Perinatal Lecture April09

8/8/2019 Perinatal Lecture April09

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Understanding terminologyUnderstanding terminologycongenitalcongenital

prenatal/antenatalprenatal/antenatalperinatalperinatalpostnatal infectionspostnatal infections

April 2009April 2009


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P renatal, perinatal & postnatalP renatal, perinatal & postnatalinfectionsinfections

many factors and sources involved,many factors and sources involved,primarily bacteria & virusesprimarily bacteria & virusesmay be opportunistic or pathogenicmay be opportunistic or pathogenic


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Congenital infections

Congenital infections

in uteroin utero infectionsinfections

infections from mother to foetusinfections from mother to foetustransplacental infectionstransplacental infections


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Mother s symptoms in congenitalMother s symptoms in congenital

infectionsinfectionsusually asymptomaticusually asymptomatic

often mildoften mildsometimes overt sometimes overt


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Effects on foetusEffects on foetus

no effect e.g.no effect e.g.common coldcommon cold

localized infectionslocalized infectionsadverse effect e.g.adverse effect e.g.

congenital infectionscongenital infections


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Consequence toConsequence to foetusfoetus

deathdeath - - spontaneous abortionspontaneous abortion(syphilis)(syphilis)

malformations (rubella)malformations (rubella)chronic infection (HIV)chronic infection (HIV)overt symptoms (see next slide)overt symptoms (see next slide)


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Consequence to foetusConsequence to foetus

Aborted foetus - rubellaStillborn - parvovirus


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Consequence to foetus (newborn)Consequence to foetus (newborn)

failure to thrive (rubella, toxoplasmosis)failure to thrive (rubella, toxoplasmosis)mental deficiencies (toxoplasmosis)mental deficiencies (toxoplasmosis)

malformations (rubella)malformations (rubella)hepatosplenomegaly (parvovirus)hepatosplenomegaly (parvovirus)chronic infection (HIV)chronic infection (HIV)


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Consequence to newbornConsequence to newborn overt symptomsovert symptoms

hydrocepalus - toxoplasmosis

hepatosplenomegal y

S yphilis - nasal Rubella - ras h


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P revention of congenital infectionsP revention of congenital infections

antenatal screening testsantenatal screening testsToRCHeS programmeToRCHeS programmeHIV, HBs/HBeHIV, HBs/HBechlamydia, gonorrhoea, group B strept.,chlamydia, gonorrhoea, group B strept.,etc.etc.If positive, what then??If positive, what then??


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ToRCHeS screeningToRCHeS screening

toxoplasmosistoxoplasmosisrubellarubellaCM VCM V -- cytomegaloviruscytomegalovirusherpes simplex virus (HSV)herpes simplex virus (HSV)

syphilissyphilis


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ToRCHeS screeningToRCHeS screening Types of TestsTypes of Tests

Antibody detectionAntibody detection Ig M &/or IgGIgM &/or IgGAntigen detetctionAntigen detetctionPC R (detects specific DNA or RNA)PC R (detects specific DNA or RNA)


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P renatal infectionsP renatal infections

before birthbefore birthfoetal membrane may rupture for a 1foetal membrane may rupture for a 1- -33

daysdaysinfection of chorioinfection of chorio- -amniotic membraneamniotic membraneinfection of mother & foetusinfection of mother & foetus


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Source of prenatal infectionSource of prenatal infection

normal floranormal floravaginavagina

reproductive tract reproductive tract

Staph.Staph.

Strept.Strept.

GmGm--neg.neg. bacteriabacteria


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P renatal infections of the motherP renatal infections of the mother

localised infection of thelocalised infection of thegenitogenito--urinary tract urinary tract

pyrexia of unknown originpyrexia of unknown origin(P UO)(P UO)


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P renatal infectionP renatal infection foetusfoetus

deathdeath stillbirthstillbirthpremature delivery & respiratorypremature delivery & respiratorydistress syndromedistress syndromedeformities & other defectsdeformities & other defects


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P erinatal infectionsP erinatal infections

during birthduring birthduring passage down the birth canalduring passage down the birth canal

infection to newborninfection to newborn


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P erinatal infectionsP erinatal infections

normal flora of genitonormal flora of genito- -urinaryurinarytract tract ORORestablished pathogensestablished pathogens


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P erinatal infection by normal floraP erinatal infection by normal flora

opportunistic infectionopportunistic infectionespecially premature deliveryespecially premature delivery

low birth weight low birth weight E. coliE. coli, coliforms, streptococci,, coliforms, streptococci,BacteroidesBacteroides, staphylococci, etc., staphylococci, etc.


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Normal floraNormal flora

Staph.Staph.

Strept.Strept. GmGm--neg.neg.

ClostridiumClostridium


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P erinatal opportunistic infectionsP erinatal opportunistic infections

of newbornof newbornnormal floranormal flora

neonatal sepsisneonatal sepsisimmunoimmuno--compromised newbornscompromised newborns


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P erinatal infections by viral pathogensP erinatal infections by viral pathogens

human immunodeficiency virushuman immunodeficiency virus(HIV)(HIV)hepatitis B virus (HBV)hepatitis B virus (HBV)herpes simplex virus (HSV)herpes simplex virus (HSV)


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HIV infection of newbornHIV infection of newborn

congenital (transplacental)congenital (transplacental)20% of HIV+ mothers20% of HIV+ mothers

perinatal (blood)perinatal (blood)postnatal (milk)postnatal (milk)lab. diagnosis is difficult lab. diagnosis is difficult


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HIV infection of newbornHIV infection of newborn

symptoms appear latersymptoms appear later

susceptible to other infectionssusceptible to other infectionslymphadenopathylymphadenopathypoor weight gain, etc.poor weight gain, etc.


