Enterovirus infection and pregnancy. Is the Coxsackie virus dangerous for pregnant women? Effect on the fetus, methods of treatment

As a rule, the Coxsackie virus does not pose a serious danger. This is a common enterovirus infection. In adults, it passes quickly and does not affect the general state of health.

But there are special warnings for pregnant women from doctors. What is the peculiarity of the Coxsackie virus? Is it dangerous for pregnant women? And if so, how much?

The Coxsackie virus, which gives an intense itchy rash, is actually common in all water bodies around the world. This disease has long been known and is predominantly a childhood disease. Mostly children from 3 to 9 years old get sick, who often put dirty toys in their mouths. In our medicine, this disease is simply called the hand-foot-mouth syndrome. The name is because the rash occurs precisely on these parts of the body.

Causes a rash enterovirus, which spreads both by airborne droplets and by contact. The disease spreads very quickly, causing epidemics. The virus, getting on the oral mucosa, penetrates into the blood, then into the intestines. And it multiplies in the intestines.

Coxsackie is a heat-loving virus, so epidemics usually occur during the hottest summer periods. Any contact with the patient's personal belongings or his sneezing next to you is already a sufficient condition to get sick.

The incubation period is about 6 days. With high humidity and hot weather, the chances of getting sick greatly increase.

Symptoms of infection

It is difficult to confuse the Coxsackie virus with other infections. He has characteristics, which can be determined without the participation of a doctor.

Signs of infection are:

• rash mainly in the mouth, on the palms and feet;
• fever;
• sometimes muscle pain.

However, in most cases, there may not be any manifestations. This intestinal infection, it happens that it simply asymptomatically multiplies in the intestines, and a person, without knowing it, is a dangerous carrier of an enterovirus. Rash and redness are classic manifestations of the disease, but there are other forms.

Forms of the disease caused by the Coxsackie virus

The disease, as we said, may not manifest itself in any way and develop secretly. But, depending on various factors, the disease can manifest itself in several forms.

Let's list them:

• flu-like form. It flows relatively easily. The patient's temperature rises slightly and the symptoms resemble mild acute respiratory infections. If a child or adult has been ill with this syndrome, no unforeseen complications arise.
• Enteroviral exanthema. The classic form, expressed in a rash. Usually there are no serious consequences either.
• Pleurodynia the syndrome is accompanied severe pain in the muscles of the chest. These muscles become inflamed.
• intestinal form- is very sharp. The temperature rises to 39-40 0 C. The patient has frequent vomiting, indigestion. Usually in children, this form is milder.
• Syndrome with the manifestation of hemorrhagic conjunctivitis. Symptoms of this form are: pain in the eyes, lacrimation, suppuration.

The latent form is the most dangerous, since the infection remains in the body and is not treated in any way, but the consequences are not long in coming. And although the disease is harmless at first glance, serious complications cause anxiety, up to damage to the cerebral cortex. But such lesions are extremely rare.

The virus itself has 2 types:

• Coxsackie A (24 subtypes);
• Coxsackie B (6 subtypes).

The Coxsackie virus is not so simple. Is a set of symptoms such as a rash, chest pain, or vomiting dangerous for pregnant women? These manifestations are not dangerous, but deviations can occur in an unformed fetus.

How does the Coxsackie virus affect the fetus?

This is just the kind of disease that is dangerous for the unborn child. Even if the woman herself easily tolerates the Coxsackie virus, the infection often leads to a delay in the development of the fetus or anomalies. The virus overcomes What does it lead to? There can be several options for pathologies:

• The child suffers in utero from hydrocephalus and is born with dropsy.
• There is a fading of pregnancy and female body gets rid of the fetus. That is, a miscarriage occurs.
• The fetus as a whole develops normally, but the heart suffers. The baby will be born with a serious heart defect.
• Malformations in the genitourinary system are also possible.

If a person has had this syndrome, he has already formed antibodies. But if a woman first encountered this virus during pregnancy, then her immunity, weakened by pregnancy, in principle, cannot protect either herself or her child. Therefore, the consequences in this case are the most serious.

If a woman "picks up" a group B virus, then most likely there will be no miscarriage, but the risk of infecting the child right during childbirth is high. It is also very dangerous for the newborn organism. Very widespread the consequence of such infection during childbirth or in the first hours after them are severe neurological abnormalities in the child.

In what trimester of pregnancy is the virus most dangerous?

So what do we know about the Coxsackie virus? Is it dangerous for pregnant women and the fetus? The most dangerous period, of course, is the 1st trimester, when the neural tube and the main internal organs are laid. What we know about the impact The consequences for the fetus and mother are not optimistic. The chance of miscarriage in the first 10-12 weeks is very high.

At this time, it is absolutely impossible to be at risk of infection. It is necessary to avoid polluted reservoirs, public pools. A pregnant woman should wash her hands often and not eat vegetables or fruits that are dirty, straight from the garden.

Coxsackie and in the second trimester of pregnancy. Reviews of women who have already been ill about such an experience are sad. You can not leave this disease unattended in any trimester, but the shorter the period, the more serious the consequences.

Complications in newborns

We described the Coxsackie virus, whether it is dangerous for pregnant women, and also discussed. Now let's talk about the consequences of infection with the virus in newborns.

Children suffer from the following complications:

• pericarditis;
• liver failure or congenital hepatitis;
• encephalomyocarditis;
• pneumonia.

Children with encephalomyocarditis often die. And if you manage to save them, then such babies remain disabled after the illness.

Even if the child was infected from the mother during childbirth, doctors recommend continuing breastfeeding. After all, the antibodies of the mother are transmitted to the baby during feeding.

Treatment of Coxsackie enterovirus during pregnancy

The first thing to do if someone in the house is sick with this syndrome is to isolate him in a separate room and give him personal dishes. A pregnant woman should not come into contact with a sick person. After all, what is the Coxsackie virus? This is an infection that can cross the placenta and cause significant harm to the fetus. How to treat the Coxsackie virus during pregnancy?

Usually treatment is symptomatic. The patient is given all the well-known antipyretic drugs for fever. But since most pharmaceutical preparations contraindicated when a woman is expecting a baby, then she is given interferon in small doses. But until 14-15 weeks, even it is forbidden to use it.

The child should develop its own interferon. An artificial drug can cause a miscarriage. In general, during pregnancy, you cannot treat infections on your own. You need to see a doctor right away.

Infection prevention

The Coxsackie virus during pregnancy is said to be very dangerous to the fetus. How to prevent infection? First, you need to thoroughly wash all fruits and vegetables. It is not recommended to overcool. It is forbidden to swim in rivers with stagnant water. You need to walk more often in the fresh clean air.

If there is an older child in the house, make sure that he also constantly washed his hands with soap after the street, and not just rinsed.

All toys brought from the street must be disinfected. The virus can stay in environment without a carrier. But if one person becomes infected, the disease quickly spreads to all family members.

Compliance with these simple rules will help reduce the risk of infection with such a dangerous enterovirus as the Coxsackie virus.

Sooner or later, every woman makes an important decision in life to become a mother. And, as a rule, it becomes it. However, not every such pregnancy proceeds in the way you would like it to. Various complications and infections can significantly disrupt both the plans of the expectant mother and the course of pregnancy as a whole.

For example, an enterovirus infection in a pregnant woman may well become a cause for serious concern. And then there will be a serious risk for the woman herself and for the fetus. But how serious everything is and whether it is really worth worrying is worth understanding in more detail.

