. Sometimes an infant becomes infected by ingesting infected amniotic fluid or during childbirth (while passing through the birth canal).

Infectious diseases of newborns depend on the pathogen that infects female body during pregnancy or even before conceiving a child.

According to experts, they can be caused by pathogens such as:

viruses (herpes, rubella, influenza, cytomegaly);
bacteria (streptococci, coli, treponema pallidum, chlamydia);
protozoa (Toxoplasma);
mushrooms.

At the same time, the threat of the negative impact of these pathogens increases in the following cases:

if a woman has chronic diseases;
when interacting with harmful substances (working on chemical production, smoking, drinking alcohol);
with regular stress in a pregnant woman;
with chronic inflammatory processes acquired before pregnancy genitourinary system.

Intrauterine infectious diseases newborns are often referred to as the TORCH group. Having different pathogens, all infections of this group manifest themselves almost identically, causing similar developmental abnormalities nervous system baby.

The abbreviation TORCH has the following meaning:

T – toxoplasmosis
O – others (other infectious diseases such as chlamydia, syphilis, enterovirus infection, hepatitis A and B, measles, mumps, etc.);
R – rubella (rubella);
WITH - cytomegalovirus infection in a newborn;
H – herpes.

The degree to which they affect the health and development of the fetus will depend on when the infection occurred:

if infected before the 12th week of pregnancy, such an infection can lead to miscarriage or fetal malformations;
when the fetus is infected during the period from 12 to 28 weeks of pregnancy, as a rule, there is a delay in its intrauterine development, as a result of which the baby is born with low weight;
infection of the fetus in late pregnancy can have negative impact on the child’s already formed organs, in particular on his brain, heart, liver and lungs.

Let's look at the most common infectious diseases of newborns.

What are the most common intrauterine infections in infants?

Today, the most common infections in newborns include:

toxoplasmosis
cytomegalovirus;
staphylococcal infection in newborns.

Cytomegalovirus infection mainly affects the fetus during its intrauterine development, less often during childbirth. For a woman it goes unnoticed, but in a newborn baby it is quite pronounced. The cause of infection for the expectant mother is the immune deficiency of her body and the inability to protect the baby from viruses and bacteria. Basically, cytomegalovirus infection in newborns has virtually no effect on the development of the child’s body, therefore drug therapy prescribed in extreme cases (if the child’s life is at risk).

Staphylococcal infection in newborns is large group purulent-inflammatory diseases of the mucous membranes, skin, internal organs, as well as the central nervous system. Infection with staphylococcus is possible both in the prenatal period and during childbirth. But most often it occurs through contact (through underwear, care items, the hands of the mother and staff), as well as through breast milk(if a woman has cracked nipples or mastitis).

Staphylococcal infection in newborns can cause various diseases, which experts divide into two large groups:

local purulent-inflammatory processes;
generalized infection (sepsis).

Diseases caused by these microorganisms include:

conjunctivitis;
omphalitis (inflammation of the umbilical ring area);
pseudofurunculosis;
vesiculopustulosis;
pemphigus of newborns;
"scalded skin syndrome";
phlegmon;
abscesses;
enterocolitis.

In addition to the indicated intrauterine diseases, infants in the first days of life are extremely susceptible to various intestinal infections.

What are the most common intestinal infections in newborns?

According to pediatricians, intestinal infections in newborns are caused by viruses or bacteria, and often occur with high fever, diarrhea and vomiting. Infection occurs by water, food, airborne droplets, household contact or fecal-oral route.

The group of intestinal infections includes such pathogens as:

dysentery;
viral diarrhea;
Proteus infection;
colienteritis;
staphylococcal damage to the intestines (most often occurs in children in the first months of life).

The expectant mother, naturally, should be especially attentive to her health. And if there is a risk of developing an intrauterine infection in the fetus, she should not panic, because modern methods diagnosis and treatment, mainly provide positive results to maintain pregnancy and birth healthy babies.

Developing in the mother's belly, the child is relatively safe. Relatively, since even in such sterile conditions there is a risk of developing infectious disease. This large group of diseases is called intrauterine infections. During pregnancy, a woman should especially carefully monitor her health. A sick mother can infect her child during fetal development or during childbirth. We will discuss the signs and methods of diagnosing such diseases in the article.

The danger of intrauterine infections is that they unceremoniously interfere with the formation of a new life, which is why babies are born weak and sick - with defects in mental and physical development. Such infections can cause the greatest harm to the fetus in the first 3 months of its existence.

