00:01
Now we will discussed perinatal infections.
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So perinatal infections are better known as the TORCHeS.
00:08
That stands for Toxoplasmosis Others Rubella CMV Herpes
and HIV and S stands for syphilis.
00:19
Let's talk about those in a little bit more detail.
00:23
So toxoplasmosis is transmitted to the fetus
through the cat feces.
00:28
So this is one of the reasons that we tell pregnant moms,
they should not deal with their kitty litter.
00:32
The O sites are passing to the kitty litter,
and if mom comes in contact with that,
she can contract toxoplasmosis that's can pass to the fetus
to the placenta.
00:42
The diagnosis is made serologically.
00:46
And what affects it's going to have on the fetus.
00:48
Well the fetus can develop chorioretinitis
and hydrocephalus.
00:51
But it is treatable.
00:53
We do give a medication.
00:55
We can either give pyrimethamine or we can give another name
for that is Daraprim.
01:01
And we give sulphadiazine along with those medications.
01:07
So varicella also known as chicken pox.
01:10
Transmission is through respiratory droplets.
01:13
So if there is coughing or sneezing and mom comes in
contact with that, she can develop varicella.
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The diagnose is again made through blood work.
01:22
And the affects on the fetus where chorioretinitis is one.
01:26
Encephalitis is another one and muscle atrophy.
01:28
Unfortunately there is no treatment if mom
contracts varicella during the pregnancy.
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The risk of congenital varicella is highest if mom contracts chicken pox five days or less before delivery.
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Or 1 to 2 days after delivery.
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If a mom think she may have been exposed to varicella and it's not immune
she can decrease the risk of congenital varicella by receiving VZIG,
A recently approved Varicella Zoster immune globulin.
01:54
Although, best given within 96 hours of exposure, it's used is approved for up to 10 days
to prevent or attenuate varicella infection.
02:01
Another infection that belongs to the others group is Hepatitis B.
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It is transmitted parenteral and sexual. A diagnosis is possible via the HB Antigen Test (HBsAg).
02:10
Hepatitis B in the pregnancy can lead to chronic Hepatitis of the child.
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For treatment, we can provide Hepatitis B immunoglobulin and vaccination of the neonate after delivery.
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A cesarian delivery is only necessary if there are obstetric complications.
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Breastfeeding is allowed.
02:26
Hepatitis C is another infection that influences the fetus.
02:29
Again, it is transmitted parenteral and sexual.
02:32
Screenings are not routinely recommended.
02:34
But when suspected, there is the HCV antibody test, followed by HCV nucleic acid testing.
02:40
Within Hepatitis C infection, there's an increased risk for progressing to chronic Hepatitis.
02:44
A cesarean delivery is only necessary if there are obstetric complications, and again breastfeeding is allowed.
02:50
A Group B Hemolytic Streptococcus infection is the last one on the other infections group.
02:56
It is transmitted through delivery after passing through a colonized genital tract.
03:00
It is routinely tested for with vaginal and rectal cultures at 35-37 weeks of gestation.
03:05
Possible effects on the fetus are pneumonia, sepsis, and meningitis.
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As treatment, we can use intrapartum antibiotic prophylaxis with IV penicillin G.
03:15
So Rubella.
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And this is a common appearance of rubella.
03:21
Transmission again is through cough or sneezing though
those water droplets.
03:27
We diagnose this serologically as well.
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And as far as the affects on the fetus,
congenital hearing loss is one of the biggest ones.
03:35
It's actually one of the most common causes of hearing loss
that comes from infection.
03:40
Also babies can develop cataracts or something called
a Blueberry Muffin rash.
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And that's what this looks like.
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There is not treatment available during pregnancy.
03:51
This is one of the reasons in our preconceptional labs
we screen to see if mom is in fact immune to rubella.
03:58
And if not we give her the vaccine
so that she can develop immunity.
04:02
CMV.
04:04
Transmission is through body fluids, such as urine, saliva,
blood, tears, semen and breast milk.
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Now fortunately most moms have been exposed to CMV
and so they do have immunity.
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However, if you are concerned that the baby may have
contracted CMV, the diagnose is made by PCR of amniotic fluid.
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And what are the affects on the fetus.
04:27
Congenital hearing loss, vision loss or seizures.
04:31
Unfortunately there is no treatment available
during pregnancy.
04:35
Now this is an example of genital herpes
and what it looks like on physical exam.
04:41
Transmission for genital herpes is through sexual transmission
via body fluids.
04:47
Again the diagnosis is made serologically.
04:50
And the affect on fetus is life threatening.
04:54
It could be death or they can have CNS abnormalities.
04:58
We do have treatment.
05:00
We give antivirals to moms who have history of genital herpes.
05:03
We administer those at 36 weeks of gestation.
05:07
We want to make sure that the mom is not having
an outbreak at the time of delivery.
05:11
If she is, C-section is warranted,
to try to prevent transmission to the fetus.
05:16
HIV, transmission is through body fluids.
05:20
And that can be through sexual contact.
05:23
It can be through blood.
05:24
Such as sharing IV needles.
05:26
Now diagnosis is made first by the ELISA test and then
confirmed by the Western blot.
05:32
Now at birth, there is no affect on the fetus.
05:36
There are no signs to tell the baby has HIV.
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And the treatment is HAART therapy.
05:41
So we do recommend that during the pregnancy so that mom can
keep a low viral load.
05:46
If the viral load is less than a 1000,
then the transmission rate is really low.
05:51
It's less than 1%.
05:53
If a mom has a viral load of less than a 1000, she can have
a vaginal delivery without worry of transmitting HIV
to the fetus.
06:00
However, if the viral load is greater than 1000,
we would recommend C-section to again try to decrease
that risk of transmission to the fetus.
06:08
This is an example of secondary syphilis.
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Transmission of syphilis is through sexual contact.
06:18
Now let's talk a little bit about the diagnosis.
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So all pregnant women should be screened for syphilis
at the initial visit.
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And then again in the 3rd trimester if they live
in a high risk area.
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Screening is via RPR or VDRL.
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However, this is non-specific test.
06:35
And there are other things that can make this test positive
such as lupus.
06:39
So the confirmation test should be performed, anybody has
a positive screen.
06:44
That confirmation test is the antibody test that you can
see here, listed here.
06:50
Of note, if a patient has ever been infected with syphilis
they will always have positive antibodies.
06:55
In those cases you do have to look at your RPR to determine
if they have a new infection based on the titer rate.
07:03
The other way that you can confirm, syphilis is looking
for treponemes on dark-field microscopy.
07:09
So with syphilis, what are the affects on the fetus?
Hepatomegaly meaning a large liver.
07:15
CNS abnormalities, saddle nose and Hutchinson's teeth.
07:19
The Hutchinson's teeth is pretty diagnostic of syphilis.
07:23
So the treatment is penicillin.
07:26
Even if a patient is allergic, we still give penicillin
as a treatment only in pregnancy.
07:32
If a patient is penicillin allergic,
they're first desensitize to make the reaction
a little bit less severe.
07:39
And then give him penicillin to make sure that they can
have their syphilis treated.