Sources of infection and symptoms of manifestation

Enterovirus infection is not a kind of independent disease. This is a whole group of disease states and symptoms that are usually caused by intestinal viruses. The most common ways of infection with enterovirus infection are enterovirus airborne transmission with subsequent infection and the fecal-oral route.

Why are these viruses so terrible and can they harm both the woman herself and her born child? How is the effect of infection on the body and what are primary symptoms disease?

Enterovirus infection most often enters the body through the mucous channels digestive system or through Airways. In this case, the infection, once in a comfortable environment for it, begins to actively multiply, thereby causing local inflammation in the body. This process is accompanied by a number of completely non-specific symptoms: chills, fever, sore throat and an insignificant runny nose.

These manifestations are characteristic only at first, until enteroviruses penetrate into the blood and with it into all internal organs. When the infection spreads, one of the forms of enterovirus infection occurs.

Forms of the disease

As already mentioned, the causes of enterovirus infection are quite common and infection can occur even if all the precautions and disinfection by the woman are observed. Today, more than a dozen forms of varieties of this infection are distinguished. Let's briefly consider each of them:

1. Herpangina caused by an enterovirus attack. Manifested as a cold: headache, chills and fever, pain when swallowing in the throat and a slight increase in lymph nodes. At the same time, scanty bubbles similar to the manifestation of a sore throat form on the tonsils, the sky, but after 5 days these symptoms disappear, although the disease progresses further.

2. Enteroviral diarrhea. The course is very similar to food poisoning against the background of cold symptoms. However, this form is characterized by: flatulence, strong liquid stool 9-10 times a day, vomiting, nausea and abdominal pain.

Agree during pregnancy is not very attractive state of health. Which, in addition to everything else, will worsen further and dangerously pronounced intoxication and dehydration of the body as a whole. This happens due to physiologically low immunity at the time of pregnancy.

3. Epidemic myalgia. One of the dangerous forms of the disease during pregnancy. It is characterized by strong bouts of muscle pain in the limbs and abdomen from half a minute to 15 minutes. Feelings and symptoms are very similar to the threat of miscarriage in a woman. Therefore, with this form, expectant mothers often end up in an obstetrics hospital.

4. This form is very rare, but it cannot be excluded from the accounts - serrous meningitis. Typical for her: heat body up to 40 degrees, repeated vomiting, convulsions, severe chills, abdominal pain, skin rashes.

Already on the 3rd day, it becomes clear that the enterovirus infection affects the membranes of the brain, manifested in the rigidity of the occipital muscles. However, this form responds very well to treatment and usually has no consequences for the expectant mother and fetus.

5. Enterovirus infection can be recovered within 3 days. This is the so-called enterovirus fever. Which is very similar to the flu and goes away on its own after 3 days without treatment.

Approximately the enteroviral exanthema also proceeds. The same fever, but plus a rash on the body of small pinkish spots. For 2 days all this continues and then disappears without a trace. As you can see, such infections are very alarming and it is unlikely that pregnant women will want to have them while carrying a child.

6. Other forms of the disease that can be provoked by enteroviruses. Against the background of infection may begin: myocarditis, encephalitis, uveitis, acute paralysis of the extremities. Everything will depend on where exactly the enterovirus infection has penetrated and where its final breeding center will be.

Dangerous periods and possible treatment for expectant mothers in case of infection

talking about dangerous periods diseases with enterovirus infection, it should immediately be said that in general, in principle, the contact of a pregnant woman with a patient with an enterovirus infection is in itself a risk and it is better to avoid them in principle.

Such contacts are most unfavorable in the first trimester of bearing a baby. Because the consequences that such viruses can provoke can pose a serious danger to the mother and child.

What is fraught with?

The fact is that an enterovirus infection easily penetrates the placenta and can cause: placental insufficiency, fetal growth retardation in general, polyhydramnios, embryonic death, hydrocephalus in a baby, and a heart disease or urogenital area of ​​the baby can also occur.

That is why it is not permissible to contact, and even more so to be an infected woman during pregnancy. The risk of miscarriage and the development of all kinds of defects in the unborn baby is very high.

invisible virus

Expectant mothers should also be wary of another terrible enterovirus attack. This is the so-called coxsackie virus, which may not manifest itself in any way during the bearing of the future child, but manifest itself directly during childbirth or immediately after them.

What is this infection and why does it manifest itself differently against the background of other enteroviruses? And is there a treatment for enterovirus in pregnant women?

It is impossible to talk only about such infections, because during the period of expectation of a child, any infection can be detrimental to health. But still, you should know more about coxsackie. It is this infection that can provoke itself like all the forms described above and manifest itself in any of the forms. It is not easy to detect such infections during pregnancy, but their detrimental effect on the placenta is nevertheless very large.

How to detect that a woman is infected with an infection?

For this, the patient must pass a blood and urine test, make an emri of the brain. A blood test detects markers in the blood produced by the body that act as a protective shield against such infections. Comprehensive diagnostics gives a hundred percent answer to the presence or absence of the disease.

How to fight?

If a girl during pregnancy in the initial trimester does not receive treatment on time, then the harm to the effect on the placenta can be significant. The treatment itself is symptomatic, depending on the site of the lesion and the organ of localization. Self-medication is unacceptable.

As a preventative measure:

- temper

- sleep well

- regularly checked by a doctor

- eat well and drink strictly boiled water

- less time in crowded places

- ventilate your room more often.

But even observing all the measures, there is still a risk, so do not neglect meetings with your gynecologist!

Enterovirus infection is a group of diseases caused by intestinal viruses (enteroviruses). The manifestations of the disease are very diverse. Enteroviruses infect the organs of the central nervous system, digestive tract, lungs and muscles. What threatens an enterovirus infection to a pregnant woman and her baby?

The reasons

AT last years In the world, there is a trend towards an increase in enterovirus infection. AT different countries outbreaks and even epidemics are recorded all over the world. One of the reasons for such an active spread of infection is a healthy virus carrier. It has been established that enteroviruses can exist in the human intestine for up to 5 months. The person does not experience any discomfort. The disease does not manifest itself, but there is an active release of viral particles into the external environment and infection of the surrounding people.

The causative agents of enterovirus infection are various representatives of the genus Enterovirus. It also includes Coxsackie and ECHO viruses. More than 100 types of microorganisms are potentially dangerous for humans.

The source of infection is a sick person or a virus carrier. The virus is transmitted by airborne droplets or the fecal-oral route. Vertical transmission of the infection (from mother to fetus) is possible. The peak incidence occurs in summer and autumn. At risk are young people under 25, including pregnant women. After recovery, a stable type-specific immunity is formed (to a certain type of enterovirus).

Symptoms

The virus enters the body through the mucous membranes of the digestive tract and upper respiratory tract. The reproduction of the microorganism leads to the development of local inflammation and the appearance of the first nonspecific symptoms of the disease:

• mild runny nose;
• pain and sore throat;
• fever.

After some time, the virus enters the blood and then into the internal organs. There is one of the possible forms of enterovirus infection:

Enteroviral herpangina

The disease is manifested by such symptoms:

• fever;
• headache;
• moderate sore throat when swallowing;
• enlargement of the cervical lymph nodes.

On examination, redness of the mucous membrane of the throat attracts attention. Bubbles up to 2 mm in size appear on the palate, uvula, tonsils, which do not merge with each other. After 1-2 days, the vesicles open with the formation of slightly painful erosions. On the 5th-6th day of illness, all changes in the respiratory mucosa disappear on their own.