Intrauterine infection during pregnancy: what statistics say

A timely diagnosed and treated infectious disease in a pregnant woman poses minimal danger to her child.
Infectious agents pass from mother to baby in 10 out of 100 pregnancies.
0.5% of infants infected in the womb are born with corresponding signs of the disease.
An infection that has settled in the mother’s body does not necessarily pass to the fetus, and the child has a chance to be born healthy.
A number of infectious diseases that do not promise anything good for the baby may be present in the mother in a latent form and have virtually no effect on her well-being.
If a pregnant woman gets sick with one or another infectious disease for the first time, there is a high probability that her child will also become infected.

Intrauterine infection - ways of infecting the embryo

There are four ways in which infectious agents can enter a tiny growing organism:

hematogenous (transplacental) – from the mother, harmful microorganisms penetrate to the fetus through the placenta. This route of infection is characteristic of viruses and toxoplasma;
ascending - infection occurs when the infectious agent rises through the genital tract to the uterus and, having penetrated its cavity, infects the embryo. So the baby may develop chlamydial infection and enterococci;
descending – the source of infection is the fallopian tubes(with adnexitis or oophoritis). From there, the pathogens penetrate the uterine cavity, where they infect the child;
contact - infection of the baby occurs during childbirth, when it moves through the birth canal of a sick mother. Pathogens enter the child’s body after he has swallowed infected amniotic fluid.

Intrauterine infection at different stages of pregnancy: consequences for the child

The outcome of infectious infection of the fetus depends on at what stage of intrauterine development it was attacked by dangerous microorganisms:

pregnancy period 3 – 12 weeks: spontaneous termination of pregnancy or the appearance of various developmental anomalies in the fetus;
gestation period 11 – 28 weeks: the fetus is noticeably delayed in intrauterine development, the child is born with insufficient body weight and various malformations (for example, congenital heart disease);
pregnancy period after 30 weeks: developmental anomalies affect the fetal organs, which by this time have already formed. The infection poses the greatest danger to the central nervous system, heart, liver, lungs and visual organs.

In addition, congenital infection has acute and chronic forms. The following consequences indicate acute infection of a child at birth:

state of shock;
pneumonia;
sepsis (blood poisoning).

Some time after birth, acute intrauterine infection in newborns can manifest itself with the following signs:

excess daily sleep duration;
poor appetite;
insufficient physical activity, which is decreasing every day.

If the congenital infection is chronic, there may be no clinical picture at all. Distant signs of intrauterine infection include:

complete or partial deafness;
mental health disorders;
vision pathologies;
lagging behind peers in motor development.

Penetration of infection to the fetus through the uterus leads to the following consequences:

stillbirth of a baby;
intrauterine embryonic death;
frozen pregnancy;
spontaneous abortion.

The following pathological consequences are recorded in children who survived such infection:

heat;
rash and erosive skin lesions;
non-immune hydrops fetalis;
anemia;
enlarged liver due to jaundice;
pneumonia;
pathologies of the heart muscle;
pathology of the eye lens;
microcephaly and hydrocephalus.

Intrauterine infection: who is at risk

Every expectant mother runs the risk of being captured by an infectious agent, because during pregnancy her body’s defenses are depleted to the limit. But the greatest danger awaits women who:

already have one or more children attending kindergarten or school;
are related to the medical field and are in direct contact with people who may be potential carriers of infection;
work in kindergarten, school and other children's institutions;
have had 2 or more medical terminations of pregnancy in the past;
have inflammatory diseases in a sluggish form;
faced untimely rupture of amniotic fluid;
have had a previous pregnancy with abnormal embryo development or intrauterine fetal death;
have already given birth to a baby with signs of infection in the past.

Symptoms of intrauterine infection in a woman during pregnancy

Doctors identify several universal signs that suggest that the expectant mother has contracted an infectious disease:

sudden increase in temperature, fever;
shortness of breath when walking or climbing stairs;
cough;
rash on the body;
enlarged lymph nodes that react painfully to touch;
painful joints that appear swollen;
conjunctivitis, lacrimation;
nasal congestion;
painful sensations in the chest.

This set of indications may also indicate the development of allergies in a pregnant woman. In this case, there is no threat of infectious infection of the fetus. Be that as it may, the expectant mother should go to the hospital as soon as at least one of these symptoms appears.

Causes of intrauterine infection during pregnancy

The activity of ubiquitous pathogenic microorganisms is main reason morbidity among women who are preparing to become mothers. Many bacteria and viruses, entering the mother's body, are transmitted to the child, provoking the development of serious anomalies. Viruses responsible for the development of acute respiratory infections viral diseases, do not pose a danger to the fetus. A threat to the child’s condition appears only if a pregnant woman develops a high body temperature.

