Intrauterine infections: from causes to consequences

Often, when parents hear about intrauterine infection, it is difficult to imagine what exactly it is about. If a pregnant woman has the flu, is it an infection or not? And if a thrush appears, can a child get infected? In this article, we will talk about intrauterine fetal infections and how to avoid them.

What it is?

Intrauterine infections are called a rather large group of ailments of the fetus and the newly born baby. Such infections become possible as a result of infection of a child during pregnancy (during his intrauterine stay), as well as during childbirth. Such an infection can cause the death of a baby even before birth, as well as a baby's lag in development. The presence of an intrauterine infection in a woman increases the likelihood of miscarriage and premature birth. The risks are great anomalies and malformations of the child's formation, damage to his organs and systems, especially the nervous one.

Viral agents, pathogenic bacteria, fungi, and sometimes some parasites can cause fetal diseases in the womb and during birth. The transmission path is always vertical, i.e. the disease passes from mother to baby. It is difficult to say how common such infections are, there are no more or less reliable statistics, however, according to the World Health Organization, every tenth newborn baby has been exposed to intrauterine infection.

In a quarter of the deaths of infants in Russia, intrauterine infections are "guilty". They are also the cause of abnormalities and gross defects in about 80% of toddlers born with some kind of deviation. Among children who died before they reached the age of one year, with congenital developmental anomalies, in about 30% of cases, the main cause of the tragedy is also intrauterine infection.

What kind of infections are we talking about? Usually the case in TORCH infections (TORCH). This abbreviation was introduced in 1971 by experts from the World Health Organization:

T - toxoplasmosis;
O - mycoplasma, syphilis, hepatitis, streptococcal infection (streptococci), candida and other viral and bacterial infections;
R - rubella;
C - cytomegalovirus;
H - herpes.

In this case, all infectious pathogens are allocated to separate groups:

viruses: rubella (rubella), cytomegalovirus, herpes viruses, viral hepatitis;
bacteria: syphilis, listeriosis, tuberculosis, sexually transmitted diseases, sepsis;
parasites: toxoplasmosis and some others;
fungi: Candida and others;
combined infections, caused by several pathogens of different groups.

Causes, ways and mechanisms of transmission

The listed infectious diseases develop in the fetus in case of its infection from the mother before birth or right during childbirth. Almost always the source of infection is a woman. Before birth, the baby can become infected through blood circulating in the mother-placenta-fetus system, through contaminated amniotic fluid. During childbirth - by contact and aspiration. An infectious infection can affect a baby even with prescribed invasive prenatal diagnostics: with cordocentesis, amniocentesis, chorionic villus biopsy, as well as with procedures associated with the introduction of blood plasma and other drugs to the baby through the umbilical cord vessels.

In the birth process, infection occurs due to the presence of infection in the birth canal of the mother. The placenta was created by nature not only for nutrition, but also to protect the child from viruses, bacteria, fungi. And for most pathogens, the placenta is indeed an insurmountable barrier. But only if the "baby seat" is not damaged, it functions normally.

If a woman is diagnosed with fetoplacental insufficiency, then infection of the child is not at all excluded.

The risk group includes pregnant women who have problems with women's health, such as colpitis, endocervicitis, or sexually transmitted diseases. The likelihood that a child will become infected with an intrauterine infection increases if a woman has a diagnosed threat of miscarriage, gestosis, if she, already being in an interesting position, has suffered the above infections in an acute form. Premature babies are more at risk of becoming infected in utero.

If a child becomes infected at the stage of organogenesis during the first 2-3 months of pregnancy, then the pregnancy usually ends in miscarriage, since many formed defects are incompatible with life and further development. If infection occurs before 12 weeks, then often this leads to the birth of a dead baby or a baby with severe defects. If the infection occurs in the middle of the gestational period or in the final third trimester, then usually the lesion is limited to one organ or the infection becomes generalized.

If a pregnant woman is seriously ill with a viral disease or a disease caused by pathogenic bacteria, this does not mean that the baby is also seriously ill, and, conversely, a mild course of the disease in the expectant mother does not guarantee an easy course of intrauterine infection of her baby. The severity of the course may well not coincide.

