Pre-natal infections – group of diseases of a fruit and the newborn developing owing to infection in the prenatal period or in labor. Pre-natal infections can lead to death of a fruit, spontaneous abortion, a delay of pre-natal development, premature birth, formation of congenital defects, damage of internals and TsNS. Methods of diagnosis of pre-natal infections include microscopic, cultural, immunofermental, molecular and biological researches. Treatment of pre-natal infections is carried out with use of immunoglobulins, immunomodulators, antiviral, antibacterial medicines.
Pre-natal infections – the pathological processes and diseases caused by antenatalny and intranatalny infection of a fruit. True prevalence of pre-natal infections is not established, however, according to the generalized data, with congenital infections not less than 10% of newborns are born. Relevance of a problem of pre-natal infections in pediatrics is caused by high reproductive losses, the early neonatal incidence leading to an invalidization and post-natal death of children. Questions of prevention of pre-natal infections lie in the plane of consideration of obstetrics and gynecology, a neonatology, pediatrics.
Reasons of pre-natal infections
Pre-natal infections develop as a result of infection of a fruit in the prenatal period or directly at the time of delivery. Usually as a source of a pre-natal infection for the child mother acts, i.e. the vertical mechanism of transfer which in the antenatalny period is implemented transplacentary or ascending (through the infected amniotic waters) in the ways, and in intranatalny - aspiration or contact in the ways takes place.
There is a yatrogenny infection of a fruit during pregnancy when carrying out to the woman of invasive prenatal diagnostics less often (amniocentesis, a kordotsentez, a biopsy a horiona), introduction to a fruit of medicines of blood through umbilical cord vessels (plasmas, the eritrotsitarny weight, immunoglobulins) etc.
In the antenatalny period infection of a fruit is usually connected with virus agents (viruses of a rubella, herpes, a cytomegalic inclusion disease, hepatitis B and C, Koksaki, HIV) and intracellular activators (toxoplasmosis, mycoplasmosis).
In the intranatalny period there is more often a microbic contamination which nature and degree depends on a microbic landscape of patrimonial ways of mother. Among bacterial agents enterobakteriya, streptococci of group B, a gonokokka, sinegnoyny sticks, proteas, a klebsiyell, etc. are most widespread. The placentary barrier is impenetrable for the majority of bacteria and protozoa, however at damage of a placenta and development of fetoplatsentarny insufficiency, there can be an antenatalny microbic infection (for example, the causative agent of syphilis). Besides, also intranatalny viral infection is not excluded.
As factors of developing of pre-natal infections serve the burdened obstetric and gynecologic anamnesis of mother (nonspecific colpitises, endotservitsita, STD, salpingoforita), the unsuccessful course of pregnancy (threat of interruption, a gestoza, a premature otsloyka of a placenta) and infectious incidence of the pregnant woman. The risk of development of a manifest form of a pre-natal infection is significantly higher at premature children and in that case when the woman is infected initially during pregnancy.
Weight of clinical displays of a pre-natal infection is influenced by terms of infection and a type of the activator. So, if infection happens in the first 8-10 weeks of an embryogenesis, pregnancy usually comes to an end with a spontaneous abortion. The pre-natal infections which arose in the early fetalny period (till 12th week of a gestation), can lead to a still birth or formation of rough malformations. Pre-natal infection of a fruit in II and the III trimester of pregnancy is shown by defeat of separate bodies (myocarditis, hepatitis, meningitis, an encephalomeningitis) or a generalized infection.
It is known that weight of manifestations of infectious process at the pregnant woman and at a fruit can not coincide. The asymptomatic or malosimptomny course of an infection and at mother can cause severe defeats of a fruit, up to his death. It is connected with the increased tropism of virus and microbic activators to embryonic fabrics, mainly to TsNS, hearts, an organ of vision.
Classification of pre-natal infections
The Etiologichesky structure of pre-natal infections assumes their division on:
- virus (viral hepatitis, herpes, rubella, SARS, cytomegalic inclusion disease, epidemic parotitis, enteroviral infection)
- bacterial (tuberculosis, syphilis, listeriosis, sepsis)
- parasitic and fungal (mycoplasmosis, toxoplasmosis, clamidiosis, candidiasis, etc.)