One way or another, intrauterine infection of the baby occurs exclusively from the sick mother. There are several main factors that can contribute to the development of infectious pathology in the fetus:

Spicy and chronic diseases mothers in the genitourinary system. Among them are inflammatory pathologies such as ectopia of the cervix, urethritis, cystitis, and pyelonephritis.
Presence in mother immunodeficiency state or HIV infection.
Organ and tissue transplantation that the woman has undergone in the past.

Intrauterine infections: main characteristics and routes of infection

Cytomegalovirus (CMV)

The causative agent of the disease is a representative of herpes viruses. You can get the disease through sexual and close household contact, through blood (for example, through a transfusion from an infected donor).

During the primary infection of a pregnant woman, the microorganism penetrates the placenta and infects the fetus. In some cases, the baby does not experience any abnormal consequences after infection. But at the same time, statistics say: 10 babies out of 100, whose mothers encountered an infection during pregnancy, have bright pronounced signs intrauterine infection.

The consequences of such intrauterine infection during pregnancy are as follows:

spontaneous abortion;
stillbirth;
hearing loss of sensorineural origin;
low birth weight;
hydro- and microcephaly;
pneumonia;
lag in the development of psychomotor skills;
pathological enlargement of the liver and spleen;
blindness varying degrees gravity.

Cytomegalovirus under a microscope

If the infectious lesion is of a general combined nature, more than half of the babies die within 2 to 3 months after birth. In addition, the development of such consequences as a lag in mental development, hearing loss and blindness. With mild local damage, the consequences are not so fatal.

Unfortunately, there are no medications yet that can be used to eliminate CMV symptoms in newborns. If a pregnant woman is diagnosed with cytomegalovirus infection, the pregnancy is abandoned because the child has a chance to remain healthy. The expectant mother will be prescribed an appropriate course of treatment to minimize the effect of the disease on her body.

Intrauterine infection - herpes simplex virus (HSV)

A newborn baby is diagnosed with a congenital herpes infection if his mother is diagnosed with herpes simplex virus type 2, which in most cases is contracted through unprotected sexual contact. Signs of the disease will appear in the child almost immediately, during the first month of life. Infection of the baby occurs mainly during the birth process, when it moves through the birth canal of the infected mother. In some cases, the virus reaches the fetus through the placenta.

When a child’s body is affected by a herpes infection, the consequences are severe:

pneumonia;
visual impairment;
brain damage;
skin rash;
heat;
poor blood clotting;
jaundice;
apathy, lack of appetite;
stillbirth.

Severe cases of infection result in mental retardation, childhood cerebral paralysis and vegetative state.

Herpes simplex virus under a microscope

Intrauterine infection - rubella

This disease is rightfully considered one of the most life-threatening embryos. The route of transmission of the rubella virus is airborne, and infection is possible even over a long distance. The disease, which poses a particularly great threat before the 16th week of pregnancy, “programs” various deformities in the development of the baby:

low birth weight;
spontaneous abortion, intrauterine death;
microcephaly;
congenital anomalies of the development of the heart muscle;
hearing loss;
cataract;
various skin diseases;
pneumonia;
unnatural enlargement of the liver and spleen;
meningitis, encephalitis.

Intrauterine infection - parvovirus B19

The presence of this virus in the body provokes the development of a disease known as erythema infectiosum. In adults, the disease does not manifest itself in any way because it is latent. However, the consequences of the pathology for the fetus are more than serious: the child may die before birth, and there is also a threat of spontaneous abortion and intrauterine infection. On average, infected children die in 10 cases out of 100. At 13–28 weeks of pregnancy, the fetus is especially defenseless against this infection.

When infected with parvovirus B19, the following consequences are noted:

swelling;
anemia;
brain damage;
hepatitis;
myocardial inflammation;
peritonitis.

Intrauterine infection - chickenpox

When an expectant mother is infected with chickenpox, the infection also affects the child in 25 out of 100 cases, but symptoms of the disease are not always present.

Congenital chickenpox is identified by the following characteristics:

brain damage;
pneumonia;
skin rash;
delayed development of eyes and limbs;
optic nerve atrophy.

Newborn babies infected in the womb are not treated for chickenpox, since the clinical picture of the disease does not progress. If a pregnant woman “caught” an infection 5 days before giving birth or later, the baby will be given an injection of immunoglobulin after birth, since there are no maternal antibodies in his body.

