The fact that many diseases of the mother can adversely affect the intrauterine development of the child is beyond doubt. However, simply listing the known cases of the relationship between a health disorder during pregnancy and the birth of a child with a particular pathology is clearly not enough to understand the essence of the matter, and most importantly, to prevent congenital anomalies in the future. The thought itself is banal, but in this situation it is not superfluous. The fact is that often teratogenic or embryotoxic properties are not possessed by the disease itself or the factors that caused it (viral, bacterial or other infection), but by various consequences of the disease: fever, toxic products formed in the body of a sick woman, and, of course, used medicines.

In order not to return more specifically to the conversation about medicines, consider, as an example, pharmaceuticals used in epilepsy, a disease of the central nervous system, characterized by attacks of seizures with loss of consciousness that come from time to time. In women with epilepsy, in a high percentage of cases, children are born with various defects: cleft lip and palate, defects in the development of the neural tube, heart, skeleton ...

Nevertheless, many researchers believe, and, apparently, rightly so, that the cause of the formation of congenital defects is not seizures or diseases of the nervous system as such, but the anticonvulsants used for many years. This can be confirmed by a study that revealed that these drugs significantly reduce the level of folic acid (a substance extremely important for the synthesis of nucleic acids) in the mother's body.

Taking folic acid along with anticonvulsant drugs allows, as far as can be judged from published data, to avoid developmental abnormalities. By the way, the same result can be achieved if you do not use anticonvulsants during pregnancy, especially in the first third of it. Of course, the doctor should choose the treatment tactics.

Many diseases of the mother can have adverse effects on the embryo or fetus, directly or indirectly, but, fortunately, they rarely cause teratogenesis or intrauterine death. The consequences, if they occur at all, usually boil down, for example, to complications of the course of pregnancy, to the underweight of the newborn, to a decrease in its activity. In other words, the deviations arising in the child, as a rule, do not lead to serious illnesses in the future and, with careful attention to the child, are quickly compensated.

Some other diseases of the mother, especially chronic ones, but also not affecting the appearance of deformities, require deeper intervention on the part of doctors to preserve the life and health of the child (for example, special management of pregnancy, and after birth - blood transfusion, intensive care). If everything is done on time and correctly, then in such cases, a successful outcome is no exception.

However, there are a number of diseases that, accompanying pregnancy, can increase the likelihood of congenital malformations, deformities and / or early termination of pregnancy.

Infectious diseases of the mother,
increasing the likelihood of fetal pathology

Rubella measles.

In the early 1940s, a wave of measles rubella swept across Australia. This epidemic was accompanied by a significant increase in the number of newborns born with various anomalies - congenital cataract (clouding of the lens of the eye), microcephaly, deafness, heart defects.

Already in 1945, N. Gregg was able to prove the connection between these pathologies and the mother's disease with rubella in the first months of pregnancy.

The fact that many viruses easily pass through the placental barrier and enter the cells of the embryo was known long before Greg, but he was the first to establish that viral diseases can cause not only a congenital infectious disease, but also some deformities. Studies carried out in Australia made it possible to establish that women who have had rubella (the disease for an adult is not at all serious and may occur in a latent form) in the first two months of pregnancy almost always had defective children.

More careful observation revealed that eye lesions (cataracts, retinitis, sometimes glaucoma) in a child sometimes occur when the mother is infected and in the third month of pregnancy, and ears (deafness) - even in the fourth.

The Australian rubella virus, which caused the most significant level of total congenital anomalies in the early 1960s, was apparently extremely active - something that has never been seen since. However, the risk of any deformities occurring is also a tragedy in the future. In addition, the harmfulness of rubella to the embryo is not limited only to its ability to cause anatomical anomalies. Even in their absence, children often lag behind in mental development, they are characterized by early mortality. Therefore, in most countries, it is recommended to terminate the pregnancy if the expectant mother becomes sick with rubella.

The complex of defects that make up the measles rubella syndrome is far from always the same and largely depends on the duration of pregnancy at which the mother underwent the infection. The fact is that rubella passes rather quickly, within a few days, and the time of illness does not have time to "cover" the periods of greatest sensitivity in various developing organs. For example, in the same child, either the eyes or the ears (more precisely, the inner ear) are usually affected - the timing of the highest susceptibility of these organs to the teratogenic action of the rubella virus does not coincide.

How do viruses get to the embryo?

In the antenatal period, the infection can be transmitted by the transplacental route:

• as a result of the penetration of the pathogen from the maternal blood into the blood of the fetus in the absence of inflammatory foci in the placenta;
• when the pathogen enters the maternal part of the placenta and forms an inflammatory focus in it, followed by the penetration of the infectious agent into the fetal blood;
• with damage to the chorion and the development of an inflammatory process in the fetal part of the placenta, membranes and infection of the amniotic fluid.

Most viruses, including measles rubella, freely pass through the placenta (from the mother's bloodstream through the walls of the villi into the fetal bloodstream), invade embryonic cells and multiply in them.

The second route of fetal infection is an ascending infection from the vagina and cervix or from the abdominal cavity through the fallopian tubes through a damaged or undamaged fetal bladder.

