HSV

Neonatal transmission is by three routes :

1. Intrauterine 5%
2. Peripartum 85%
3. Post natal 10%

HSV
Neonates have the highest Rate of
dissemination and mortality of any population
studied, 70%
HSV2
Congenital infection is manifest shortly after
birth by seizures, irritability, jaundice,
hepatomegaly, bleeding, chorioretinitis,
pneumonitis and skin vesicles. Rapid
Respiratory and cardiac deterioration follow.

HSV 2
Infection acquired during delivery is usually
diagnosed between 10 and 21 days of life
skin vesicles 70%
Involvement of the central nervous system or
disseminated infection result in 50%
mortality 80%

Antiviral for Herpesvirus :

Pregnancy
recommendation
Primary or first episode infection :
Acyclovir, 400mg orally three times daily for 7-10 days, or
Valacyclovir, 1 g orally twice daily for 7-10 days

Symptomatic recurrent infection :

Acyclovir, 400mg orally three times daily for 5 days, or

Acyclovir, 800 mg orally twice daily for 5 days, or
Valacyclovir, 500mg orally twice daily for 3 days, or
Valacyclovir, 1 g orally once daily for 5 days

Antiviral for Herpesvirus :

Pregnancy recommendation
Daily suppression :

Acyclovir, 400mg orally three times daily from

36 weeks until delivery or
Valacyclovir, 500mg orally twice daily from 36
weeks until delivery

Congenital Varicella Syndrome

Infection in the first trimester of pregnancy
may result in Congenital Varicella Syndrome.
Mother develops Varicella within 5 days before
or after delivery
The attack Rate
20%
mortality Rate 35%

Congenital Varicella Syndrome

Cicatricial lesions of a limb in a dermatomal

distribution
Microphthalmia
Cataract
Chorioretinitis
Deafness
Cortical atrophy of the brain

CMV
Recurrent maternal infection

infects the fetus in only 0.15

to 1 % of cases
Transplacental fetal infection
is more likely during the first
half of pregnancy
8

CMV Screening
CMV IgG : positive

IgG avidity index : high

CMV IgM : Negative

Latent CMV Infection

CMV IgG : positive or

seroconvertion
Primary CMV
IgG Avidity index : low
Infection
CMV IgM : positive

CMV Screening
Uncertain serologic results

Undefined

CMV
Infection
CMV IgG : positive

IgG avidity index : high

CMV IgM : positive
CMV IgG : negative

Recurrent CMV
infection
CMV uninfected

CMV IgM: negative

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Congenital CMV infection may be

Asymptomatic (90%)
5%-20%
Hearing loss
Poor intelectual performance
Severe disease :
Hepatosplenomegaly
Jaundice
Chorio Retinitis
Petechiae
Respiratory distreso
Neurologic abnormalitis : microcephaly focal
calcification in the brain
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Human parvovirus B19

B19 virus replicates in rapidly proliferating cells

such as erythroblast precursors. This can lead to

anemia, which is its central fetal effect
By adulthood only 40% of women are susceptible
There is vertical transmission to the fetus in about

a third of maternal parvovirus infection

Fetal infection has been associated with abortion,

non immune hydrops, and stillbirth.

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Human parvovirus B19

Parvovirus is the most common infectius cause

of non immune hydrops in autopsied fetuses.

This complication develops only in about 1% of
infected demand and usually is caused by
infection in the first half of gestation. At least
85% cases of fetal infection developed within 10
weeks of maternal infection.
13

Human parvovirus B19

More than 80% of hydrops cases were found in

the second trimester with a mean gestational age

of 22 to 23 weeks
The critical period for maternal infection leading

to hydrops was estimated to be between 13 and

16 weeks

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Human parvovirus B19

Has been associated with fetal death.
most commonly occurred from the 10th trough
20th weeks of pregnancy
HYDROPS FOETALIS

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Rubella
Maternal viremia is followed by infection of
the placenta, which often leads to virus
invasion of the fetus. Esp. The first 16 weeks
of pregnancy.
Chromosomal breakage
Irihibitian of normal mitosis

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Congenital Rubella Infection

DEAFNESS
Congenital heart disease
Eye defects. (cataracts, glaucoma, retinitis,
microophthalmia)
Growth / Retardation
Trombocytopenic purpura
Osteitis
Hepatitis
Interstitial pneumonitis
Encephalitis
Cerebral demage with mental retardation.
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Rubella
Neonatus born with congenital rubella may

shed the virus for many months and thus a

threat to other infants as well as to
susceptible adults who come in contacts.