Intrauterine infection - hepatitis B

Get it dangerous virus possible during sexual intercourse with infected person in the absence of barrier methods of contraception. The causative agent of the disease penetrates the baby through the placenta. Most dangerous period in terms of infection - from 4 to 9 months of pregnancy. The consequences of infection for a child are:

hepatitis B, which can be treated with the appropriate approach;
liver cancer;
indolent form of hepatitis B;
acute form of hepatitis B, which provokes the development of liver failure and he dies;
delay in the development of psychomotor functions;
hypoxia;
miscarriage.

Intrauterine infection - human immunodeficiency virus (HIV)

HIV infection is a scourge for special immune lymphocytes. In most cases, infection occurs during sexual intercourse with a sick partner. A child can become infected while in the womb or during birth. HIV-infected children are shown intensive complex treatment, otherwise they will not live even two years - the infection quickly “eats” the weak body. Infected children die from infections that do not pose a mortal danger to healthy children.

To confirm HIV in an infant, the polymerase chain reaction diagnostic method is used. It is also very important to promptly detect the infection in the body of a pregnant woman. If the baby is lucky enough to be born healthy, the mother will not breastfeed him so that the infection is not transmitted to him through milk.

Intrauterine infection - listeriosis

The disease develops as a result of the activity of the Listeria bacterium. The microorganism easily penetrates the fetus through the placenta. Infection of a pregnant woman occurs through unwashed vegetables and a number of food products (milk, eggs, meat). In women, the disease may be asymptomatic, although in some cases fever, vomiting and diarrhea are noted. In an infected baby, the signs of listeriosis are as follows:

rash and multiple accumulations of pustules on the skin;
inflammation of the brain;
refusal of food;
sepsis;
spontaneous miscarriage;
stillbirth of a baby.

If signs of listeriosis become obvious in the first week after birth, then babies die in 60 cases out of 100. After confirmation of listeriosis in a pregnant woman, she is prescribed a two-week course of treatment with Ampicillin.

Intrauterine infection - syphilis

If a pregnant woman has syphilis, which she has not treated, the probability of infecting her child is almost 100%. Out of 10 infected babies, only 4 survive, and those who survive are diagnosed with congenital syphilis. The child will become infected even if the mother’s disease is latent. Results of infection activity in children's body the following:

tooth decay, damage to the organs of vision and hearing;
damage to the upper and lower extremities;
formation of cracks and rashes on the skin;
anemia;
jaundice;
mental retardation;
premature birth;
stillbirth.

Intrauterine infection - toxoplasmosis

The main carriers of toxoplasmosis are cats and dogs. The causative agent of the disease enters the body of the expectant mother when she takes care of a pet or, out of habit, tastes meat with an insufficient degree of heat treatment while preparing dinner. Infection during pregnancy poses a great danger to the intrauterine development of the baby - in 50 cases out of 100, the infection overcomes the placental barrier and affects the fetus. The consequences of a child becoming infected are as follows:

damage to the organs of vision;
hydrocephalus;
microcephaly;
abnormally enlarged liver and spleen;
inflammation of the brain;
spontaneous abortion;
delay in the development of psychomotor functions.

Cytomegalovirus, rubella, toxoplasmosis, herpes, tuberculosis, syphilis and some other diseases are combined into a group of so-called TORCH infections. When planning a pregnancy, future parents undergo tests that help identify these pathological conditions.

Tests for intrauterine infections during pregnancy

Within 9 months expectant mother there's more to go through laboratory test so that doctors can make sure that she is healthy. Pregnant women take a blood test for hepatitis B and C, and syphilis. The PRC method is also used for pregnant women, thanks to which it is possible to detect active viruses in the blood, if any. In addition, expectant mothers regularly visit the laboratory to take a vaginal smear for microflora.

Of no small importance for successful pregnancy management is ultrasonography. This method is absolutely safe for the fetus. And although this procedure is not directly related to the diagnosis of infectious diseases, with its help doctors can detect abnormalities of intrauterine development caused by pathogenic microorganisms. There is every reason to talk about an intrauterine infection if the following symptoms become obvious on an ultrasound:

Formed developmental pathologies.
Polyhydramnios or oligohydramnios.
Swelling of the placenta.
Enlarged abdomen and unnaturally enlarged structural units of the kidneys.
Enlarged internal organs: heart, liver, spleen.
Foci of calcium deposition in the intestines, liver and brain.
Enlarged ventricles of the brain.