Cytomegalovirus infection.

In addition to the measles virus, a teratogenic effect was also found in the cytomegalovirus. This virus is quite widespread in laboratory and wild animals and can be transmitted from them to humans. For adults, infection is practically asymptomatic, but if cytomegalovirus enters the fetus (and this usually occurs at 3-4 months of embryogenesis), then in most cases this leads either to fetal death or to the occurrence of congenital defects, deformities and (or ) a whole set of diseases - fetal lag in development, malnutrition, microcephaly, periventricular cerebral calcifications, chorioretinitis, hepatosplenomegaly, hyperbilirubinemia, petechial rash and thrombocytopenia.

Mechanisms of teratogenic action of viruses have not been studied enough yet. But our knowledge about viruses in general - about how they enter the cell and how they behave in it - is quite enough to reasonably assume that there are many opportunities to cause a congenital anomaly in viruses. They are capable of disrupting the functions of chromosomes of embryonic cells, the process of mitosis, inducing cell death, and negatively affecting the course of biopolymer syntheses.

What exactly is the mechanism of action of rubella and cytomegalovirus viruses is not known for sure; looking for an answer to this question is a task for specialists, and here one should confine oneself to stating the fact of their direct teratogenicity.

Perhaps only in relation to these two viruses, more precisely, their teratogenic activity, the opinions of the majority of researchers agree. As for other viruses, such data are contradictory (strictly speaking, the absolute proof of the teratogenicity of cytomegalovirus is sometimes also disputed).

Many observations have been published linking the birth of children with congenital anomalies and a viral infection suffered by the mother during pregnancy: flu, chicken pox, herpes, measles, glanders and others. However, few people take the liberty of claiming that the causal relationship between the virus and the deformity is direct. Obviously, it is more correct to look for mediating factors - an increase in temperature, drugs, toxic substances formed in the mother's body, and much more.

Herpetic infection.

The incidence of neonatal herpes infection is 1 in 7500 births. Diseases of the fetus and newborn are more often caused by genital type II virus, which is secreted from cervical secretions and urine in 9.4% of pregnant women.

With a mother's disease in the first trimester of pregnancy, the virus, penetrating the fetus by the hematogenous route, leads to spontaneous abortion or the formation of malformations (microcephaly, microphthalmia, calcifications in the brain tissue).

Herpetic infection in later stages of pregnancy leads to death, and if infected immediately before childbirth or during birth, generalized or local forms of infection are observed in children.

Influenza and respiratory viral infection.

Influenza and ARVI viruses penetrate the fetus by the transplacental route. With intrauterine infection, especially in the early stages of development, early termination of pregnancy often occurs, there is a high perinatal mortality rate, congenital malformations of the fetus (hypospadias, clitoris anomaly, cleft lip, etc.).

As for microscopic algae and fungi, clinical teratology does not have any reliable data on their ability to cause congenital anomalies.

Effect of bacterial infection on the fetus

There is also no consensus when it comes to bacterial infections and their effect on the fetus. True, the differences of opinion are of a slightly different nature than in the dispute about the action of viruses: speaking of bacteria, some researchers generally reject their teratogenic effect, while others are more cautious and do not exclude, at least, the indirect influence of bacteria.

For example, there is evidence that congenital contractures, that is, persistent damage to normal mobility in the joint, can be a consequence of infection with syphilis or bacteria of the Clostridium genus, and some bacteria of the mycoplasma class probably play a role in the occurrence of malformations of the nervous system and some internal organs(There are a lot of infections that can adversely affect the condition of the fetus until its death, both viral and bacterial; here only those are mentioned that are capable or suspected of being capable of causing developmental abnormalities, deformities).

Unfortunately, the list of infectious diseases with teratogenic properties is not limited to viral and bacterial infections. There are also so-called protozoal infections (they are caused by unicellular organisms belonging to different types of the simplest animals), and for some of them such properties are characteristic, although here we can speak of teratogenicity of only two species of the simplest organisms.

From an infected mother, who most often does not even suspect about her illness, Toxoplasma penetrates through the placenta to the embryo and populates its cells, and exhibit the greatest affinity for the cells of the nervous system. The result is very serious consequences: the death of either the fetus in the womb, or the newborn in the first months of life. The surviving children experience lesions of the central nervous system and sensory organs - blindness, hydro- and microcephaly, and sometimes even anencephaly, that is, the absence of most of the brain.

The main source of Toxoplasma for humans is domestic animals - cows, horses, goats and others, and in cities - primarily cats, which themselves become infected by eating mice, rats, and raw meat. Toxoplasma secreted from the body of an animal with feces can get, for example, on its fur, and then infect a person through mucous membranes or damaged skin (scratch).

All that has just been said is by no means a call for the destruction of cats, especially since toxoplasmosis can be infected not only from them, but also from other domestic animals. You can also get infected by eating insufficiently cooked meat. There is even evidence that toxoplasma can be transmitted through the bites of fleas, bedbugs, mosquitoes. But if a cat lives in the house, especially if it is allowed to walk outside, then it is better for a pregnant woman to do special tests for the presence of toxoplasma (every antenatal clinic has information about where and how this is done).