Symptoms and signs

Medical workers can guess about the possible presence of an intrauterine infection in the baby already during the birth process. Opaque, turbid amniotic waters with impurities of meconium will lead them to such an idea. Usually, the original dark green feces come out of the intestines of the fetus after birth, but when infected, defecation often occurs involuntarily while still in the womb, so the waters have a dark color and a very pronounced putrid smell.

The fact that the risk of infection is high is indicated to obstetricians by the characteristic of the "child's place". The placenta with intrauterine infection has signs of plethora, there are microthrombi, areas of a necrotic nature.

Many babies with intrauterine infection are born with asphyxia, they have less weight than necessary, there are signs of a hypotrophic physique. They have a slightly enlarged liver, some developmental abnormalities may be observed, sometimes microcephaly or hydrocephalus is observed at birth.

From the first hours of life, such newborns have jaundice, pustules on the skin, various rashes in the form of roseola or vesicles, fever and fever, convulsions, and breathing problems may occur. From the first days, pneumonia, omphalitis, inflammation of the heart muscle can develop, the amount of hemoglobin in the child's blood is reduced, the eyes are often affected by conjunctivitis or keratoconjunctivitis, punctate hemorrhage of a multiple nature on the skin can be observed - hemorrhagic syndrome. An examination in a maternity hospital can show congenital glaucoma, cataracts, heart and vascular defects, and brain problems.

Newborn babies with intrauterine infections regularly spit up, this is abundant, their muscles are weakened, there are signs of depression of the central nervous system, the skin has a grayish tint. These are common signs for all babies with intrauterine infections. But each specific infection can have its own, distinctive clinical manifestations.

Toxoplasmosis is a congenital form

If a child in the womb is affected by a single-celled parasite - toxoplasma, this leads to serious consequences, which are manifested in a significant delay in development, malformations of the brain, organs of vision, heart and bones of the skeleton.

After a baby is born with congenital toxoplasmosis, he has fever, severe jaundice, edema, redness of the skin like exanthema, hemorrhagic rashes, loose stools, convulsions, there may be inflammation of the heart muscle, kidneys, lungs. Much depends on the time of infection. If it happened recently, and the child's disease has a subacute course, then this is usually manifested by meningitis or encephalitis.

If the baby has been infected for a relatively long time, and the disease has become chronic, then hydrocephalus, a decrease in the volume of the brain, is most often observed. Children are often born with strabismus, complete or partial atrophy of the optic nerve.

The consequences of congenital toxoplasmosis can be oligophrenia, the development of epilepsy and blindness.

Rubella

A child can be born with this infectious disease when his mother, during the period of gestation of the baby, fell ill with rubella. You need to know that the risks that the child will also become infected directly depend on the specific period:

in the initial stages - the risk is estimated at 85% or more;
in the second trimester - the probability is approximately 20%;
in third - about 10%.

Rubella can lead to termination of pregnancy at any stage of childbearing due to the death of the baby.

Babies who are fortunate enough to survive in the womb with congenital rubella are born with low birth weight, and childbirth is usually preterm. In the very first hours, they have a profuse hemorrhagic rash throughout the body, jaundice associated with the breakdown of red blood cells, it lasts a long time. As a rule, the symptoms associated with infections are called the triad, since they are usually present in one degree or another.

It can be:

abnormalities of the organs of vision: cataracts, glaucoma or microphthalmia;
heart damage: various defects, for example, patent ductus arteriosus or stenosis of the pulmonary artery;
hearing anomalies: congenital anomalies of the auditory nerves and hair cells, congenital hearing loss or deafness.

If a woman falls ill with rubella already for a long time, there may not be a congenital heart defect, and the set of symptoms will be limited only by damage to the organs of vision and hearing.