In the diagnostic program for examining expectant mothers belonging to the risk groups we discussed above, a special place is occupied by the seroimmunological method for determining immunoglobulins. As necessary, doctors resort to amniocentesis and cordocentnesis. The first method of research is to study amniotic fluid, the second involves studying umbilical cord blood. These diagnostic methods very informative in detecting infection. If the presence of an intrauterine infection is suspected in a baby, then the material for research is the baby’s biological fluids - for example, saliva or blood.

The danger of TORCH infections during pregnancy. Video

– a group of diseases of the fetus and newborn that develop as a result of infection in the prenatal period or during childbirth. Intrauterine infections can lead to fetal death, spontaneous abortion, intrauterine growth retardation, premature birth, birth defects, damage to internal organs and the central nervous system. Methods for diagnosing intrauterine infections include microscopic, cultural, immunoenzyme, and molecular biological studies. Treatment of intrauterine infections is carried out using immunoglobulins, immunomodulators, antiviral and antibacterial drugs.

General information

Intrauterine infections - pathological processes and diseases caused by antenatal and intrapartum infection of the fetus. The true prevalence of intrauterine infections has not been established, however, according to generalized data, at least 10% of newborns are born with congenital infections. The relevance of the problem of intrauterine infections in pediatrics is due to high reproductive losses, early neonatal morbidity, leading to disability and postnatal death of children. Issues of preventing intrauterine infections lie in the area of consideration of obstetrics and gynecology, neonatology, and pediatrics.

Causes of intrauterine infections

Intrauterine infections develop as a result of infection of the fetus in the prenatal period or directly during childbirth. Typically, the mother is the source of intrauterine infection for the child, i.e., there is a vertical transmission mechanism, which in the antenatal period is realized by transplacental or ascending (through infected amniotic fluid) routes, and in the intranatal period by aspiration or contact routes.

Iatrogenic infection of the fetus occurs less frequently during pregnancy when a woman undergoes invasive prenatal diagnostics (amniocentesis, cordocentesis, chorionic villus biopsy), the introduction of blood products to the fetus through the vessels of the umbilical cord (plasma, red blood cells, immunoglobulins), etc.

In the antenatal period, infection of the fetus is usually associated with viral agents (rubella, herpes, cytomegaly, hepatitis B and Coxsackie viruses, HIV) and intracellular pathogens (toxoplasmosis, mycoplasmosis).

In the intranatal period, microbial contamination more often occurs, the nature and extent of which depends on the microbial landscape of the mother’s birth canal. Among the bacterial agents, the most common are enterobacteria, group B streptococci, gonococci, Pseudomonas aeruginosa, Proteus, Klebsiella, etc. The placental barrier is impenetrable to most bacteria and protozoa, however, if the placenta is damaged and fetoplacental insufficiency develops, antenatal microbial infection can occur (for example, with the causative agent of syphilis ). In addition, intrapartum viral infection cannot be ruled out.

Factors in the occurrence of intrauterine infections are a burdened obstetric and gynecological history of the mother (nonspecific colpitis, endocervicitis, STDs, salpingophoritis), unfavorable course of pregnancy (threat of miscarriage, gestosis, premature placental abruption) and infectious morbidity of the pregnant woman. The risk of developing a manifest form of intrauterine infection is significantly higher in premature infants and in cases where a woman is primarily infected during pregnancy.

To the heaviness clinical manifestations intrauterine infection is influenced by the timing of infection and the type of pathogen. So, if infection occurs in the first 8-10 weeks of embryogenesis, pregnancy usually ends in spontaneous miscarriage. Intrauterine infections that occur in the early fetal period (before 12 weeks of gestation) can lead to stillbirth or the formation of gross malformations. Intrauterine infection of the fetus in the II and III trimester pregnancy is manifested by lesions individual organs(myocarditis, hepatitis, meningitis, meningoencephalitis) or generalized infection.

It is known that the severity of the manifestations of the infectious process in a pregnant woman and in the fetus may not coincide. Asymptomatic or asymptomatic course infections in the mother can cause severe damage to the fetus, including its death. This is due to the increased tropism of viral and microbial pathogens towards embryonic tissues, mainly the central nervous system, heart, and organ of vision.

Classification

The etiological structure of intrauterine infections suggests their division into:

To designate the group of the most common intrauterine infections, the abbreviation TORCH syndrome is used, combining toxoplasmosis, rubella, cytomegalovirus, and herpes simplex. The letter O (other) denotes other infections, including - viral hepatitis, HIV infection, chicken pox, listeriosis, mycoplasmosis, syphilis, chlamydia, etc.).