Enteroviral diarrhea

Typical symptoms:

• pain in the epigastric and umbilical region;
• nausea and vomiting;
• loose stools up to 7-10 times a day;
• flatulence.

Signs of enteroviral diarrhea are not specific and resemble the symptoms of any food poisoning. Quite often, diarrhea occurs against the background of a mild runny nose, sore throat and fever. All symptoms of the disease persist for 3-5 days. Pregnant women, due to a physiological decrease in immunity, enterovirus infection threatens with rapid progression with the development of severe intoxication and dehydration.

epidemic myalgia

With this form of the disease, severe muscle pain occurs in the anterior region. abdominal wall, lower abdomen, limbs. The attack of pain lasts from 30 seconds to 15 minutes. Such symptoms are often taken as a threat of abortion (with localization of pain in the womb area), which becomes a reason for hospitalization in an obstetric hospital.

Serous meningitis

A rare form of enterovirus infection. The disease begins with an increase in body temperature to 38-40 ° C, severe chills, severe headache. At the same time, other symptoms appear:

• muscle pain;
• abdominal pain;
• nausea and repeated vomiting;
• skin rashes;
• disturbance of consciousness;
• convulsions.

On the 2-3 day from the onset of the disease, there are signs of damage to the membranes of the brain (stiff neck, etc.). Meningitis with enterovirus infection usually proceeds without complications and responds well to therapy.

Enteroviral fever

Other names: minor illness or three-day fever. A common but difficult-to-diagnose form of enterovirus infection. Characterized by the appearance of moderate fever within 3 days with minimal changes general condition. It resolves on its own without treatment.

Enteroviral exanthema

With this form of the disease, against the background of fever, a rash on the skin appears in 1-2 days. A rash in the form of small reddish-pink spots is localized on the face, trunk and limbs. The rashes last for 1-2 days, after which they disappear without a trace.

Other forms of enterovirus infection

Enteroviruses can cause such conditions:

• myocarditis (inflammation of the muscle tissue of the heart);
• encephalitis (brain damage);
• hepatitis;
• uveitis (inflammation of the choroid of the eye);
• acute paralysis of the limbs.

Complications of pregnancy and consequences for the fetus

Pregnant women are at high risk for infection with enteroviruses and the development of various complications. A decrease in immunity in anticipation of a baby leads to the fact that the virus easily penetrates into a weakened body and spreads through the bloodstream. Penetrating through the placenta, enterovirus can cause such conditions:

• placental insufficiency;
• delayed fetal development;
• polyhydramnios.

On the early dates pregnancy enterovirus infection can lead to the death of the embryo and miscarriage. There is a very high probability of the formation of various defects internal organs and nervous system, including:

• hydrocephalus (violation of the outflow of fluid from the membranes of the brain);
• heart defects;
• malformations of the urinary tract.

The shorter the gestational age at the time of infection, the higher the likelihood of an adverse outcome. On the later dates enterovirus infection can cause premature birth and the birth of a small child.

The likelihood of infection of the fetus increases in women carriers of enterovirus. The virus circulating in the body is often activated during gestation due to physiological restructuring immune system. Women who first encountered the virus only during pregnancy are also at high risk for the development of complications. The absence of protective antibodies leads to the rapid spread of infection and the penetration of a dangerous microorganism through the placenta.

Principles of treatment

specific antiviral therapy not assigned. To increase the overall resistance of the body, preparations based on interferon are used. Treatment is carried out at any stage of pregnancy. The duration of therapy is determined by the doctor, taking into account the severity of the condition of the expectant mother.

With the development of enteroviral diarrhea, it is important to prevent dehydration. For this purpose, glucose-salt solutions are prescribed (Rehydron, Oralit, etc.). The drug is diluted with water according to the instructions. The solution should be taken throughout the day in small sips (volume up to 1.5 liters per day) until the general condition improves. If signs of dehydration increase, treatment continues in the hospital.

To alleviate the condition with herpangina, antiseptic agents are used in the form of lozenges and sprays. The choice of drug will depend on the duration of pregnancy. The course of therapy is 5-7 days until the complete disappearance of cough and sore throat. Seawater-based solutions can be used to rinse the nose.

IUI is one of the leading causes perinatal morbidity and mortality. The frequency of IUI varies widely and depends on many factors: the type of pathogen, the condition of the fetus and newborn, gestational age, etc. At present, the frequency of various manifestations of IUI is 10-53% (Fig. 102).

Rice. 102. Various manifestations of IUI

There are two concepts: IUI itself and intrauterine infection.

IUI is a disease in which the source of infection of the fetus is the body of an infected mother and which has a variety of clinical manifestations in the form of pyoderma, conjunctivitis, rhinitis, hepatitis, gastroenteritis, pneumonia, otitis, meningoencephalitis, even sepsis. The infection does not clinical manifestations in the fetus and is expressed only in the penetration of the pathogen into his body

la. The disease in the fetus does not occur as a result of the mobilization of immunity and protective mechanisms in the mother-fetus system. In both cases, infection occurs in the antenatal period or during childbirth.

etiology of intrauterine infections

The obstetric axiom is known: there is no parallelism between the severity of the infectious process in the mother and in the fetus. A mild, mild or even asymptomatic infection in a pregnant woman can lead to severe damage to the fetus up to its disability or even death. This phenomenon is largely due to the tropism of pathogens (especially viral ones) to certain embryonic tissues, as well as the fact that fetal cells with their highest level of metabolism and energy are an ideal environment for reproduction (replication) of microbes. This explains the great similarity of embryo- and fetopathy caused by various infectious agents.

To designate the IUI group, the abbreviation TORCH was proposed (according to the first letters of the names of infections, however, the word "torch" carries a greater meaning - with of English language it translates as "torch", which emphasizes the danger and severe consequences of IUI).

Abbreviation TORCH decoded as follows. Toxoplasmosis- toxoplasmosis.

Others- other infections (absolutely proven: IUI causes syphilis pathogens, chlamydia, enterovirus infections, hepatitis A and B, gonococcal infection, listeriosis; measles and mumps; hypothetical - pathogens of influenza A, lymphocytic choriomeningitis, human papillomavirus).

Rubeola- rubella.

Cytomegalia- cytomegalovirus infection. Herpes- herpesvirus infection.

These infections are most widespread among the adult population, including pregnant women.

Toxoplasmosis occurs in 5-7% of pregnant women, while in 30% of cases infection of the fetus is possible (encephalitis and its consequences, chorioretinitis, a generalized process accompanied by hepatosplenomegaly, jaundice and damage to the cardiovascular system).

Infection of the fetus with syphilis occurs at 6-7 months of pregnancy, spirochetes can penetrate through an intact placenta. As a result, a miscarriage occurs with a macerated fetus or the birth of a dead child with signs of visceral syphilis (liver damage, interstitial pneumonia, osteomyelitis, osteochondritis).

During pregnancy, chlamydia is detected in 12.3% of cases, about 50% of children born to mothers with chronic endocervicitis have signs of chlamydial infection.

Quite common entero viral infections. ECHO and Coxsackie viruses are of the greatest interest as causative agents of IUI. Enteroviruses are transmitted to pregnant women through direct contact with patients who have lesions of the upper respiratory tract, lungs, or manifestations of an intestinal infection. The experiment proved the etiological role of Coxsackieviruses of group A (serotypes 3, 6, 7, 13) and group B (serotypes 3,4), as well as ECHO viruses (serotypes 9 and 11).