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MUMPS
A higher occurrence of fetal death after
mumps infection in the first trimester of
pregnancy has been reported
Infection with the mumps virus during
pregnancy, has not linked to any pattern of
mumps embryopathy.

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Hepatitis B
Acute hepatitis has a case fatality rate 0,1%. For

patients ill enough to be hospitalized, it is as high as

1%.
Most fatalities a due to fulminant hepatic necrosis,

which in later pregnancy may resemble acute fatty

liver. Hepatic encephalopathy is the usual
presentation, and the mortality rate is 80%.
Approximately half of patients with fulminant disease

have hepatitis B infection, and coinfection with the

delta agent is common.

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Hepatitis B Vaccination
Hepatitis B vaccine
At birth : all newborns before hospital discharge
If mother HBsAg + administer HepB vaccine +

0,5ml HB/G within 12 hours of birth

If mother HBsAg status unknown administer
HepB vaccine within 12 hours of birth
If HBsAg + administer HBIG (no later than age
1 week)

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Pregnant women in the US 4 times or >

antibody rises during pregnancy occur,

consistent with virus reactivation.
No evidence of congenital transmission of
either JCV or BKV has been found in either
English or American studies, Japanese studies
have some positive evidence.

POLYOMAVIRUSES

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ENTEROVIRUSES
Perinatal infections : the enteroviruses can

cause severe disease in some newborn, the

viruses can be acquired either across the
placenta (most often immediately before
delivery) or by ingestion of contaminated
materials during the birth process.
Severe neonatal disease : most implicated :
coxsackie B, echo virus type 11. The disease is
generally multisystem : fever, meningitis,
miocarditis, hepatitis, adrenal cortical
involvement.
23

Influenza
Influenza A is more serious and usually develop

during winter. Infection usually is not lifethreatening in otherwise healthy adults, but
pregnant women appear to be more susceptible
serious pulmonary involvement.
In early 2003, widespread influenza A
commonly infected pregnant women. At
Parkland Hospital more than 100 women were
hospitalized for infection, and 12% had
pulmonary infiltrates seen on chest radiograph.
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There is no firm evidence that influenza A a

virus causes congenital malformation.

Lynberg and co workes (1994)
Reported increased neural tube defects in
neonates born to women with influenza early
in pregnancy possibly associated with early
hypertermia.

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Respiratory viruses
Rhinovirus, coronavirus, and adenovirus are

major causes of the common cold. Teratogenic

effects are controversial.
Adenoviral infection is a common cause of
chilhood myocarditis. Towbin (1994) and
Fornes (1998) used PCR to indentify and link
adenovirus to fetal myocarditis and non
immune hydrops.

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Measles (rubeola)
The virus doesnot appear to be teratogenic. There

is an increased frequency of abortion, preterm

delivery, and low-birth weight neonates with
maternal measles.
If a woman develops measles shortly before birth,

there is considerable risk of serious infection

developing in the neonate, especially in a preterm
neonate.
27

Dengue
Vertical transmission of dengue virus to neonates

whose mothers had an onset of primary or

secondary dengue fever up to 5 weeks before
delivery has resulted in acute neonatal dengue
manifasting as fever, cyanosis, apnea, mottling,
hepatomegali, and reduced platelet counts as low
as 11.000/mm3
One baby died of intracerebral haemorrhage, but

others, although ill, did not have others signs of

DHF, and they recovered without incident.

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Dengue
Dengue Virus was isolated from the neonates in

some cases.
The outcome of infection acquired earlier in

pregnancy has not been addressed satisfactorily.

Anecdotal reports have described spontaneous
abortion and a variety of birth defect and, in a post
epidemic investigation, an increases in neural
tubes defects. Other investigation have found no
increases in abnormal pregnancy outcomes.
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