Nevertheless, it is known that when the fetus is infected before the fourth month of development, it usually dies. Infection after this period leads to prematurity, a decrease in the total weight of the newborn at birth, and an increase in the weight of the liver and spleen. As for the emergence of deformities as a result of infection of the fetus with malaria, the messages on this topic that appear from time to time should be treated, if not with suspicion, then with caution: reliable cases, apparently, have not yet been registered.

Not infectious diseases mothers and fetal pathology

Many of the somatic diseases are far from indifferent to developing organism... And we will start with one of the most common diseases - diabetes.

In the process of digestion, a person absorbs and enters the bloodstream of many different components, including glucose (sugar), the most important source of energy in living cells. Under the influence of the hormone insulin, which is produced by the pancreas, glucose is absorbed from the blood by some cells, but mainly by skeletal muscle cells (they primarily need energy). However, in tens, if not hundreds of millions of people, this glucose conversion pathway is disrupted to one degree or another due to a lack of insulin in the body. Such people suffer from diabetes mellitus, or insulin-dependent diabetes (diabetes insipidus is a disease of a different nature; we will not touch on it).

As a result of a decrease in the functional activity of the pancreas in diabetics, large amounts of glucose are excreted in the urine. Tissues that have not received a sufficient amount of sugar begin to transform and include proteins and fats in the metabolism - the patient loses weight dramatically. Increased oxidation of fats leads to the accumulation of toxic substances in the body.

When pancreas extracts were used for the first time in medical practice since 1922, insulin injections extended the lives of millions of diabetics for many years, and life is full in all respects, except for the obligatory daily injections of insulin.

Even before the widespread use of this method of treating diabetic patients, it was known that in women susceptible to this disease, pregnancy was extremely rare - diabetes, among other things, causes a disruption in the functioning of the gonads. If pregnancy did occur, then in half of the cases, sooner or later, it led to the death of the fetus and the mother.

There is also diabetes mellitus, in which the patient does not need insulin treatment, and he may not even know about his illness. Supersaturation of the same blood with sugar occurs only with an abundant diet of carbohydrates. In some cases, the non-occurrence of pregnancy or constant spontaneous miscarriages can be explained by precisely these circumstances. This type of diabetes, called non-insulin dependent, is treated with special antihyperglycemic pills.

With the help of insulin and pills, it was possible to significantly reduce the number of infertile marriages in insulin-dependent and non-insulin-dependent diabetes mellitus, according to some estimates from 95 to 15 percent. Mortality has decreased, and the course of pregnancy has returned to normal, but there are still many problems associated with childhood pathology. It should be stipulated right away that mild forms of diabetes, for example, caused by the pregnancy itself or those that can be "corrected" by a special diet, do not have a noticeable teratogenic effect.

With diabetes mellitus in pregnant women, there are two types of disorders in offspring, depending on at what stage of development - embryonic (up to 12 weeks) or fetal (after 12 weeks) - the developing child will suffer.

The pathology that arose during the fetal period manifests itself in a significant increase in height - up to 60 centimeters - and the weight of the newborn - from four to six and a half kilograms. This happens mainly due to the deposition of fat in the subcutaneous tissue, tissue edema, hypertrophy of internal organs - liver, heart, spleen.

It is clear that all this cannot but affect the generic process: childbirth in this case is usually complicated. In addition, such children are born physically weakened, and they require long-term supervision of a pediatrician.

It is much worse if diabetes affects the early stages of development. Numerous observations indicate that in mothers with diabetes, children with congenital malformations are born several times more often than in healthy ones. At the same time, a multiplicity of anomalies is characteristic of the teratogenic effect of diabetes: complexes of defects of the musculoskeletal system, heart and blood vessels, and the central nervous system.

Thus, diabetes causes a wide variety of metabolic disorders in the patient, therefore, which is quite obvious, there can also be a lot of factors that cause the appearance of congenital anomalies in mother's diabetes. These are defects in the metabolism of fats and amino acids, and hormonal disorders, and a low oxygen content in the tissues. The main factor, as it is believed, is an increased blood sugar level, hence, disruptions in energy metabolism.

However, even one of these disorders is enough to adversely affect the development of the child - it is not surprising that diabetes leads to multiple congenital anomalies.

The subtle mechanisms of the teratogenic effect of diabetes, however, are still not fully understood. The role of genetic characteristics and the degree of family risk in the occurrence of congenital malformations during pregnancy complicated by diabetes is also not entirely clear.

Nevertheless, the diagnosis of diabetes is not an absolutely insurmountable obstacle to the realization of a woman's desire to have healthy children. Of course, the severity of the disease is of great importance, and there are three of them - mild, moderate and severe. Accordingly, the hopes for a successful pregnancy outcome are not the same. But the current methods of pregnancy management in diabetes involve the use of the most rational diets, soft and, at the same time, effective ways drug therapy and even the preparation of a medico-genetic prognosis.

Constant medical supervision, preferably in a hospital, can significantly reduce the risk (but, unfortunately, not completely exclude) the occurrence of pathologies. In extreme cases, a variety of prenatal diagnostic methods will make it possible to recognize the anomaly that has arisen as early as possible and decide on the need for artificial termination of pregnancy.