Up to 1% of pregnant women are carriers of the Australian (HBsAg) antigen, while the risk of infection of the fetus and newborn is 10%.

Perinatal infection with listeriosis occurs transplacentally, rarely ascending and through the amniotic fluid in listeriosis pyelitis, endocervicitis, or influenza-like illness; the child is usually born with a generalized form of the infection (granulomatous sepsis).

Measles is one of the most common infections and occurs in 0.4-0.6 cases per 10 thousand pregnancies.

The rubella virus is able to cross the placental barrier. The probability of infection of the fetus depends on the duration of pregnancy and is 80% in the first 12 weeks, 54% - in 13-14 weeks and not more than 25% - by the end of the second trimester.

Cytomegalovirus - common cause IUI (intrauterine infection - in 10% of cases). The risk of fetal infection in recurrent cytomegalovirus infection in a pregnant woman it is small due to the fact that the fetus is protected by antibodies circulating in the mother's blood. Therefore, the risk group for congenital cytomegaly is the children of seronegative mothers with seroconversion that occurred during this pregnancy.

The defeat of the genital herpes virus is detected in 7% of pregnant women. Herpetic infection is characterized by lifelong carriage of the virus.

Special relevance herpetic infection associated with AIDS patients. It has been established that herpes viruses can activate the HIV genome, which is in the provirus stage, and are a cofactor in the progression of HIV infection. Up to 50% of children born to HIV-infected mothers become infected antenatal, intrapartum or in the early neonatal period through mother's milk.

SARS, transferred in the second half of pregnancy, is a risk factor for the development of IUI due to transplacental transmission of the virus to the fetus. Respiratory viruses, which cause perinatal damage in 11% of cases, can persist and multiply in the placenta, the fetal brain, and especially in the choroid plexuses of the lateral ventricles of the brain.

pathogenesis of intrauterine infections

The pathogenesis of IUI is diverse and depends on many factors, primarily on the course of the infectious process in the mother (acute, latent, stage of remission or exacerbation, carriage). At infectious disease in the mother during pregnancy, the embryo and fetus are affected not only by pathogens, but also by toxic products formed when the mother's metabolism is disturbed, during the decay of the infectious agent, and, in addition, hyperthermia and hypoxia that occur during an acute process.

Gestational age plays an important role in pathogenesis. In the pre-implantation period (the first six days after fertilization), under the influence of the infectious agent, the zygote dies or completely regenerates. During the period of embryogenesis and placentogenesis (from the 7th day to the 8th week), hy-

Bel embryo, development of deformities, primary placental insufficiency. In the early fetal period (from 9-10 to 28 weeks), the fetus and placenta become sensitive to the pathogen. It is possible to develop deformities (the so-called pseudo-deformities), as well as sclerotic changes in organs and tissues.

IUI leads to a violation of the further development of an already formed organ. So, urinary tract infection can lead to hydronephrosis, meningoencephalitis - to hydrocephalus against the background of narrowing or obliteration of the Sylvian aqueduct of the brain. After the 28th week of gestation, the fetus acquires the ability to specifically respond to the introduction of the infectious agent with leukocyte infiltration, humoral and tissue changes.

Outcome of intrauterine infection may be different: prematurity, intrauterine growth retardation, antenatal death or various manifestations of a local and generalized infectious process, placental insufficiency, impaired adaptation of the newborn; clinical manifestations of IUI can be observed in the first days of life (in the first four days, and in some types of specific infection - after the 7th day and beyond).

The localization of the infectious process in the fetus and newborn depends on the route of penetration of the pathogen. are considered classic four ways of intrauterine infection:ascending path- through the birth canal (bacterial and urogenital infection); transplacental (hematogenous) route(bacterial foci of inflammation; viral infections; listeriosis; syphilis; toxoplasmosis); descending path(at inflammatory processes in the organs abdominal cavity); mixed path.

Bacterial IUI develops mainly due to the penetration of an ascending infection from the birth canal, and first chorioamnionitis occurs, amniotic fluid becomes infected, and the fetus is affected due to ingestion of amniotic fluid or their entry into the respiratory tract. Infection is possible when the fetus passes through the birth canal, which is typical for bacterial and urogenital infections. With hematogenous infection of the fetus, there should be a purulent-inflammatory focus in the mother's body. The causative agent affects the fetal part of the placenta, breaking the placental barrier, penetrates

into the fetal circulation. With hematogenous infection, a generalized lesion of the fetal body often occurs - intrauterine sepsis. All true congenital viral infections are characterized by a transplacental route of infection, including such specific ones as listeriosis, syphilis, toxoplasmosis, and cytomegalovirus infection. Transdecidual (transmural), descending and mixed routes of infection are observed much less frequently, the pathogenesis of fetal damage does not differ from that in hematogenous and ascending infection.

clinical picture

Clinical manifestations of IUI are mostly non-specific and depend on the gestational age at infection, the number and virulence of pathogens, and the route of infection.

It was noted that the shorter the gestation period during infection, the more severe the course and the worse the prognosis of IUI. The most pronounced lesions of the liver and brain, which are disseminated in nature, are caused by pathogens that penetrate the fetus transplacentally. Clinically, this is manifested by spontaneous abortion, death of the fetal egg, premature birth, fetal growth retardation, anomalies in its development, and the birth of a sick child. Such lesions are typical for: measles, rubella, chickenpox, cytomegaly, mumps, influenza, parainfluenza, herpes simplex type II, Coxsackie, parvovirus B19 (in early pregnancy), as well as HIV infection and some bacterial infections (listeriosis, streptococcal infection).

When infected in the first trimester of pregnancy, the fetus may develop micro- and hydrocephalus, intracranial calcification, malformations of the heart and limbs, in the II and III trimesters - chorioretinitis, hepatosplenomegaly and jaundice, pneumonia, malnutrition.

The ascending route of infection is typical for conditionally pathogenic microorganisms, gardnerella, protozoa, fungi, chlamydia, mycoplasmas, etc. The pathogens multiply and accumulate in the amniotic fluid, which is clinically manifested by the syndrome of "infection" or "amniotic fluid infection". During pregnancy, with such an infection, polyhydramnios, malnutrition and

fetal hypoxia, edematous syndrome, fetal enlargement of the liver and spleen, hyperbilirubinemia; possible miscarriage, premature birth.

At the same time, asymptomatic colonization of amniotic fluid by various microorganisms is not excluded. Asymptomatic chorioamnionitis should be considered if tocolytic treatment is unsuccessful in impending preterm labor.

To nonspecific clinical manifestations of IUI in newborns, respiratory distress syndrome, signs of asphyxia, hyaline membrane disease, congenital malnutrition, jaundice, edematous syndrome, DIC, as well as a symptom complex requiring careful differential diagnosis with manifestations of CNS damage of hypoxic-traumatic genesis (general lethargy, decreased muscle tone and reflexes, regurgitation, breast rejection, intense weight loss and slow recovery, respiratory disorders, bouts of cyanosis).

In some newborns, the manifestations of IUI are different, specific character: vesiculopustulosis at birth, conjunctivitis, otitis media, intrauterine pneumonia, enterocolitis, meningoencephalitis, gastrointestinal syndrome.