For designation of group of the most widespread pre-natal infections TORCH syndrome abbreviation, the uniting toxoplasmosis (toxoplasmosis), a rubella (rubella), a cytomegalic inclusion disease (cytomegalovirus), herpes (herpes simplex) is used. The letter About (other) designates other infections among which - viral hepatitises, HIV infection, chicken pox, listeriosis, mycoplasmosis, syphilis, clamidiosis, etc.).
Symptoms of pre-natal infections
Presence of a pre-natal infection at the newborn can be suspected already at the time of delivery. In favor of pre-natal infection can testify izlity the muddy amniotic waters polluted by meconium and having an unpleasant smell, a condition of a placenta (polnokrovy, mikrotroboza, micronecroses). Children with a pre-natal infection often are born in a condition of asphyxia, with the prenatal hypotrophy increased by a liver, malformations or stigmata of a disembriogenez, a mikrotsefaliya, hydrocephaly. From the first days of life they note jaundice, elements of a piodermiya, rozeolezny or vezikulezny rashes on skin, fever, a convulsive syndrome, respiratory and cardiovascular frustration.
The early neonatal period at pre-natal infections is quite often burdened by interstitsialny pneumonia, omfality, myocarditis or a carditis, anemia, keratokonjyunktivity, horioretinity, a hemorrhagic syndrome, etc. At tool inspection the congenital cataract, glaucoma, congenital heart diseases, cysts and kaltsifikata of a brain can be found in newborns.
In the perinatal period at the child frequent and plentiful vomiting, muscular hypotonia, a syndrome of oppression of TsNS, gray color of integuments are noted. In late terms at the long incubatory period of a pre-natal infection development of late meningitis, encephalitis, osteomyelitis is possible.
Let's consider displays of the main pre-natal infections making TORCH syndrome.
Pre-natal infection with a monocelled protozoan parasite of Toxoplasma Gondii leads to severe defeats of a fruit – to an arrest of development, congenital malformations of a brain, an eye, hearts, a skeleton.
After the birth in the sharp period the pre-natal infection is shown by fever, jaundice, an edematous syndrome, ekzantemy, gemorragiya, diarrhea, spasms, a gepatosplenomegaliya, myocarditis, nephrite, pneumonia. At a subsharp current I dominate symptoms of meningitis or encephalitis. At a chronic persistention hydrocephaly with a mikrotsefaliya develops, iridotsiklit, squint, an atrophy of optic nerves. Sometimes monosimptomny and latent forms of a pre-natal infection meet.
The pre-natal infection arises because of a disease of a rubella at pregnancy. The probability and consequences of infection of a fruit depend on gestational term: in the first 8 weeks the risk reaches 80%; as consequences of a pre-natal infection can serve spontaneous termination of pregnancy, embrio-and fetopatiya. In the II trimester the risk of pre-natal infection makes 10-20%, in III – 3-8%.
Children with a pre-natal infection usually are born premature or with low body weight. Hemorrhagic rash, long jaundice is characteristic of the period of a neonatality.
Classical displays of a congenital rubella are presented by Greg's triad: damage of eyes (mikroftalmiya, cataract, glaucoma, horioretinity), VPS (open arterial channel, DMPP, DMZhP, stenosis of a pulmonary artery), damage of an acoustical nerve (sensonevralny deafness). In case of development of a pre-natal infection in the second half of pregnancy the child usually has a retinopathy and deafness.
Except the main displays of a congenital rubella, at the child also other anomalies can come to light: mikrotsefaliya, hydrocephaly, sky crevices, hepatitis, gepatosplenomegaliya, malformations of urinogenital system and skeleton. Further the pre-natal infection reminds of itself lag of the child in physical development, ZPR or intellectual backwardness.
Congenital cytomegalic inclusion disease
Pre-natal infection with a Cytomegaloviral infection can lead to local or generalized defeat of many bodies, an immunodeficiency, is purulent - to septic complications. Congenital defects of development usually include a mikrotsefaliya, a mikrogiriya, a mikroftalmiya, a retinopathy, a cataract, VPS, etc. The neonatal period of a congenital cytomegalic inclusion disease is complicated by jaundice, a hemorrhagic syndrome, bilateral pneumonia, interstitsialny nephrite, anemia.