These signs are basic. They are found in the vast majority of newborns with the congenital form of rubella. But there are other symptoms that can be observed - for example, a decrease in the volume of the brain, dropsy of the brain, clefts of the soft palate, malformations of the bones of the skeleton, anomalies in the development of the urinary organs and the reproductive system.

A child with such a congenital disease develops with a significant lag behind his peers, while he lags behind both physically and mentally.

CMV infection (cytomegaly)

The disease of a child in the womb with cytomegalovirus after birth is manifested by the defeat of individual or extensive anomalies of many organs. This virus leads to a pathological decrease in immunity, purulent and septic consequences.

Cytomegalovirus is often the main reason for a decrease in the volume of the child's brain, the development of retinopathy, cataracts. Infection in the first trimester usually leads to the fact that children have heart and vascular defects. After birth, bilateral pneumonia usually develops, kidney damage. The nerves also suffer from this virus: visual and auditory. Therefore, the occurrence of blindness and deafness is not excluded.

Congenital herpes infection

Herpes viruses can affect the child's body in different ways: a generalized infection develops in about half of the cases, the nervous system suffers in every fifth case, the skin and mucous membranes suffer in 20% of cases.

A child born with a generalized form of herpes infection, usually has significant problems breathing spontaneously - the so-called distress syndrome develops. His condition is complicated by pneumonia, enlarged liver, thrombocytopenia. With the defeat of the nerve endings, encephalitis and meningoencephalitis most often develop. With the cutaneous form, the child is born with a profuse vesicle-type rash, while the rash affects not only the skin, but also the mucous membranes and internal organs. If a bacterial infection is added to this form, then sepsis usually develops.

Herpes viruses can cause a decrease in the volume of the brain in a child, blindness, hypoplasia of the extremities, delayed mental and psychomotor development.

Chlamydia is a congenital form

Infected mothers transmit chlamydia to their babies in about 45-50% of cases. Every fifth baby born with chlamydia develops pneumonia, almost all have chlamydial eye lesions. Babies are infected mainly during the passage through the birth canal at the time of their birth. And the first symptoms of infection appear within 1-2 weeks after childbirth.

Doctors diagnose nasopharyngitis in every fourth child, conjunctivitis in every third child, which cannot be treated with any antibiotics, only tetracycline has a small effect. In 15% of cases, pneumonia develops with a severe cough. Less commonly, the disease manifests itself as gastroenteritis. Affected in 15% of cases are the genitourinary organs of the child - vulvitis in girls and urethritis in children of both sexes.

Mycoplasmosis

The child becomes infected with mycoplasma during childbirth. If a pregnant woman is diagnosed with mycoplasma, treatment must necessarily be carried out after 16 weeks of the period, which helps to reduce the frequency of infection in children.

Mycoplasmosis in newborns makes itself felt with pneumonia, which develops very slowly. The child is pale, shortness of breath appears and increases gradually. About 15% of children die from such pneumonia in the first months of life.

Candidiasis is a congenital form

It is most difficult to recognize congenital candidiasis, because often it runs latently, and the diagnosis is made late. Most often, fungal infections are found in babies who rushed to be born prematurely, as well as in babies whose mothers suffered from diabetes mellitus during the period of gestation, if there is candidiasis in the analyzes of the expectant mother.

Fungi can lead to a wide variety of lesions: skin lesions, lesions of the mucous membranes, generalized candidal infection can be observed. Infection with candida is visceral, with it the heart muscle, liver, and kidneys are affected by fungi. The disease can be easy and difficult.

Congenital syphilis

The cause of the disease in a newly born child is a similar disease in the mother while waiting for the baby. That is why all expectant mothers undergo a three-time examination for RV during the gestation period.

Signs of congenital syphilis in a toddler may not appear immediately, but during the first two years of life. Usually, the ailment makes itself felt with syphilitic rhinitis, pemphigus, osteoporosis and an enlarged liver.

If syphilis was detected in the expectant mother during pregnancy, then the umbilical cord blood is taken from the child for analysis immediately after birth. Congenital syphilis may be indicated by a pathologically enlarged and structurally modified placenta.