It should be noted the possibility of developing IUI in children in the late period of development, associated with the persistence of the virus (chlamydial conjunctivitis, progressive cataract when infected with rubella virus, hydrocephalus with persistence of Coxsackie viruses, chronic pyelonephritis and juvenile diabetes with chronic congenital enterovirus infection).

Features of clinical manifestations of certain diseases in pregnant women

Flu. With influenza in the first trimester, miscarriages occur in 25-50% of cases. However, the frequency of fetal malformations is not increased.

Rubella. Fetal infection occurs in women who first get rubella during pregnancy. Infection of the fetus in the first 12 weeks of embryogenesis leads to the development of hereditary rubella syndrome (cataract, microphthalmia, impaired function of the hearing organs, micro- and hydrocephalus, and heart defects). With a disease in the first trimester of pregnancy, the risk of miscarriages and congenital anomalies develops

is high enough that the pregnancy should be terminated. When infected at a later date, the organ of hearing is most often affected. After 16 weeks of gestation, the risk of infection decreases, but infection during these periods can lead to the development of a chronic disease with impaired liver function, anemia, thrombocytopenia, CNS damage, immunodeficiency, and dental dysplasia. In parallel, the placenta is affected (inflammation of the villi and vasculitis), which disrupts the nutrition of the fetus. The risk of fetal infection with the rubella virus depends on the gestational age at which the mother was infected (Table 24).

Measles. The risk of abortion is increased (as with the flu), but there are no abnormalities in the development of the fetus.

Polio. During pregnancy, the risk of the disease and its severity are increased. Up to 25% of fetuses from affected mothers carry polio in utero. This virus does not cause fetal abnormalities.

Mumps. Characterized by low morbidity and mortality. flows into mild form. There is no risk of developmental anomalies.

Hepatitis A (RNA virus). Oral-fecal route of infection. There are practically no complications during pregnancy if the disease is mild.

Hepatitis B (DNA virus). Ways of infection - parenteral, perinatal and sexual. Up to 10-15% of the population are chronic carriers of the hepatitis B virus. A pregnant woman infects the fetus during childbirth (the use of the fetal head for monitoring control during labor is not recommended).

Parvovirus. The DNA virus crosses the placenta during pregnancy, causing a non-immune edematous syndrome in the fetus. Clinical picture the mother is characterized by the presence of a rash, arthralgia, arthrosis, transient aplastic anemia. 50% of women have antibodies against parvovirus. If a pregnant woman does not have antibodies, then the greatest risk of abortion is noted up to 20 weeks. Infection of the fetus occurs in the phase of viremia. The virus has a tropism for erythrocyte precursor cells. Clinical manifestations of IUI depend on the gestational age: early pregnancy - spontaneous abortion, late - non-immune dropsy of the fetus as a manifestation of a severe form of hemolytic anemia, intrauterine fetal death; the edematous syndrome developing in the fetus occurs due to heart failure caused by anemia. An unfavorable outcome is observed in 20-30% of cases. In 70-80% of cases of serologically confirmed infection in the mother, no damaging effect on the fetus is noted, which can be explained by the neutralization of the virus by antibodies. There is no specific therapy.

Herpes. The greatest role in the pathology of pregnancy and intrauterine infection for the fetus is played by viruses of the family herpesviridae.

Herpes viruses are transmitted in a variety of ways, but highest value has a sexual route of infection. Primary genital herpes in the mother and exacerbation of chronic are the most dangerous for the fetus. If 0.5-1% of newborns are intranatally infected, then with acute genital herpes and exacerbation of chronic (which is manifested by vesicular lesions of the skin and mucous membranes of the genitals), the risk of infection of the fetus during childbirth reaches 40%. Adverse outcomes for the fetus are mainly associated with the transplacental (hematogenous) route of transmission of the pathogen.

Infection of the fetus in the first trimester of pregnancy leads to hydrocephalus, heart defects, anomalies in the development of the gastrointestinal tract, etc. Spontaneous abortion is often noted. Infection in the II and III trimesters is fraught with the development of hepatosplenomegaly, anemia, jaundice, pneumonia, meningoencephalitis, sepsis, and malnutrition in the fetus. With an ascending infection path (from the cervix), the pathogen multiplies and accumulates in the amniotic fluid, polyhydramnios is noted. Postnatal infection of newborns is also possible in the presence of herpetic manifestations on the skin of the mother, relatives or medical personnel.

Thus, infection of the fetus before 20 weeks of gestation leads to spontaneous abortion or fetal abnormalities in 34% of cases, in the period from 20 to 32 weeks - to premature birth or antenatal death of the fetus in 30-40% of cases, after 32 weeks - to the birth of the patient a child with skin lesions (herpetic eruptions, ulcerations, which are quite rare), eyes (cataracts, microphthalmia, chorioretinitis) and the central nervous system (microor hydrocephalus, cerebral necrosis). It should be noted the severity of the manifestations of the disease in a newborn when infected with the herpes simplex virus (meningoencephalitis, sepsis); death occurs in 50% of cases. Surviving children in the future have severe complications (neurological disorders, visual impairment, psychomotor retardation). Neonatal herpes occurs with a frequency of 20-40 cases per 100 thousand newborns.

Cytomegalovirus infection. Obstetric complications such as spontaneous miscarriages, premature births, antenatal death and fetal abnormalities, polyhydramnios, non-developing pregnancy are possible. The probability of infection with a latent course of infection is practically absent, with reactivation and persistence it is 0.5-7%, and with primary infection it exceeds 40%. The classic manifestations of cytomegalovirus disease are hepatosplenomegaly, thrombocytopenia, brain development disorders (microcephaly, intracranial calcification), encephalitis, chorioretinitis, pneumonia, and intrauterine growth retardation. Mortality in congenital cytomegaly is 20-30%.

Coxsackievirus infection. In the first trimester of pregnancy, this infection is rare, leading to the formation of malformations of the gastrointestinal and urogenital tracts, the central nervous system. When infected in late pregnancy, the following clinical manifestations are possible in a newborn: fever, refusal to eat, vomiting, hypotension, skin rashes, convulsions. Some newborns have otitis, nasopharyngitis, pneumonia.

HIV infection. The possibility of intrauterine infection of the fetus from a mother infected with HIV is confirmed by the detection of virus antigens in the tissues of the fetus and in the amniotic fluid. There are three ways for the virus to overcome the placental barrier: 1) the transfer of free virus as a result of damage to the placental barrier and interaction with T4 receptors of fetal lymphocytes; 2) primary infection of the placenta, secondary infection of the fetus; carriers of the virus

Hofbauer cells of the placenta are formed, through which diaplacental transmission is possible; 3) the transition of the virus during childbirth from the affected cells of the cervix and vagina through the mucous membranes of the fetus. HIV infection acquire 20-30% of newborns from infected mothers. In children infected with HIV, skin lesions in the form of bacterial, fungal and viral exanthema are noted.

bacterial infection. The development of intrauterine bacterial infection is facilitated by the presence of focal foci (tonsillitis, sinusitis, carious teeth, pyelonephritis, chronic and acute lung diseases, etc.). Pathogens can penetrate the fetus through the placenta. Ascending infection often occurs when the integrity of the amniotic sac during pregnancy or childbirth. In addition, colpitis, cervicitis, invasive methods for assessing the condition of the fetus (amnioscopy, amniocentesis, etc.), numerous vaginal examinations during childbirth, isthmicocervical insufficiency, and the threat of abortion contribute to ascending infection. With generalized microbial contamination of amniotic fluid, chorioamnionitis is manifested by fever, chills, tachycardia, purulent discharge from the genital tract and other symptoms. The fetus is diagnosed with hypoxia.

