Viral infection during pregnancy
Viral infections - general
Morbidity various viral infections has been steadily increasing every year.The exception does not become and women during pregnancy.Thus acute (primary) viral infections can lead both to the loss of the pregnancy and for the birth of children with various developmental disorders.Chronic (latent infection), which often progresses to the background of gestational immunosuppression, rarely lead to fetal malformations, but the frequency of pathology of pregnancy (fetal loss syndrome, FPN, fetal retardation syndrome) is correlated with that of acute viral diseases.The reasons for this lie in the ability of viruses to hit the fabric with the development of the placenta and endotheliopathy violation of local immunity.
Viruses received in previously uninfected body, penetrate into the cells and begin to actively replicate.Intracellular virus penetration due to the interaction of the viral envelope glycoproteins with receptors of the target cell.As a result of the viral envelope fuses with the cell membrane - the virus "undresses", and the exposed viral capsid enters the cell.Subsequently, the DNA replication process begins or RNA virus which results in the formation of daughter virus particles.The latter, coming out of the infected cell, "covered" the outer shell.In this case the outer shell of the virion is formed with the participation of the cell membrane of the damaged cells.Child virions leaving infected cell receptors interact with neighboring cells still intact, repeating the process described above.
viral infection during pregnancy - diagnosis
Diagnostics.Algorithm surveys both primary (acute) or chronic (latent) of viral infection is as follows.
At the first stage of the survey pregnant with a viral infection doubly determined titers of IgM and IgG in the blood of the patient, which allows you to diagnose the infection and make a differential diagnosis between primary and reinfection.Serological tests are the most accurate, since many, particularly latent viral infections, virological diagnostic methods are ineffective or diagnosis is difficult as a result of technological difficulties of growing virus in culture media.
Serological diagnosis of primary viral infection is based on detection of seroconversion (the appearance of specific IgM and IgG) or a four-fold growth of specific IgG in paired serum samples at intervals of 3 to 4 weeks.Detection of IgA is not diagnostically significant, since some infections (rubella), they appear in the primary infection, whereas they identified are not always at the other (CMV) infection.
diagnosis of viral infections should always be carried out on the basis of a study of paired sera at intervals of several weeks.For a single study is not always possible to differentiate primary from secondary infection, since the detection of specific IgM is possible with:
Another important serological test for the differential diagnosis of primary and chronic infection is to determine not only the titer of IgG, but also the degree of antibody activity.In acute infections the development level of activity increases several times in the study of paired sera at intervals of several weeks.At the same time viral infections antibody maturation speed kinds: for example, in the case of CMV antibody activity peaks for a few months, and at this period Rubella takes a range of less than one month.
When the diagnosis of acute viral infection tactics of the patient will depend on the type of infection, duration of pregnancy and other related viral infections, pregnancy, and pregnant state.In some cases, amniocentesis is recommended for confirmation of infection of the fetus.Also, fetal infection can be confirmed by detection of specific IgM during cordocentesis.Carrying cordocentesis is possible only after 22 weeks of gestation and is shown mainly for suspected fetal rubella 6 weeks after seroconversion in the mother.Specificity in this study was 100% rubella, other viral infections, the importance was not so high, and the specificity is about 50-60%.
In the case of diagnosis of secondary (Patent), a viral infection of the fetus at risk IUI many infections is low, and in case of transmission to the fetus of fetal intrauterine percentage is also low.The main problem for chronic viral infections becomes defeat fetoplacental complex with impaired immune function and rheological placenta.Therefore, management of these patients should be directed at optimizing the functioning of the placental system and the prevention of threatened abortion.
for pregnant women with a viral infection in the I trimester:
for pregnant women with a viral infection in the II trimester:
for pregnant women with a viral infection in the III trimester:
general principles of labor management in patients with viral infections patients:
Caesarean section shownwith genital herpes (in the case of primary infection in the last month of pregnancy, genital herpes sores or HSV isolation from the cervical canal before birth and resistant to acyclovir), HIV infection (if the woman did not take AZT during pregnancy).
viral infection during pregnancy - prevention
necessary to carry out prevention of bleeding in the development of disseminated intravascular coagulation (especially in the case of hepatitis B and hepatitis C).
study of umbilical cord blood of the fetus shows:
General principles of the postpartum period in patients with various viral infections:
Indications for abortion during viral infection:
Relative indications for abortion in viral infections.
Viral infections in pregnant women - vaccination
prevention of viral infections during pregnancy.Depending on the presence of risk factors in women planning a pregnancy, you can use the following vaccines:
When accidental vaccination during early pregnancy with live attenuated vaccines, it is not an indication for its interruption.