Diabetes is perhaps the only non-infectious maternal disease (excluding various genetic abnormalities), the teratogenic properties of which are undeniable. As for other diseases associated with pregnancy, the situation here is not so clear, but let's say a few words about them.

Various violations have become extremely widespread, especially in the last two decades. of cardio-vascular system, starting with heart defects and ending with hypo- and hypertension. The fact that diseases of this group to one degree or another affect pregnancy is undoubtedly, but they do not lead to anatomical disorders in the child (that is, deformities), but mainly physiological or functional.

With sufficiently severe forms of pathologies of the cardiovascular system, the mother may give birth to premature or weakened children. Changes in the central nervous system often become a feature of such children, and they can persist for quite a long time: children, with a great delay, begin to hold their heads, sit, walk; later they may develop, for example, speech defects. In other words, these phenomena are more related to teratology of behavior than to teratology in the "old" sense of the word.

However, it should be noted that from time to time there are reports in the press about deformities caused by disorders in the mother's cardiovascular system, in particular, chronic arterial hypertension. However, this is more the exception than the rule.

The reasons for the occurrence of all such deviations in the intrauterine development of a child are easy to understand. The most important damaging factor here are circulatory disorders in the mother, which inevitably leads to oxygen starvation of the fetus, expressed to one degree or another.

Among other diseases that adversely affect embryonic development and, accordingly, the health of the child, it is necessary to name dysfunction of the thyroid gland, anemia (anemia), thyrotoxicosis and other toxicosis of pregnant women, immunological incompatibility of the mother and the fetus, leading to hemolytic disease of the newborn. But once again, we note that these diseases of the mother, apparently, do not possess teratogenic activity.

Until now, it has been said about the effect on the embryo and fetus only of maternal diseases. Do paternal factors play a role in this regard?

Paternal factors and fetal pathology

If you do not take into account the huge amount of data available in the literature on the role of the father's genetic anomalies, then it must be admitted that information on this score is very scarce. Can we conclude from this that for the occurrence of any kind of congenital anomalies in offspring, non-genetic diseases of the father, as a rule, do not matter? Probably yes, you can. Let us recall the process of fertilization: only the nucleus of the sperm penetrates into the egg, that is, the father brings only genetic factors, and in this case they are not considered.

Many diseases of the father can affect the course of spermatogenesis and the quality of spermatozoa (for example, motility) or their quantity. But such an effect will only affect a decrease in the fertilizing ability of a sick man, and not his offspring (however, there are also controversial points here).

However, it is not necessary to almost absolutize the independence of the future child's health from non-genetic diseases of the father. The situation is not so unambiguous, although there is no need to talk about teratogenesis. There are a number of microorganisms that are sexually transmitted, and this number is not limited to the causative agents of well-known syphilis and gonorrhea. The pathogenic role of such microorganisms as mycoplasma, Trichomonas, ureaplasma and chlamydia is also very great, and they are much more common than the causative agents of sexually transmitted diseases, and their infection in an adult is usually completely asymptomatic. You can be a carrier of, say, mycoplasmas for decades and not even suspect about it.

We will not consider in detail the action of these microorganisms in relation to each individual type of bacteria, we only emphasize that in pregnant women such intoxication can lead to diseases of the child, and to prematurity, and to a decrease in the weight of the newborn, and to spontaneous termination of pregnancy on different dates... The transmission of the pathogen from the father does not occur directly to the child - the mother is the first to become infected, and already changes in her body due to intoxication lead to those unfavorable consequences for the child that have just been mentioned.

Concluding this topic, I want to say: the alleged addition of a family must be treated consciously from all sides, and not only, say, from the material side. But if everyday problems are resolved, one should also think about how diseases and medications taken will affect the offspring. It is better to undergo an examination in a timely manner, to be treated if necessary, and only then to plan an increase in the family. Do not forget about vaccine prophylaxis as a guarantee of the health of the unborn child.

Compiled based on: Balakhonov A.V. Development errors.
Ed. 2nd, rev. and add. - SPb., "ELBI-SPb." 2001.288 s.

The fetus is surrounded in the uterus by protective membranes and waters, which are a kind of barrier on the way of infectious pathogens and viruses. An additional means of protecting the child in the uterus is a mucous plug that clogs the cervix. Sometimes, for some reason, the fetal defense mechanism is disrupted and intrauterine infection occurs.

Causes of intrauterine fetal infection

The infectious agent can enter the uterine cavity to the fetus in several ways:

• through the cervix in case of violation of the integrity of the fetal bladder and discharge of the mucous protective plug;
• through the placenta from a sick mother;
• with blood flow.

Infection of a child in the uterus is most often caused by the following microorganisms:

• viruses - herpes, cytomegalovirus, rubella virus, influenza virus, parainfluenza, adenovirus;
• microorganisms - listeria, Koch's bacillus (tuberculosis), pale treponema (syphilis);
• chlamydia, gonococcus, ureaplasma, toxoplasma;
• mushrooms.