Among IUIs of a bacterial nature, STDs prevail. The most common causative agents of urogenital infections are Chlamydia trachomatis. Chlamydia mainly affects the cells of the cylindrical epithelium. More than half of infected women have no clinical manifestations.

Clinical manifestations of chlamydial infection in newborns are conjunctivitis, which occurs at an atypical time for IUI - after 1-2 weeks, and sometimes 5 weeks after birth, and interstitial pneumonia, which develops within 2-4 months from the moment of birth. Such long-term manifestations of infection indicate the predominant route of infection of the fetus with chlamydia through direct contact with the mother's birth canal, although the ascending route of infection through intact fetal membranes is not excluded.

mycoplasma infection. Mycoplasmosis during pregnancy develops mainly in persons with immunodeficiency states. Urogenital mycoplasmosis can lead to IUI, which is

cause of miscarriage, stillbirth; in premature newborns, mycoplasmas cause the development of pneumonia, meningitis, and a generalized infection.

congenital syphilis. The disease is polysystemic various forms. Its manifestations resemble secondary syphilis. Most babies look healthy at birth, some have vesicular-bullous rashes on the palms and soles, but 4 days to 3 weeks after birth, the following symptoms of the disease may appear.

Flu-like syndrome:

meningeal symptoms;

Tearing (inflammation of the iris);

Discharge from the nose, the mucous membranes are hyperemic, edematous, eroded, replete with pale treponemas;

Angina (there are papules on the mucous membrane of the pharynx);

Generalized arthralgia (due to pain, there are no active movements in the limbs - Parro's pseudo-paralysis, signs of osteochondritis are noted on the radiograph, periostitis is often detected, in particular, of the tibia (saber legs).

Increasing all groups lymph nodes(cervical, elbow, inguinal, axillary, popliteal).

Hepatosplenomegaly (in severe cases - anemia, purpura, jaundice, edema, hypoalbuminemia).

Rashes:

maculopapular;

Merging of papular lesions with the formation of wide condylomas.

Listeriosis. In pregnant women, listeriosis can occur as a flu-like illness, in a subclinical form with blurred symptoms. There are abortions or premature births, stillbirths or fetal deformities that are incompatible with life. In fetuses, listeriosis manifests as granulomatous sepsis or septicopyemia with metastatic purulent meningitis; in newborns, sepsis and pneumonia are most common. The lethality of newborns with listeriosis reaches 60-80%.

Toxoplasmosis. The disease often occurs in close contact with animals. Females become infected either with sporodonts from the soil (by

fallen there with the feces of animals, such as cats), from hands, furniture, floors, or cystozoids from Toxoplasma cysts contained in the tissues of intermediate hosts (when eating insufficiently thermally processed meat). The clinical picture is characterized by polymorphism (presence or absence of fever, enlarged lymph nodes, liver and spleen, myocarditis, pneumonia, etc.). With toxoplasmosis, the development of endometritis, placental damage, the threat of abortion, and fetal hypotrophy are possible.

Candidiasis. Often develops during pregnancy urogenital candidiasis. This condition, like bacterial vaginosis, is the background for the addition of another bacterial and / or viral infection.

diagnostics

There are no reliable methods for diagnosing fetal IUI. It can only be assumed by indirect signs and the infection of the fetus and fetal egg can be established.

In a newborn, the infection appears either from the moment of birth or within 3-4 days (with the exception of chlamydia and a number of other infections that may appear later). Its diagnostic signs depend on the localization or degree of generalization of the process.

In the diagnosis of IUI, bacteriological and immunological methods are the main ones. These include the detection in crops of etiologically significant microorganisms in an amount exceeding 5x10 2 CFU / ml, and PCR, carried out to identify certain fragments of DNA or RNA of pathogen cells.

Crops and scrapings (to identify intracellularly located pathogens) in pregnant women are taken from the vagina and cervical canal. In pregnant women at high risk of developing IUI, invasive methods are used to obtain material for bacteriological examination (chorionic aspiration in early pregnancy, examination of amniotic fluid after amniocentesis and cord blood obtained by cordocentesis). Bacteriological studies should be combined with the identification of antigen in the blood serological methods IgM and IgG definitions that are specific to that

or other pathogen. Studies should be repeated at least 1 time in 2 months.

Currently, great importance is attached to ultrasound, which can be used to determine the indirect signs of IUI of the fetus.

Indirect ultrasound signs of IUI

Symptom of fetal growth retardation.

Abnormal amount of amniotic fluid (usually polyhydramnios).

Signs of premature or delayed maturation of the placenta. Violation of its structure ( varicose veins its vessels, the presence of hyperechoic inclusions, placental edema, contrasting of the basal plate).

Irregularly shaped expansion of the intervillous space, not corresponding to the centers of the cotyledons.

Early appearance of placental lobulation.

Expansion of the pyelocaliceal system of the kidneys of the fetus.

Micro- and hydrocephalus.

Expansion of the ventricles of the brain, increased echogenicity of brain tissue, cystic changes or foci of calcification (necrosis) in the periventricular zone of the brain, liver tissue.

Ascites, pericardial or pleural effusion, hepatomegaly, hypoechoic bowel, fetal hydrops.

Screening tests in newborns at high risk of developing IUI include the study of amniotic fluid smears, placenta, cord blood cultures and stomach contents of the newborn. In some cases, it is recommended to study the blood culture of the newborn, and the most appropriate is the collection of capillary rather than umbilical cord blood. The activity of alkaline phosphatase is determined, the number of platelets is counted (thrombocytopenia below 150x10 9 / l is considered a sign of infection), the ratio of young forms of leukocytes and neutrophils and the radioisotope determination of B-lactamase (to detect infection with B-lactamase-producing microorganisms). Of great importance is the histological examination of the placenta, although inflammatory changes do not always correspond to the disease of the child. In the diagnosis of viral infections, examination of formalin-fixed placental tissue may be useful. PCR method. When conducting a serological examination in a newborn child (IgG, IgM), the following principles should be remembered:

Examination of a newborn should be carried out before the use of donor blood products in the treatment of a child;

The results of the examination of the child must always be compared with the results of the examination of the mother;

The presence of specific class G immunoglobulins in a titer equal to or less than the titer of the corresponding maternal antibodies indicates not an intrauterine infection, but a transplacental transfer of maternal antibodies;

The presence of specific class M immunoglobulins in any titer indicates the primary immune response of the fetus or newborn to the corresponding bacterial / viral antigen and is an indirect sign of infection;

The absence of specific class M immunoglobulins in the blood serum of newborns does not exclude the possibility of intrauterine or intrapartum infection.

A comparative analysis of the main methods for detecting IUI pathogens is shown in Table. 25.

prevention and treatment

Identification of risk groups is of great importance in the prevention of IUI. Numerous risk factors can be divided into the following three groups.

Chronic infectious diseases: chronic infections of the respiratory system, digestion, caries, tonsillitis; urogenital infections (pyelonephritis, colpitis, STDs); intestinal dysbacteriosis, bacterial vaginosis.

Complications of pregnancy: anemia, preeclampsia, miscarriage, isthmic-cervical insufficiency and its surgical correction, exacerbation chronic diseases and SARS in the second half of pregnancy.