Diagnostics

Taking into account the severity of the possible consequences of such infections for the baby, medical workers deal with the identification of infectious diseases as soon as a woman “in position” comes to the hospital to register. TORCH-complex tests, vaginal smears for microflora, bacterial culture are performed several times during the waiting period for the child, starting from the first trimester.

A doctor can suspect an intrauterine infection in a child at any time. In this case, the woman will be given a referral for an invasive diagnostic procedure. Umbilical cord blood of the fetus or a sample of amniotic fluid after an in vitro study (in vitro - "in vitro") will be able to give an accurate answer to the question of whether the baby has an infection or not.

There are also markers that are visible on ultrasound. Very often, intrauterine infection of the crumbs is accompanied by a change in the amount of amniotic fluid up or down, so the question of a possible infection must be raised in the case of oligohydramnios or polyhydramnios. In the waters, ultrasound often detects the so-called suspension.

An infection in a child is indicated by the premature maturation of the placenta, as well as edema of the fetus itself, which becomes obvious from the results of fetometry measurements.

An experienced doctor of ultrasound diagnostics will certainly pay attention in a timely manner to anomalies in the development of some internal organs of the baby, to a violation of blood flow in the umbilical cord, placenta. On CTG after 29-30 weeks of pregnancy, a change and deviation from the PSP standards may indicate possible infectious diseases of the fetus.

After the child is born, medical workers will have much more opportunities for diagnostics - this is the whole range of laboratory tests, both bacteriological and virological. The histology of placental tissues is considered a very informative method.

During the first day, newborns with suspected intrauterine infection must be examined by a neurologist, cardiologist, ophthalmologist, on the third day, together with the rest of the newborns, such a baby is examined for auditory function.

Treatment

All babies born with intrauterine infections immediately begin to receive treatment. If a viral lesion is registered, treatment with interferons, immunoglobulins is prescribed, the child is injected with immunomodulators. Herpetic viruses require the use of a special drug, which was developed against them - "Acyclovir". If the child has a bacterial infection, antibiotic treatment is prescribed.

All these measures are designed to eliminate and neutralize the body, which is responsible for infection and all pathological processes. In addition to the main drug, symptomatic treatment is also prescribed. And it depends on what specific symptoms in the toddler are accompanied by infection.

You need to understand that some of the consequences require surgical intervention, for example, congenital heart defects. And children with deafness are shown cochlear implantation and other methods of correcting hearing impairment.

No doctor can confidently answer the question of what are the prognosis for a child who was born with an intrauterine infection.- it all depends on the nature of the disease, the degree of damage to the small organism, its own immunity, and even on the child's desire to survive. But statistics show that in 80% of cases with generalized congenital infection, the death of the baby occurs, regardless of how well the maternity hospital and the children's department in it are technically equipped.

Medicine can cope with lesions of individual organs, but there is practically no significant correction of lesions of the central nervous system. And here the predictions will depend on how impaired the functioning of the brain is, how much the brain structures have suffered.

Prevention

The main way to avoid intrauterine infection of the fetus is a detailed examination of the woman before pregnancy occurs. It is necessary to determine in time, to identify all possible infections in a woman and her sexual partner, many diseases are easily and rather quickly treated, the main thing is that this is done before two stripes appear on the test, indicating a new period in the life of a couple - a waiting period child.

A woman who is planning a pregnancy, as well as already carrying a child under her heart, should exclude communication and contact with infectious patients. For most infections in the body of those who have been ill, antibodies are formed that protect against re-infection, as happens with rubella and chickenpox. And if a woman who plans to become a mother has not previously suffered from such diseases, she must be done 3-4 months before pregnancy. appropriate vaccinations. This will help to avoid infection while the baby is waiting.

After suffering an infectious disease in the first trimester, the doctor may offer an abortion for medical reasons. This is also one of the methods of preventing intrauterine infectious diseases in children.

If it becomes clear that the child has become infected, which is confirmed by tests and invasive diagnostics, then the woman and her family should decide the question of terminating the pregnancy. Everyone has the right to both agree and refuse.