Symptoms and signs of infection in the fetus in the womb

Unfortunately, the insidiousness of intrauterine infections is the absence of a clinical picture of the child's disease in the woman herself, that is future mom can learn about the pathology only by ultrasound. The most common manifestations of intrauterine infection in a child are as follows:

• congenital malformations;
• an increase in the internal organs of the child;
• development of blindness and deafness in the fetus;
• delay intrauterine development;
• congenital pneumonia, rubella and other infections;
• at birth, the baby may have a rash on the skin.

Consequences of infection of the fetus in the womb

The development of the consequences of intrauterine infection of a child largely depends on at the time of infection:

• If infected from 3 to 5 weeks- most often, a spontaneous miscarriage occurs, thus, natural selection is triggered and the body gets rid of the "abnormal" weak embryo;
• Infection from 5 to 12 weeks- at this stage, either a spontaneous miscarriage develops as a result of the formation of defects incompatible with life, or a congenital malformation of the organ that was laid at the time of infection is formed;
• 13 to 22 weeks gestation- all the internal organs of the fetus are formed and only their improvement and growth occurs, with infection at this time, the fetus may form a "cleft palate", "hare lip" or other small deformities;
• Infection from 22 to 35 weeks- in most cases, the infectious agent affects the nervous system of the fetus, resulting in the development of hydrocephalus, encephalitis and other pathologies;
• From 35 to 39 weeks- Infection of the fetus at this gestational age in most cases leads to either the death of the child or the birth of a baby with symptoms of this disease.

Treatment of intrauterine fetal infection

Treatment of an infection acquired in the womb is carried out after the birth of the child. The doctors' actions are based on the following:

• prescribing to a newborn drugs that have a detrimental effect on the pathogen - antibiotics, antifungal, antiviral;
• maintenance and strengthening of immunity - funds based on recombinant interferon;
• symptomatic therapy - elimination of seizures, reduction of fever, and, if necessary, surgery.

Prevention of intrauterine infection

The main principle of prevention of intrauterine infection of a child is the early planning of pregnancy. At the planning stage, a woman is prescribed tests for TORCH infections (herpes, cytomegalovirus, rubella, toxoplasmosis), vaginal smears, blood, including latent infections. Identification of pathology before conception and its timely treatment is the key healthy pregnancy and the birth of the child on time.

Irina Levchenko, obstetrician-gynecologist, specially for the site site

The infection gets into amniotic fluid from the vagina;
- the infection enters the amniotic fluid through the fallopian tubes;
- the infection enters the amniotic fluid through the wall of the uterus.

• Through the placenta.
• Through the blood.

Intrauterine infection most commonly caused by the following microorganisms:

1. Viruses:

• Herpes virus (congenital herpes).
• (congenital cytomegaly).
• Rubella virus (congenital rubella).
• Less commonly: enteroviruses, influenza virus, adenovirus.

2. Bacteria:

• Listeria (congenital listeriosis).
• Tuberculosis bacillus (congenital tuberculosis).
• The causative agent of syphilis (congenital syphilis).

3. Chlamydia (congenital rubella). It is recommended to treat chlamydia, and your doctor will tell you how to treat chlamydia.
4. Mycoplasma (congenital mycoplasmosis).
5. Toxoplasma (congenital toxoplasmosis).
6. Mushrooms (congenital candidiasis).

Influence of gestational age on the course of intrauterine infection

Flow intrauterine infection strongly depends on the gestational age at which the fetus became infected. Changes in the fetus that occur at a certain stage of pregnancy will be similar with any infection, be it herpes, or toxoplasma, or another pathogen.

On the 1st-2nd week is coming the formation of a multicellular embryo of the fetus. By the end of the 1st week, the embryo is introduced into the mucous membrane of the uterus (embryo implantation), and this process can be disrupted. Any negative impact during this period, including infection, will provoke intrauterine fetal death and spontaneous death.

From the 3rd to the 12th week, the formation of the main vital organs and systems occurs: the circulatory, respiratory, digestive, nervous, genitourinary systems are laid, etc. The action of the infection during this period will lead either to fetal death and miscarriage, or to development gross defects (malformations of the heart, brain, kidneys, intestines, etc.).

From the 13th week before delivery occurs fast growth fetus, the fine structures and functions of the body are maturing.

Therefore, with an unfavorable effect during this period, the violation will be at the level of the functions of organs and systems. Such an impact will not cause gross deformities. Some minor blemishes may appear, such as splitting upper lip("Cleft lip"), if the infection was active at the beginning of this period.

If the infection occurs at the end of pregnancy in the third trimester (from the 22nd week), the fetus will develop a real illness with characteristic symptoms: hepatitis, pneumonia, encephalitis, nephritis, etc. In addition, the size of the fetus will suffer: the baby will be born small and small in stature. A child born in the acute period of an infectious disease is contagious.

Depending on the time of infection, the following disease outcomes are possible:

• Intrauterine fetal death and miscarriage (infection occurred on early dates pregnancy).
• Malformations (eg, heart defects, brain defects, and others). The infection occurred at a fairly early stage, and the inflammatory process has already ended.
• The birth of a child in the midst of an illness. Infection occurred on later dates, the inflammation continues, the child is contagious.
• The birth of a child with malnutrition (low weight) and short stature.