Complications of childbirth: ARVI in childbirth, prenatal outflow of water; weakness of labor activity; protracted course of childbirth; multiple vaginal examinations; childbirth operations and benefits; long waterless period.

Continuation of the table. 25

Exist general principles prevention and treatment of IUI.

1. Etiotropic antimicrobial (antiviral) therapy, taking into account the stage, general and local symptoms, the duration of the course of an infectious and inflammatory disease, the presence of a mixed infection, gestational age, clinical and laboratory signs of IUI.

2. Prevention (treatment) of dysfunctions of the fetoplacental complex at 10-12, 20-22 and 28-30 weeks of pregnancy, as well as at individual critical times and in the complex of prenatal preparation (metabolic therapy, vasoactive drugs and antiplatelet agents).

3. Immunomodulatory, interferon-correcting therapy: herbal adaptogens, viferon.

4. Correction and prevention of violations of microbiocenoses of the pregnant woman's body: bifidumbacterin, lactobacterin (at least 15 doses per day), floradophilus (1 capsule 2 times) enterally for 10-14 days; in combination with acylact or lactobacterin vaginally.

5. Pregravid preparation.

6. Treatment of sexual partners in the presence of STDs.

Row preventive measures in most economically developed countries of the world, including the Russian Federation, have long been legalized by the state (Wassermann reaction, determination of the Australian antigen, HCV antibodies and antibodies to HIV in the blood serum). Children should be vaccinated against hepatitis B immediately after birth, after a week, after a month and after 6 months of life to prevent development severe forms diseases. There is no specific treatment for hepatitis A. For the prevention of severe course, immunoglobulin 0.25 ml per 1 kg of body weight can be used.

Women who have not previously had rubella, who have not received rubella vaccinations and therefore do not have antibodies to rubella virus, are recommended to be vaccinated before the expected pregnancy. Vaccination should be performed 3 months before pregnancy. A pregnant woman, especially at risk, should avoid any contact with a patient with an exanthemic infection. In the case of rubella in the first 16 weeks of pregnancy, its termination is indicated.

If infection occurred at a later date, the tactics are individual, it is advisable to conduct an IgM study of cord blood (cordocentesis), a virological or PCR study of am-

niotic fluid or chorion biopsy (amniocentesis). With confirmed infection of the fetus, termination of pregnancy is desirable.

For women who refuse to terminate a pregnancy >16 weeks, administration of specific IgG may be a measure to prevent infection in the fetus.

The introduction of gamma globulin to patients with rubella during the gestation period slightly reduces the incidence of fetal abnormalities. Pregnant women are not vaccinated.

When pregnant with chickenpox 5-7 days before delivery or in the first 3-4 days after delivery, immediate administration of Zoster immunoglobulin or Varicella-Zoster immunoglobulin is indicated to the newborn. With the development of the disease in a newborn (despite the implementation of preventive measures), treatment with acyclovir at a dose of 10-15 mg per 1 kg of body weight 3 times a day is recommended. Treatment of sick pregnant women with acyclovir is carried out only in severe cases of the disease.

With parotitis and measles, vaccination of pregnant women is not carried out, since a live attenuated vaccine is used. There is an inactivated vaccine for types A and B against influenza. There is no risk to the fetus during vaccination. It is recommended to vaccinate pregnant women according to strict epidemiological indications in the II and III trimesters.

Since there is no specific therapy for parvovirus infection, the use of immunoglobulin is recommended to prevent severe complications.

If a pregnant woman has a herpes infection, the nature of preventive and therapeutic measures, obstetric tactics will depend on the type of disease, its form (typical, atypical, asymptomatic, duration of the course), as well as the presence of genital lesions, the condition of the membranes, etc.

With the primary infection of a pregnant woman in the early stages of pregnancy, it is necessary to raise the question of its termination. If the pathology occurs at a later date or the woman was infected before pregnancy, preventive measures include dynamic ultrasound monitoring of the development and condition of the fetus, prescribing a course of therapy, including a metabolic complex, cell membrane stabilizers, unithiol.

The basic antiviral drug is acyclovir (Zovirax). Despite the lack of evidence of its teratogenic and embryotoxic

effects, the appointment of acyclovir to pregnant women suffering from genital herpes, it is advisable to limit the following indications: primary genital herpes; recurrent genital herpes, typical form; genital herpes in combination with a permanent threat of abortion or symptoms of IUI. Acyclovir is prescribed 200 mg 5 times a day for 5 days. The question of a longer use of the drug and repeated courses of treatment is decided individually. High efficiency of means in prevention of a perinatal infection is noted. In pregnant women with frequent relapses infections, there is a positive experience of permanent therapy with acyclovir (suppressive therapy). In case of a complicated course of a herpes infection (pneumonia, encephalitis, hepatitis, coagulopathy), treatment is carried out together with an infectious disease specialist. Required intravenous administration the drug at a dose of 7.5 mg/kg every 8 hours for 14 days. At the same time, it is advisable to use immunoglobulin therapy, interferon preparations, antioxidants (vitamins E and C). Among interferons, preference should be given to viferon, adaptogens are also prescribed. plant origin. Perhaps the use of laser blood irradiation, plasmapheresis and enterosorption. It is also necessary to treat bacterial diseases associated with genital herpes (most often chlamydia, mycoplasmosis, trichomoniasis, candidiasis, bacterial vaginosis). After complex therapy complications for the mother and fetus are reduced by 2-3 times.

Particular attention should be paid to the tactics of childbirth in women with primary and recurrent herpes. C-section as a prophylaxis of neonatal herpes, it is necessary in the presence of herpetic eruptions on the genitals or primary genital herpes in the mother 1 month or less before delivery. When abdominal delivery against the background of rupture of the membranes, the anhydrous interval should not exceed 4-6 hours.

Treatment and prevention of cytomegalovirus infection is quite difficult. Treatment consists of passive immunization courses. It is possible to use anticytomegalovirus immunoglobulin 3 ml intramuscularly 1 time in 3 days, 5 injections per course. More effective treatment human immunoglobulin(intravenous administration of 25 ml every other day, 3 infusions per course). Intraglobin-F is administered at the rate of 4-8 ml per 1 kg of body weight once every 2 weeks for prophylactic use. Number of preventive

infusions, as well as the regimen of preventive treatment are determined individually. Cytotect in case of proven cytomegalovirus infection with therapeutic purpose administer 2 ml per 1 kg of body weight every 2 days under the control of serological parameters. Prophylactic prenatal preparation includes infusion of 5 ml of Cytotec 2 times a week for 2 weeks. In any case, the expected benefit from the use of immunoglobulins should exceed the risk of possible complications (allergic and pyrogenic reactions, production of antibodies - antigammaglobulins, exacerbation of infection). The specific antiviral drug ganciclovir is used according to strict vital indications on the part of the mother and the newborn. Viferon is also used to prevent complications.

Currently, zidovudine and other nucleoside analogues with antiviral activity are used to treat AIDS. The facts of the teratogenic effect of these drugs have not been established, however, their use in HIV-infected patients in the early stages of pregnancy should be strictly justified. The main goal of prescribing drugs to seropositive pregnant women is to prevent the transmission of the virus to the fetus (it is carried out through the placenta or to the newborn when passing through an infected birth canal, and especially often through breast milk and in close contact with the mother). Zidovudine is prescribed at a dose of 300-1200 mg / day. Although experience with its use is limited, the administration of zidovudine to HIV-infected pregnant women may be effective method prevention of HIV infection in young children. Breastfeeding is stopped.