Symptoms of intrauterine infections

The presence of intrauterine infection in a newborn may be suspected already during childbirth. Intrauterine infection may be indicated by the discharge of turbid amniotic fluid contaminated with meconium and containing bad smell, condition of the placenta (plethora, microthrobosis, micronecrosis). Children with intrauterine infection are often born in a state of asphyxia, with prenatal malnutrition, enlarged liver, malformations or stigmas of dysembryogenesis, microcephaly, hydrocephalus. From the first days of life, they experience jaundice, elements of pyoderma, roseolous or vesicular rashes on the skin, fever, convulsions, respiratory and cardiovascular disorders.

The early neonatal period with intrauterine infections is often aggravated by interstitial pneumonia, omphalitis, myocarditis or carditis, anemia, keratoconjunctivitis, chorioretinitis, hemorrhagic syndrome, etc. instrumental examination Newborns may present with congenital cataracts, glaucoma, congenital heart defects, cysts, and brain calcifications.

In the perinatal period, the child experiences frequent and profuse regurgitation, muscle hypotension, central nervous system depression syndrome, grey colour skin. At a later date with prolonged incubation period intrauterine infection may develop late meningitis, encephalitis, osteomyelitis.

Let us consider the manifestations of the main intrauterine infections that make up the TORCH syndrome.

Congenital toxoplasmosis

After birth in the acute period, intrauterine infection manifests itself as fever, jaundice, edematous syndrome, exanthema, hemorrhages, diarrhea, convulsions, hepatosplenomegaly, myocarditis, nephritis, pneumonia. In the subacute course, signs of meningitis or encephalitis dominate. With chronic persistence, hydrocephalus with microcephaly, iridocyclitis, strabismus, and optic nerve atrophy develop. Sometimes monosymptomatic and latent forms of intrauterine infection occur.

To the number late complications Congenital toxoplasmosis includes mental retardation, epilepsy, and blindness.

Congenital rubella

Intrauterine infection occurs due to rubella during pregnancy. The probability and consequences of fetal infection depend on the gestational age: in the first 8 weeks the risk reaches 80%; The consequences of intrauterine infection can include spontaneous abortion, embryo- and fetopathy. In the second trimester, the risk of intrauterine infection is 10-20%, in the third – 3-8%.

Babies with intrauterine infection are usually born premature or at low birth weight. The neonatal period is characterized by a hemorrhagic rash and prolonged jaundice.

Congenital herpetic infection

Intrauterine herpes infection can occur in a generalized (50%), neurological (20%), mucocutaneous form (20%).

Generalized intrauterine congenital herpetic infection occurs with severe toxicosis, respiratory distress syndrome, hepatomegaly, jaundice, pneumonia, thrombocytopenia, hemorrhagic syndrome. Neurological form congenital herpes clinically manifested by encephalitis and meningoencephalitis. Intrauterine herpes infection with the development of skin syndrome is accompanied by the appearance of a vesicular rash on skin and mucous membranes, including internal organs. When layering bacterial infection neonatal sepsis develops.

Intrauterine herpes infection in a child can lead to the formation of developmental defects - microcephaly, retinopathy, limb hypoplasia (cortical dwarfism). Late complications of congenital herpes include encephalopathy, deafness, blindness, retardation psychomotor development.

Diagnostics

Currently, the urgent task is prenatal diagnosis intrauterine infections. To this end, at early stages During pregnancy, smear microscopy, bacteriological culture of the vagina for flora, PCR examination of scrapings, and examination for the TORCH complex are performed. Pregnant women from the group high risk for the development of intrauterine infection, invasive prenatal diagnostics are indicated (chorionic villus aspiration, amniocentesis with the study of amniotic fluid, cordocentesis with the study of umbilical cord blood). detects signs.

Treatment of intrauterine infections

General principles for the treatment of intrauterine infections involve immunotherapy, antiviral, antibacterial and syndromic therapy.

Immunotherapy includes the use of polyvalent and specific immunoglobulins, immunomodulators (interferons). Antiviral therapy directional action is carried out mainly by acyclovir. Antibiotics are used for antimicrobial therapy of bacterial intrauterine infections wide range actions (cephalosporins, aminoglycosides, carbapenems), for mycoplasma and chlamydial infections - macrolides.

Syndromic therapy of intrauterine infections is aimed at relieving individual manifestations of perinatal damage to the central nervous system, hemorrhagic syndrome, hepatitis, myocarditis, pneumonia, etc.

rubella vaccinations, must be vaccinated no later than 3 months before the expected pregnancy. In some cases, intrauterine infections may be the basis for artificial

Any infectious diseases during pregnancy can cause infection of the fetus. Signs of pathology do not appear immediately, but the consequences can be very severe. Intrauterine infection (IUI) is difficult to diagnose and difficult to treat. Changes in the fetus are manifested by nonspecific symptoms, which cannot always be used to suspect an infection.