Intrauterine infection symptoms

For intrauterine infection the following signs are characteristic:

• Neurological disorders: seizures, hypertensive-hydrocephalic syndrome and others.
• Developmental defects.
• Prolonged, growing jaundice, lasting several months.
• Enlargement of the liver and spleen.
• Anemia.
• Temperature rises.
• Delayed development: physical, mental, motor.
• A rash on the skin of a different nature, depending on the pathogen.

Congenital rubella (rubella). Rubella is dangerous only for pregnant women, because in the overwhelming majority of cases it causes fetal deformities (changes in the size of the skull, congenital deafness, cataracts and heart defects). If a woman suffers from rubella in the first three months of pregnancy, this is considered an absolute indication for its termination.

Congenital cytomegaly. Multiple lesions are characteristic: enlarged liver and spleen, anemia, prolonged jaundice, blood clotting disorders, pneumonia, brain damage, eyes, low weight.

Congenital herpes. Herpes infection can occur not only in the womb, but also during the passage of the child through the birth canal. The disease occurs in about 50% of infected infants. A common herpes infection is accompanied by significant damage to the brain, liver, adrenal glands. Bubble rashes on the skin are characteristic. The course of the disease is very difficult and in the overwhelming majority of cases ends in coma and death of the child.

Congenital listeriosis. Listeria is a bacteria that a pregnant woman can get from animals. They enter the fetus through the blood. They affect the brain, often cause fetal death. In the clinical picture: meningitis, encephalitis, muscle tone disorders, skin rash and respiratory distress.

Congenital chlamydia. The development of chlamydial pneumonia and conjunctivitis is characteristic.
If an intrauterine infection is suspected, special blood tests are performed, confirming its presence, determining the pathogen and the period of the course (the acute period or inflammation has already been completed).

Treatment of intrauterine infection

Main directions:

• If a child was born in an acute period, he is prescribed drugs that act on the pathogen.
• Basically, the treatment is symptomatic: the treatment of the manifestations of the disease. Hypertensive-hydrocephalic syndrome, convulsive syndrome, pneumonia, hepatitis are treated, surgical operations are performed to eliminate malformations, etc.
• Preparations for enhancing immunity.

Forecast intrauterine infection generally disappointing. Usually, the later the infection occurs, the better for the child, there will be no terrible malformations, the disease will not have time to damage the vital organs and the brain.

Prevention of intrauterine infection

It is advisable, before conceiving a child, to be tested for intrauterine infections and treat them if they show up. Women who have not had rubella can be vaccinated. Many infections that affect the fetus are sexually transmitted. Hygiene of sexual relations and fidelity in the family are the key to the prevention of these diseases.

When carrying a child, a woman tries to protect him from adverse external influences. Health developing baby- this is the most important thing during this period, all protective mechanisms are aimed at its preservation. But there are situations when the body cannot cope, and the fetus is affected in utero - most often it is an infection. Why it develops, how it manifests itself and what risks it carries for the child - these are the main questions of concern to expectant mothers.

Causes

In order for an infection to appear, including intrauterine, the presence of several points is necessary: ​​the pathogen, the route of transmission and susceptible organism... Microbes are believed to be the immediate cause of the disease. The list of possible pathogens is very wide and includes various representatives - bacteria, viruses, fungi and protozoa. It should be noted that intrauterine infection is mainly due to microbial associations, that is, it has a mixed character, but monoinfections are not uncommon. Among the common pathogens, the following are worth noting:

1. Bacteria: staphylo-, strepto- and enterococci, Escherichia coli, Klebsiella, Proteus.
2. Viruses: herpes, rubella, hepatitis B, HIV.
3. Intracellular agents: chlamydia, mycoplasma, ureaplasma.
4. Fungi: candida.
5. The simplest: Toxoplasma.

Separately, a group of infections was identified, which, despite all the differences in morphology and biological properties, cause similar symptoms and are associated with persistent developmental defects in the fetus. They are known under the abbreviation TORCH: toxoplasma, rubella, cytomegalovirus, herpes, and others. It must also be said that for last years there have been certain changes in the structure of intrauterine infections, which is associated with the improvement of diagnostic methods and the identification of new pathogens (for example, listeria).

The infection can penetrate to the child in several ways: through the blood (hematogenous or transplacental), amniotic fluid (amnial), the mother's genital tract (ascending), from the wall of the uterus (transmurally), through the fallopian tubes (descending) and with direct contact. Accordingly, there are certain risk factors for infection that a woman and a doctor should be aware of:

• Inflammatory pathology of the gynecological sphere (colpitis, cervicitis, bacterial vaginosis, adnexitis, endometritis).
• Invasive interventions during pregnancy and childbirth (amniocentesis or cordocentesis, chorionic biopsy, C-section).
• Abortions and complications in the postpartum period (postponed earlier).
• Insufficiency of the cervix.
• Polyhydramnios.
• Placental insufficiency.
• Common infectious diseases.
• Focuses of chronic inflammation.
• Early onset of sexual activity and promiscuity in sexual relations.