Congenital herpetic infection
Pre-natal herpes infection can proceed in generalized (50%), neurologic (20%), a mucous and skin form (20%).
The generalized pre-natal congenital herpetic infection proceeds with the expressed toxicosis, respiratory a distress syndrome, a gepatomegaliya, jaundice, pneumonia, thrombocytopenia, a hemorrhagic syndrome. The neurologic form of congenital herpes is clinically shown by encephalitis and an encephalomeningitis. Pre-natal herpes infection with development of a skin syndrome is followed by emergence of vesicular rash on integuments and mucous membranes, including internals. At stratification of a bacterial infection sepsis of newborns develops.
Pre-natal herpes infection at the child can lead to formation of malformations - mikrotsefaliya, retinopathies, hypoplasias of extremities (kortikalny dwarfism). Among late complications of congenital herpes - encephalopathy, deafness, a blindness, a delay of psychomotor development.
Diagnosis of pre-natal infections
Now an urgent task is prenatal diagnosis of pre-natal infections. For this purpose on early terms of pregnancy dab microscopy, bacteriological crops from a vagina on flora, a scrape PTsR-research, inspection on TORCH complex is carried out. Invasive prenatal diagnostics is shown to pregnant women from group of high risk on development of a pre-natal infection (aspiration a horiona, amniocentesis with a research of amniotic liquid, with a research of umbilical blood).
Identification of ekhografichesky markers of pre-natal infections by means of obstetric ultrasonography is possible. Lack of water or abundance of water belong to indirect ekhografichesky signs of pre-natal infection; existence of a giperekhogenny suspension in amniotic waters or amniotic tyazhy; the hypoplasia a horiona, platsentit; placenta presenilation; an edematous syndrome of a fruit (ascites, perikardit, pleurisy), a gepatosplenomegaliya, kaltsifikata and malformations of internals, etc. In the course of the Doppler research of a blood-groove violations of a fruit and placentary blood-groove come to light. Kardiotokografiya finds symptoms of a hypoxia of a fruit.
After the child's birth for the purpose of reliable verification of an etiology of a pre-natal infection serological (IFA) techniques of inspection are used microbiological (virologic, bacteriological), molecular and biological (DNA hybridization, PTsR). Important diagnostic value has a histologic research of a placenta.
According to indications newborns with pre-natal infections in the first days of life have to be examined by the children's neurologist, the children's cardiologist, the children's ophthalmologist, etc. experts. It is expedient to carry out EhoKG, a neyrosonografiya, an oftalmoskopiya, a hearing research by method of the caused otoakustichesky issue.
Treatment of pre-natal infections
The general principles of treatment of pre-natal infections assume carrying out an immunotherapy, antiviral, antibacterial and posindromny therapy.
The immunotherapy includes use of polyvalent and specific immunoglobulins, immunomodulators (interferon). Antiviral therapy of the directed action is performed, mainly, by an acyclovir. For antimicrobic therapy of bacterial pre-natal infections antibiotics of a broad spectrum of activity (tsefalosporina, aminoglycosides, karbapenema) are used, at mikoplazmenny and chlamydial infections – macroleads.
Posindromny therapy of pre-natal infections is directed to knocking over of separate manifestations of perinatal defeat of TsNS, hemorrhagic syndrome, hepatitis, myocarditis, pneumonia etc.
Forecast and prevention of pre-natal infections
At generalized forms of pre-natal infections the lethality in the neonatal period reaches 80%. At local forms there are serious damages of internals (a cardiomyopathy, HOBL, interstitsialny nephrite, chronic hepatitis, cirrhosis etc.). Practically in all cases pre-natal infections lead to defeat of TsNS.
Prevention of pre-natal infections consists in carrying out predgravidarny preparation, treatment of STD before pregnancy, an exception of contacts of the pregnant woman with infectious patients, correction of the program of conducting pregnancy at women of risk groups. The women who earlier did not have a rubella and not receiving rubella inoculation have to be vaccinated not later than 3 months before alleged pregnancy. In some cases pre-natal infections can be the basis for abortion.