Etiology and prevalence

The reasons for the development of intrauterine infection of the fetus are associated with infection of the mother during pregnancy or with activation chronic infection. The exact frequency and prevalence have not been established, not all pregnancies with infection result in childbirth, and the causes of early miscarriage are not always possible to determine. According to various studies, intrauterine infection accompanies up to 10% of all pregnancies.

Etiological factors perform different kinds microorganisms:

rubella, herpes, hepatitis, HIV viruses;
bacteria of syphilis, tuberculosis, STIs;
protozoa: toxoplasma;
fungi of the genus Candida.

A combination of several pathogens is also common.

There is a concept of a TORCH complex. This abbreviation stands for Latin names the most common causative agents of fetal diseases. These include:

T – toxoplasmosis;
O - other pathogens, which include syphilis, hepatitis, mycoplasma, candidiasis and many other infections;
R – rubella;
C – cytomegalovirus;
H – herpes.

Intrauterine infections in newborns cause death before 1 year of age in 30% of cases, and congenital malformations in 80% of cases.

Most often, the fetus is affected by viruses, much less often by bacteria and fungi. They can cause disease secondary to viral activation.

Consequences depending on the duration of infection

The greatest danger to the unborn child is primary infection of the mother during pregnancy. Her body must intensively produce protective antibodies, and therefore is not able to protect the fetus. If activation or re-encounter with the pathogen occurs, the consequences are less significant. The mother already has antibodies to the pathogen, so the disease is much easier, and the child is protected by maternal immunity.

The consequences of intrauterine infection for the fetus depend on the period when the infection occurred. In the first 2 weeks of embryo formation, the laying of the main tissues is disrupted, so spontaneous development occurs. It would be more correct to call the outcome of blastopathy a biochemical pregnancy, because the fertilized egg may be at the initial stage of implantation, and the woman will not know about her position. In this case, pregnancy can only be registered through blood tests.

When the pathogen penetrates during 2-10 weeks of gestation, severe malformations are formed, which are a consequence of cell damage and disruption of organ formation. They are often incompatible with life and end in fetal death, stillbirth or death in the first months of life.

Infection of the fetus between 11 and 28 weeks of gestation causes fetopathies. The fetal body is already capable of an inflammatory response; only some organs are affected. But the mechanism of inflammation is not complete. After the first phase - alteration, there is no second - exudation, as a result of which there is an influx of leukocytes and the release of substances that are aimed at localizing infectious agent. The third phase of inflammation is pronounced - proliferation, when increased synthesis occurs connective tissue and delimitation of the pathological focus. Therefore, children infected during this period are born with defects of individual organs, often with fibroelastosis, hydronephrosis, and polycystic disease.

If fetal infection occurs in later, 28-40 weeks, then full-fledged inflammatory reaction, which involves several organs. A child is born with encephalitis, nephritis, hepatitis, pneumonia.

Infection can also occur at the time of birth. Inflammation of one or two organs develops, most often the lower ones suffer Airways and liver, pneumonia and hepatitis are diagnosed.

Signs of infection

Clinical signs infectious process in the fetus is nonspecific. During pregnancy, some infections can occur in women with minimal symptoms. Signs of intrauterine fetal infection include diagnosed fetoplacental insufficiency and (FGR). Inflammatory processes are often accompanied by polyhydramnios, less often oligohydramnios occurs.

Low placentation can also be an indicator of the presence of infection in the uterus, often chronic inflammatory processes such as endometritis.

An increase in the size of the fetal liver and spleen indicates an intrauterine disease. Pathology can be suspected at the birth of a child with stigmata of disembryogenesis. These are minor developmental anomalies that do not significantly affect general state health, but indicate diseases that occurred in utero. These include:

abnormalities in the structure of the skull, low forehead, large brow ridges;
changes in the shape of the eyes, shape of the jaw and chin, curvature of the nose;
excessively protruding ears, lack of natural curvature, tragus;
curvature of the neck, folds of skin on it;
shape changes chest, abdominal hernia;
short or long fingers, their fusion, transverse groove on the palm, curvature of the fingers;
clitoral enlargement, cryptorchidism, small labia;
darlings and dark spots, hemangiomas.

But to diagnose pathologies that arose in utero, it is necessary to detect 5 or more stigmas.

The newborn may have respiratory disorders, diseases of cardio-vascular system. Physiological jaundice is more difficult to tolerate, has more long course. The skin may become covered with a rash, there are neurological disorders, and feverish conditions.