In addition, many infections are characterized by a latent course, undergoing reactivation in case of metabolic and hormonal processes in the female body: hypovitaminosis, anemia, heavy physical exertion, psychoemotional stress, endocrine disorders, exacerbation of chronic diseases. Those who have identified such factors are at high risk of intrauterine infection of the fetus. He is also shown regular monitoring of the condition and preventive measures aimed at minimizing the likelihood of the development of pathology and its consequences.

Intrauterine infection develops when infected with microbes, which is facilitated by many factors on the part of the maternal body.

Mechanisms

The degree of pathological impact is determined by the characteristics of the morphological development of the fetus at a particular stage of pregnancy, its response to the infectious process (the maturity of the immune system), the duration of microbial aggression.

the severity and nature of the lesion are not always strictly proportional to the virulence of the pathogen (the degree of its pathogenicity). Often, latent infection caused by chlamydial, viral or fungal agents leads to intrauterine death or the birth of a seriously abnormal baby. This is due to the biological tropism of microbes, i.e., the tendency to multiply in embryonic tissues.

Infectious agents have different effects on the fetus. They can provoke an inflammatory process in various organs with the further development of a morphofunctional defect or have a direct teratogenic effect with the appearance of structural anomalies and malformations. Of no small importance are fetal intoxication with products of microbial metabolism, metabolic disorders and hemocirculation with hypoxia. As a result, fetal development suffers and the differentiation of internal organs is impaired.

Symptoms

Clinical manifestations and the severity of the infection are determined by many factors: the type and characteristics of the pathogen, the mechanism of its transmission, the strength of the immune system and the stage of the pathological process in the pregnant woman, the gestational age at which the infection occurred. In general, this can be represented as follows (table):

The symptoms of intrauterine infection are noticeable immediately after birth or in the first 3 days. But it should be remembered that some diseases may have a longer incubation (latent) period or, conversely, appear earlier (for example, in premature babies). Most often, the pathology is manifested by the syndrome of infection of the newborn, manifested by the following symptoms:

• Weakening of reflexes.
• Muscle hypotension.
• Refusal to feed.
• Frequent regurgitation.
• Pale skin with periods of cyanosis.
• Change in the rhythm and frequency of breathing.
• Muffled heart tones.

Specific manifestations of pathology include a wide range of disorders. Based on the tissue tropism of the pathogen, intrauterine infection during pregnancy can manifest itself:

1. Vesiculopustulosis: a rash on the skin in the form of blisters and pustules.
2. Conjunctivitis, otitis media and rhinitis.
3. Pneumonia: shortness of breath, cyanosis of the skin, wheezing in the lungs.
4. Enterocolitis: diarrhea, bloating, sluggish sucking, regurgitation.
5. Meningitis and encephalitis: weak reflexes, vomiting, hydrocephalus.

Along with a local pathological process, the disease can be widespread in the form of sepsis. However, its diagnosis in newborns is difficult, which is associated with the low immune reactivity of the child's body. At first, the clinic is rather scarce, since there are only symptoms of general intoxication, including those already listed above. In addition, the baby is underweight, the umbilical wound does not heal well, jaundice appears, the liver and spleen enlarge (hepatosplenomegaly).

In children infected in the prenatal period, violations of many vital systems are revealed, including the nervous, cardiovascular, respiratory, humoral, and immune systems. Key adaptive mechanisms are violated, which is manifested by hypoxic syndrome, malnutrition, cerebral and metabolic disorders.

The clinical picture of intrauterine infections is very diverse - it includes specific and general signs.

Cytomegalovirus

Most babies infected with cytomegalovirus do not have any visible abnormalities at birth. But in the future, signs of neurological disorders are revealed: deafness, slowing down of neuropsychic development (mild mental retardation). Unfortunately, these disorders are irreversible. They can progress to the development of cerebral palsy or epilepsy. In addition, a congenital infection can manifest itself:

• Hepatitis.
• Pneumonia.
• Hemolytic anemia.
• Thrombocytopenia.

These disorders disappear over a period of time, even without treatment. Chorioretinopathy may occur, which is rarely accompanied by decreased vision. Severe and life-threatening conditions are very rare.

Herpetic infection

The greatest danger to the fetus is a primary genital infection in the mother or an exacerbation of a chronic disease. Then the child becomes infected by contact, passing through the affected genital tract during childbirth. Intrauterine infection is less common, it occurs before the natural end of pregnancy, when the fetal bladder bursts, or at other times - from the first to the third trimester.

Infection of the fetus in the first months of pregnancy is accompanied by heart defects, hydrocephalus, abnormalities of the digestive system, intrauterine growth retardation, and spontaneous abortions. In the second and third trimesters, pathology leads to the appearance of the following deviations:

• Anemia.
• Jaundice.
• Hypotrophy.
• Meningoencephalitis.
• Hepatosplenomegaly.

And herpes infection in newborns is diagnosed by vesicular (vesicular) lesions of the skin and mucous membranes, chorioretinitis and encephalitis. There are also common forms when several systems and organs are involved in the pathological process.