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HBV infection of newbornHBV infection of newborn

mother HBs &/or HBe +vemother HBs &/or HBe +ve

bloodblood8080--90% newborns become infected90% newborns become infectedHBsAg+ve after 2HBsAg+ve after 2- -5 months5 months


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P revent HBV infection of newbornP revent HBV infection of newborn

screen mother for HBs & HBescreen mother for HBs & HBeduring pregnancyduring pregnancyif +ve, ...if +ve, ...protect newborn after birthprotect newborn after birth


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P rotect newborn against HBVP rotect newborn against HBV

HBs vaccine plusHBs vaccine plus

specific hyperspecific hyper- -immunoglobulinimmunoglobulinwhat does this mean?what does this mean?


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HSV infection of newbornHSV infection of newborn

infected mother with HSV lesionsinfected mother with HSV lesions

tend to be severe & disseminatedtend to be severe & disseminatedhepatitis, pneumonitis, encephalitishepatitis, pneumonitis, encephalitis

acyclovir for treatment acyclovir for treatment


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HSV infection of newbornHSV infection of newborn

80% confined to skin lesions80% confined to skin lesions

60% haveC

NS signs60% haveC

NS signsfits, bulging fontanelle, etc.fits, bulging fontanelle, etc.


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P erinatal infections by bacteriaP erinatal infections by bacteriapathogenspathogens

Neisseria gonorrhoeaeNeisseria gonorrhoeaeChlamydia trachomatisChlamydia trachomatisGroup B streptococciGroup B streptococciStaphylococcus aureusStaphylococcus aureus


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Ophthalmia neonatorumOphthalmia neonatorum

staphylococci ( sticky eye )staphylococci ( sticky eye )

gonorrhoea (refer STD)gonorrhoea (refer STD)chlamydia (refer STD)chlamydia (refer STD)


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Chlamydia infections of newbornChlamydia infections of newborn

ophthalmia neonatorumophthalmia neonatorumatypical pneumoniaatypical pneumonia


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Group B streptococci of newbornGroup B streptococci of newborn

normal vagina flora of mothernormal vagina flora of motherrespiratory route to...respiratory route to...septicaemia & meningitissepticaemia & meningitisother symptomsother symptoms

L ancefield grouping


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Group B streptococci infectionsGroup B streptococci infections - -specimensspecimens

blood cultureblood culture

cerebrospinal fluidcerebrospinal fluid

B lood culture


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Group B streptococciGroup B streptococci - - lab. diagnosislab. diagnosis

microscopymicroscopycultureculturedirect (latex)direct (latex)agglutinationagglutination

G ram stain

L atex agglutination


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Group B streptococciGroup B streptococci - - treatment treatment

penicillin, antibiotic of choicepenicillin, antibiotic of choice


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Group B streptococciGroup B streptococci - - preventionprevention

antenatal screeningantenatal screening

prenatal screeningprenatal screeningif +ve, when to treat.if +ve, when to treat.


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P erinatal staphylococci infectionsP erinatal staphylococci infections

Staphylococcus aureusStaphylococcus aureus

toxintoxin--producing strainsproducing strainscellulitis (epidermolytic toxincellulitis (epidermolytic toxin - -scalded skin)scalded skin)

toxaemiatoxaemia


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scalded babyscalded babysyndromesyndrome


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P ostnatal infectionsP ostnatal infections

Respiratory Distress SyndromeRespiratory Distress Syndrome---- neonatal I CUneonatal I CU

nosocomial infectionsnosocomial infectionsrespiratory tract to septicaemiarespiratory tract to septicaemia


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P ostnatal infectionsP ostnatal infections

other hospital acquired infectionsother hospital acquired infections

rotavirus, herpes simplex virus (HSV)rotavirus, herpes simplex virus (HSV)MRSA (MRSA (methicillin resistant Staph. aureusmethicillin resistant Staph. aureus ))


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Neonatal tetanusNeonatal tetanus

home deliveryhome delivery

traditional practice ontraditional practice onumbilical cordumbilical cord


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Neonatal tetanusNeonatal tetanus - - symptomssymptoms

classical tetanus symptoms (tetanospasm)classical tetanus symptoms (tetanospasm)risus sardonicus (lockjaw), opisthothonusrisus sardonicus (lockjaw), opisthothonus

(arching of the back)(arching of the back)treatment treatment


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prevention measuresprevention measurestrained doctors/midwivestrained doctors/midwivesantenatal immunisationantenatal immunisation

Neonatal tetanusNeonatal tetanus


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P ostnatal infections to the motherP ostnatal infections to the mother

delivery or abortion = traumadelivery or abortion = traumatrauma = infection risktrauma = infection riskinfections:infections:

endogenous & exogenous microbesendogenous & exogenous microbes


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P ostnatal infections to the motherP ostnatal infections to the mother

puerperal sepsis (childbirth fever)puerperal sepsis (childbirth fever)

nonnon--aseptic techniques / instrumentsaseptic techniques / instruments


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Thank you!!Thank you!!

Any questions??Any questions??

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Perinatal Lecture April09