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Intrauterine Infections STORCH Syphilis Toxoplasmosis Others Rubella Cytomegalovirus Herpes Hepatitis B Human Immunodeficiency Virus (HIV) Human

Papilloma Virus (HPV) Human Parvovirus Hepatitis C Syphilis Treponema pallidum Transmission Mother-to-child (during fetal development)(vertical transmission) Birththrough placenta Congenital Syphilis (CS) Early CS Late CS Diagnosed during 1st 2 years of life Present after 2 years of life Includes stillbirths Manifest near puberty Asymptomatic at birth Affects bones, teeths, CNS Early-stage symptoms Watery nasal discharge Saddle nose (deformity cartilage) Irritability Bone lesion humerus Failure to thrive Fever (non-specific) Hutchingson teeth Rash Saber shins Lesions mouth, anus, genitalia Blindness Deafness Investigations VDRL (Venereal Diseases Research Laboratory) RPR (Rapid Plasma Reagin) TPHA (T. pallidum haemagglutination assay) TPPA (T. pallidum particle agglutination assay) FTA-ABS (Fluorescent treponemal antibody absorption test) Treatment Penicillin Toxoplasmosis Toxoplasma gondii Transmission Congenital Toxoplasmosis (infection transmitted to fetus during pregnancy) Immunodeficiency AIDS (infection, reinfection of toxoplasmosis) Mother Infected in Pregnancy Earlier Later Risk of infection of fetus Risk of infection of fetus Severe disease Severe disease (subclinical) Severity of Infection Subclinical Overt Late onset symptoms Abortion (chorioretinitis) Classical Triad No symptoms at all Chorioretinitis Intracranial calcification Hydrocephalus Investigations Serological diagnosis Serological screening (detect asymptomatic infections) Serological tests IgG, IgM Amniocentesis PCR technique y PCR +ve fetus had infection, should be treated y PCR ve fetus not yet infected, mother receive ATT Ultrasound hydrocephalus, intracranial calcifications

Congenital Rubella Syndrome Togavirus (genus Rubivirus) Transmission Infect and replicate in placenta Major Manifestation Tissue destruction Scarring Congenital Rubella Syndrome (CRS) Abortions Miscarriages Stillbirths Severe birth defects Signs & Symptoms Children Few, no constitutional symptoms

Adults Fever ( grade) (1-5d prodrome) Headache Malaise Mild coryza Conjunctivitis

Eyes y Cataracts y Glaucoma y Retinitis Heart y Patent ductus arteriosus (PDA) y Pulmonary artery stenosis CNS y Mental retardation y Motor retardation y Small head (microcephaly) from failed brain development y Encephalitis y Meningitis Others y Deafness y Platelet y Enlarged liver, spleen y Abnormal muscle tone y Bone disease Investigations Isolation of rubella virus Rubella-specific IgM , IgG

Cytomegalovirus (CMV) Epidemiology Primary maternal infection 1-4% of susceptible women Reactivation 10% of seropositive pregnant women Transmission rate 40% after primary infection 0.2-1.8% after recurrent infection Transmission Urine Saliva Genital secretions Transplacental Infect placental tissue, amniotic fluid (swallowed by fetus) Genital secretions during labour, breast milk (perinatal) Signs & Symptoms Petechiae Jaundice Microcephaly Small size for gestational age Investigations Complement fixation (peak viral titers 4-7 weeks after infection) Antigen testing Virus isolation Liver Function Test (LFT) y Bilirubin y Hepatocellular enzymes FBP y Thrombocytopenia y CSF protein

CMV Enlarged cell Viral inclusion bodies Treatment Ganciclovir Foscarinet

CMV Owl s eye

Herpes Simplex Epidemiology Most cases acquired during labour, delivery Caused by HSV type 2 Risk Factors Active genital lesion (during delivery) Primary infection (greater risk than with recurrence) History of genital herpes in mother, partner Delivery through infected birth canal, LSCS 6h after rupture of membrane Instrumental assisted delivery Signs & Symptoms Vesicular skin lesion Keratoconjunctivitis, chorioretinitis Encephalitis Disseminated disease

Day 17 Day 1 Investigations Isolation of virus (maternal, fetal skin lesion) Direct immunoflourescent assay (DFA) Serology (less useful difficult distinguish acute, past infection) PCR of cervical fluid (detect asymptomatic women) Hepatitis B Immunization HBIG (Hep B immune globulin) Hep B vaccine HIV Zidovudin ( transmission rate) Postpartum breastfeeding can transfer maternal infection to infant Avoid obstetric intervention that breach fetal skin Fetal scalp electrode application Forcep delivery Human Papiloma Virus Causes Genital warts Condylomata acuminate Laryngeal papiloma (LP) (in children) (vocal cord, epiglottis) Cause malignant transformation of cervical cells Cervical intraepithelial neoplasia Cervical cancer Transmission Birth canal Placenta Investigations Cervical scraping Biopsy, scraping of lesions PCR (from biopsy, scraping) Treatment Trichloroacetic acid in 70% ethanol Human Parvovirus Parvovirus B19 Causes Erythema infectiosum (children) Aplastic crisis (haemolytic anaemia patients) Fetal hydrop Fetal death Hepatitis C Seen in women HIV +ve Transmission risk - maternal Hep C viral load