In the presence of signs of a bacterial intrauterine infection, intensive antibiotic therapy (penicillins, cephalosporins) is carried out. A newborn born with signs of IUI is prescribed antibiotic therapy initially with the same antibiotics, and then depending on the isolated microflora and its sensitivity to antibiotics.

Prevention of congenital chlamydia is similar. During pregnancy, macrolides are used to treat the disease (erythromycin 500 mg orally 4 times a day for 10-14 days). Josamycin (Vilprafen) is close to erythromycin in the spectrum of antimicrobial action, practically does not give side effects, does not break down in the acidic environment of the stomach, and in terms of antichlamydial action

equivalent to doxycycline. The drug is prescribed 2 g per day in 2-3 doses for 10-14 days. Spiramycin (rovamycin) is used at 3,000,000 IU 3 times a day (at least 7 days). With individual intolerance to natural macrolides, it is permissible to prescribe clindamycin orally at 0.3-0.45 g 3-4 times a day or intramuscularly at 0.3-0.6 g 2-3 times a day.

Treatment of patients with urogenital infection caused by Mycoplasma hominis and Ureaplasma urealytica, should begin immediately after confirmation of the diagnosis by laboratory methods. The pregnant woman and her husband are being treated. It does not differ significantly from that in urogenital chlamydia. During pregnancy, preference should be given to rovamycin and vilprafen. Against the background of antibiotic therapy, it is advisable to prescribe eubiotics (acylact, lactobacterin). It should be noted that a more effective prevention of IUI caused by mycoplasmosis and chlamydia is the treatment of women outside of pregnancy, when a wider range of antibacterial (tetracyclines, fluoroquinolones, etc.) and immunostimulating agents (decaris, prodigiosan, taktivin, etc.) can be used. .

Prevention of congenital toxoplasmosis

Identification of women who were first infected during this pregnancy (by increasing antibody titer in paired sera), timely decision on termination of pregnancy.

Treatment during pregnancy to prevent transmission of the infection to the fetus.

Examination and treatment of newborns.

Serological monitoring of uninfected women throughout pregnancy.

Treatment is with sulfonamides.

The drug of choice in the treatment of listeriosis is ampicillin (penicillin), used in doses of 6-12 g / day for severe forms of the disease and 3-4 g / day for minor manifestations - daily for 2-4 weeks. Pregnant women and women in childbirth should be isolated. Treatment of newborns with listeriosis is very difficult and should be started as early as possible. The drug of choice is ampicillin, administered intramuscularly at 100 mg/kg 2 times a day during the 1st week of life and 200 mg/kg 3 times a day during

grow older than 1 week. The duration of the course of treatment is 14-21 days.

Treatment of patients with syphilis during pregnancy is carried out according to the general principles and methods of therapy for this infection. With each subsequent pregnancy, a patient with syphilis must be given specific treatment. Mandatory is a three-fold serological examination of each pregnant woman in the first, second half of pregnancy and after 36 weeks of pregnancy.

In urogenital candidiasis in pregnant women, it is preferable to use local therapy (clotrimazole, miconazole, isoconazole, natamycin). Feasibility of enteral administration antifungal agents determined by the presence or absence of candidiasis of the gastrointestinal tract. Recurrent vaginal candidiasis is an indication for testing for viral and bacterial sexually transmitted infections. Patients should be informed that they and their sexual partners are recommended to be examined, if necessary - treated, abstinence from sexual activity until recovery, or the use of barrier methods of protection.

Bacterial vaginosis is clinical syndrome, characterized by the replacement of the normal microflora of the vagina, in which lactobacilli predominate, with opportunistic anaerobic microorganisms. In the treatment of pregnant women, intravaginal administration of clindamycin phosphate in the form of 2% vaginal cream, 5 g at night for 7 days or 0.75% metronidazole gel, 5 g at night, also 7 days from the second trimester of pregnancy, is preferable. With insufficient efficiency local therapy oral administration of the following drugs is possible: clindamycin 300 mg 2 times a day for 5 days or metronidazole 500 mg 2 times a day for 3-5 days. It is advisable to use eubiotics, vitamins and other means that help normalize the microbiocenosis of the vagina and intestines.

The issues of prevention and treatment of IUI cannot be considered fully resolved. The validity of the prophylactic prescription of antibiotics to pregnant women and newborns of high-risk groups for developing IUI is still a subject of discussion, although most clinicians consider such measures to be appropriate.

Due to the inability to conduct massive complex antibacterial therapy in pregnant women when planning

the family of the child long before the onset of pregnancy should treat the couple as a pre-conception preparation.

Scheme of pregravid preparation

1. A comprehensive examination with the study of the immune, hormonal, microbiological status, diagnosis of concomitant extragenital diseases, consultations of related specialists.

2. Immunostimulating, immunocorrective and interferon corrective therapy:

Drug therapy (pyrogenal, prodigiosan, taktivin, immunofan, specific immunoglobulin therapy and vaccine therapy, ridostin, larifan, viferon), laser therapy, plasmapheresis;

Phytotherapy (ginseng, eleutherococcus, aralia, lemongrass, etc.)

3. Etiotropic antibacterial or antiviral therapy according to indications:

Tetracyclines;

macrolides;

Fluoroquinolones;

clindamycin, rifampicin;

Cephalosporins;

Aciclovir, ganciclovir.

4. Eubiotic Therapy:

For oral administration- bifidumbacterin, lactobacterin, floradophilus, solkotrikhovak;

For vaginal use - bifidumbacterin, acylact, lactobacterin, "Zhlemik", "Narine".

5. Metabolic therapy.

6. Correction of violations menstrual cycle and associated endocrinopathies.

7. Mandatory treatment of a sexual partner in the presence of STDs, using individual schemes for chronic inflammatory diseases of the genitals.

Thus, the greatest risk of intrauterine infection threatens those children whose mothers are primarily infected with IUI during pregnancy. For infections such as rubella, toxoplasmosis, primary infection of a pregnant woman is the only option for infection of the fetus. Calculations show that the identification of female

risk groups at the stage of pregnancy planning and appropriate preventive measures can reduce the risk of IUI with severe consequences by 80%.

The implementation of mass screening for IUI is currently hardly possible for financial reasons. However, in cases where the expectant mother approaches the birth of a child with full responsibility and turns to an obstetrician-gynecologist at the stage of pregnancy planning, it is necessary to assign a minimum amount of research for IUI - the determination of IgG to the main pathogens - cytomegalovirus, toxoplasma, herpes simplex virus, rubella virus . The results of the study will make it possible to find out whether a woman belongs to any risk group. Taking preventive measures (for example, vaccination for rubella), as well as following recommendations by a woman at risk to prevent infection during pregnancy, will significantly reduce the risk of IUI in an unborn child.

The second important aspect of screening for IUI before pregnancy is the possibility of proving the primary infection of the pregnant woman. Its presence is evidenced by IgG seroconversion, which requires the use of invasive methods for examining the fetus or early termination of pregnancy. case detection of antibodies class IgM, which are an indicator of primary infection and reactivation chronic infection, as well as PCR research.

At the same time, laboratory methods should be considered as secondary to clinical examination (including ultrasound). For the diagnosis of genital herpes, chlamydia, mycoplasmosis in pregnant women, direct methods (PCR, etc.) are more effective.