But an accurate diagnosis can only be made after diagnosis.

Risk factors

The mechanism of transmission of intrauterine infection can be of three types:

ascending – from the mother’s reproductive tract;
transplacental – from foci of chronic or acute infection in the maternal body;
descending - through the fallopian tubes;
intrapartum – during childbirth.

Considering the possible routes of infection of the fetus, a woman during the preconception period needs to sanitize the foci of existing infection. It is necessary to achieve remission in chronic infectious pathologies(tonsillitis, sinusitis, cystitis), sanitation oral cavity, treatment of carious teeth.

Risk factors have been identified that increase the likelihood of developing IUI. Spicy inflammatory process which occurs during pregnancy, especially for the first time, significantly increases the chances of infection of the fetus. In the first trimester, when the placenta has not yet formed, there is a greater likelihood of influence from bacterial flora. In subsequent trimesters, when the placenta is already capable of retaining large cells of pathogens, viral pathology more often develops.

Chronic lesions can lead to the spread of pathogens hematogenously, lymphogenously or by implantation. The risk of disease increases with decreased immunity. Mild immunosuppression is a natural process. This occurs under the influence of progesterone, which suppresses local protection to prevent rejection of the fertilized egg, which is partially foreign to the mother's body. But long-term chronic diseases, somatic pathologies, hypothermia and overheating, stressful situations may further suppress the immune system.

Impaired placental permeability, which occurs when pathological course pregnancy increases the possibility of transmission of an infectious agent to the fetus. The placenta itself is also affected; foci of hemorrhages, calcifications and various inclusions may appear in it, which impair the flow of blood to the fetus. This leads to its chronicity and developmental delay.

Poor social conditions are also a risk factor. Conditions arise for poor hygiene, and contact with infectious patients is possible. Women from low social strata are more likely to be infected with sexually transmitted infections.

Characteristics of major infections

Each disease has its own characteristics, pathogenesis, course and intrauterine infection.

Toxoplasmosis

Congenital toxoplasmosis develops when infected after 26 weeks; the likelihood of such an outcome increases as the time of birth approaches. If infection occurs in the early stages, spontaneous miscarriage or fetal death.

The classic triad of signs is chorioretinitis, microcephaly and hydrocephalus. But it doesn't always happen. Considering the severe malformations of the fetus and its disability, pregnant women who have had toxoplasmosis are offered termination of pregnancy. medical indications up to 22 weeks.

Herpes simplex

Herpes simplex viruses are most common among adults. The first type predominantly manifests itself as a rash on the lips, while the second affects the anogenital area. Viruses can remain latent for a long time and only appear when the immune system is weakened.

The placenta protects the fetus well from infection, so cases of congenital herpes are rare. Intrauterine herpetic infection possible with viremia in the mother during primary infection during gestation. If this occurs in the early stages, spontaneous termination of pregnancy is possible. In later stages, IUI is characterized by lesions various organs.

Late-term genital herpes can lead to infection during childbirth. If this is a relapse of the disease in the mother, then the child will be protected by her antibodies. During primary infection there is heavy defeat newborn

For a newborn, herpes threatens neurological complications. Their severity depends on the time of infection. The earlier, the more extensive the damage to the nervous system and the more severe the manifestations. Signs of damage to the nervous system, encephalitis, do not appear immediately, but 2 weeks after birth. If left untreated, death occurs in 17%.

With the primary infection of genital herpes (later), severe damage to the newborn occurs, often leading to death

Measles

The virus is transmitted by airborne droplets. Pregnancy does not affect the clinical manifestations of the pathology. The effect of the measles virus on pregnancy is controversial. The risk of teratogenicity is low, but there is evidence of damage to the membranes and the threat of premature birth in women with measles.

A newborn only becomes ill if the mother becomes ill 7 days before birth or within a week after birth. Manifestations of pathology can be different - from a mild course to a fulminant course, which ends in death. Infection postnatally leads to mild manifestations of the disease that are not dangerous for the child.

Diagnosis is carried out according to characteristic clinical picture and by detecting antibodies. Treatment is symptomatic.

Vaccination against measles during gestation is contraindicated. But this pathology is included in the calendar preventive vaccinations held in childhood.

Numerous types of intrauterine infections are diagnosed during pregnancy only when clinical manifestations of the disease occur. The exceptions are: dangerous diseases, like HIV, syphilis. Also, a woman must be examined for gonorrhea. Smears, which are taken at regular intervals and when complaints of discharge occur, help sanitize the genital tract and prevent infection during childbirth.