Main pathogens
Traditionally, there is a group of infections that are most significant for the fetus: toxoplasmosis, rubella, cytomegalovirus, herpes, as well as syphilis, hepatitis B and C, HIV, parvovirus and listeriosis. The most common congenital infection is cytomegalovirus. The greatest risk for the child is created by primary infection of the mother during pregnancy, especially in the early stages, when organs are forming. If a woman was ill before pregnancy and has immunity, the danger is much lower. A separate group is bacterial infections transmitted during childbirth, for example group B streptococcus.
- Cytomegalovirus is the most common congenital infection
- Toxoplasmosis
- Rubella
- Herpes simplex
- Syphilis, hepatitis, HIV
- Group B streptococcus transmitted during childbirth
How does the infection get to the child?
There are three possible ways. Through the placenta, the pathogen enters the blood of the fetus during a primary infection in the mother or during an exacerbation of a chronic one. The ascending route means the spread of bacteria from the vagina and cervix into the uterine cavity, especially during a long anhydrous period. Finally, a child can become infected directly during childbirth, passing through the birth canal, as happens with herpes and group B streptococcus. The consequences depend on the period: in the early stages, malformations and termination of pregnancy are possible, in the later stages - inflammatory changes in the child’s organs.
- Through the placenta into the fetal blood
- Ascending tract from the birth canal
- Infection during childbirth
- Early stages - risk of developmental defects
- Late stages - inflammatory changes in organs
- Breast milk as a route of transmission for selected infections
How does it manifest in a newborn?
There is no single picture; manifestations depend on the pathogen and the period of infection. Low weight during full-term pregnancy, early and persistent jaundice, enlarged liver and spleen, pinpoint hemorrhages on the skin, anemia, cramps, lethargy and poor sucking should be of concern. Changes in neurosonography, eye damage, and unusual head sizes may be detected. Some children look healthy at birth, but problems appear later: most often this is hearing loss due to congenital cytomegalovirus infection. This is why hearing screening and monitoring during the first years of life are important.
- Low birth weight
- Early or prolonged jaundice
- Enlarged liver and spleen
- Rash in the form of hemorrhages
- Cramps and lethargy
- Changes on neurosonography
- Late hearing or vision loss
Examination of mother and child
During pregnancy, examinations provided for in the observation protocol are carried out: tests for syphilis, HIV, hepatitis, assessment of immunity to rubella, and, if indicated, tests for toxoplasmosis and cytomegalovirus. Randomly taking multiple tests for all infections in a row without indications often leads to unnecessary anxiety and treatment. Fetal ultrasound plays an important role, which can reveal indirect signs of infection. If a newborn is suspected, the blood and urine are examined using PCR, antibodies are determined, neurosonography is performed, an examination by an ophthalmologist and a hearing test are performed. The doctor should interpret the results taking into account the clinical picture.
- Routine examination of a pregnant woman according to the protocol
- Assessment of immunity to rubella and toxoplasma
- Ultrasound of the fetus in dynamics
- PCR of blood and urine of a newborn
- Neurosonography and fundus examination
- Hearing Screening
- Refusal of unnecessary tests without indications
Treatment and prevention
The tactics depend entirely on the pathogen. For syphilis and bacterial infections, antibiotics are used, for herpes and some other viral infections - antiviral drugs, for HIV - to prevent transmission to the child using special schemes. In many cases, treatment is supportive: correction of jaundice, seizures, anemia, nutrition and observation. There are no universal drugs for all intrauterine infections, so prescriptions like general immunostimulants are useless. Prevention is much more effective: vaccination against rubella before pregnancy, maintaining food hygiene to protect against toxoplasmosis and listeriosis, washing hands after contact with children if there is a risk of cytomegalovirus, routine monitoring and treatment of infections in a pregnant woman.
- Pathogen-specific treatment
- Antibiotics for bacterial infections and syphilis
- Antiviral drugs according to indications
- Prevention of HIV transmission according to the protocol
- Maintenance therapy and observation
- Rubella vaccination before pregnancy
- Food hygiene and hand washing during pregnancy