Rubella

A child can become infected from the mother at any stage of pregnancy, and clinical manifestations will also depend on the time of infection. The disease is accompanied by damage to the placenta and fetus, intrauterine death of the latter, or does not give any consequences at all. For children born with an infection, rather specific anomalies are characteristic:

• Cataract.
• Deafness.
• Heart defects.

But in addition to these signs, there may be other structural abnormalities, for example, microcephaly, cleft palate, skeletal disorders, genitourinary system, hepatitis, pneumonia. But in many children born infected, no pathology is detected, and in the first five years of life, problems begin - hearing deteriorates, psychomotor development slows down, autism, diabetes mellitus appears.

Rubella has a clear teratogenic effect on the fetus, leading to various abnormalities, or provokes its death (spontaneous abortion).

Toxoplasmosis

Infection with toxoplasmosis in early pregnancy can be accompanied by severe consequences for the fetus. An intrauterine infection provokes the death of a child or the occurrence of multiple abnormalities, including hydrocephalus, brain cysts, edema syndrome, and destruction of internal organs. Congenital disease is often common, manifesting itself with the following symptoms:

• Anemia.
• Hepatosplenomegaly.
• Jaundice.
• Lymphadenopathy (swollen lymph nodes).
• Fever.
• Chorioretinitis.

With infection at a later date, the clinical manifestations are rather scarce and are mainly characterized by decreased vision or unexpressed disorders in the nervous system, which often remain undetected.

Additional diagnostics

Of great importance is the prenatal diagnosis of an infectious lesion of the fetus. To determine the pathology, laboratory and instrumental methods are used to identify the pathogen and identify deviations in the development of the child at various stages of pregnancy. If intrauterine infection is suspected, perform:

1. Biochemical blood test (antibodies or microbial antigens).
2. Analysis of smears from the genital tract and amniotic fluid (microscopy, bacteriology and virology).
3. Genetic identification (PCR).
4. Ultrasound (fetometry, placentography, Doppler ultrasonography).
5. Cardiotocography.

After birth, newborns are examined (skin washings, blood tests) and the placenta (histological examination). Comprehensive diagnostics allows you to identify pathology at the preclinical stage and plan further treatment. The nature of the activities carried out will be determined by the type of infection, its spread and clinical picture. An important role is also played by prenatal prevention and the correct management of pregnancy.

Calm pregnancy, easy childbirth, the birth of a healthy child is sometimes overshadowed by a sudden deterioration in the baby's condition for 2-3 days of life: lethargy, frequent regurgitation, no weight gain. All this can be the result of intrauterine infections of the fetus. What are these infections how to avoid them?

Intrauterine infection is the presence in a woman's body of pathogens that lead to inflammatory processes in the genitals and not only. The consequence of such an infection is the subsequent infection of the fetus during intrauterine development. In most cases, fetal infection occurs due to the same blood flow between the woman and the child. It is also possible to infect a newborn when passing through the birth canal and when swallowing infected amniotic fluid. Let's take a closer look at the infection routes.

What are intrauterine infections?

The type of infection depends on the pathogen that affects the female body during pregnancy or even before the baby is conceived. The cause of intrauterine infection can be pathogens:

• viruses (herpes, flu, rubella, cytomegaly);
• bacteria (Escherichia coli, chlamydia, streptococcus, treponema pallidum;
• mushrooms;
• protozoa (toxoplasma).

The risk of negative effects of these pathogens increases when a woman has chronic diseases, she works in hazardous industries, is exposed to constant stress, has bad habits, inflammatory processes of the genitourinary system untreated before pregnancy, and chronic diseases. For a child, the risk of being exposed to intrauterine infection increases if the mother with this infection meets for the first time during the period of gestation.

The group of intrauterine infections is usually called the TORCH group. All infections from it, having different pathogens, are almost equally manifested clinically and cause similar deviations in the development of the fetal nervous system.

TORCH is decrypted as follows:

T- toxoplasmosis

O- Others (this group includes other infectious diseases such as syphilis, chlamydia, enterovirus infection, hepatitis A and B, listeriosis, gonococcal infection, measles and mumps)

R- rubella

WITH- cytomegalovirus infection

N- herpes

Consider major intrauterine infections

Cytomegalovirus from the group of herpes viruses. Infection of the fetus occurs even in the prenatal period, less often during childbirth. The infection proceeds imperceptibly for a woman, but clearly manifests itself in a child born with this virus. The cause of a woman's infection is an immune deficiency, which has a detrimental effect on the body's inability to protect the child from infection. Treatment of infection is possible with specific drugs. In newborns, CMV is very rarely manifested by developmental disorders, therefore, drug treatment is prescribed only when the baby's life is threatened.

Herpetic infections Is another fairly common IUI. Infection of the fetus with this infection mainly occurs during its passage through the birth canal. In the case of diagnosing a disease in a woman, a planned cesarean section is most often prescribed before the amniotic fluid leaves. Newborns susceptible to intrauterine infections of this type undergo a course of specific therapy that minimizes the negative consequences for the development of the central nervous system.

Chlamydia sexually transmitted, therefore, you should be extremely careful in contacts when carrying a baby. This intrauterine infection is detected by analysis of smears from the female genital tract. In case of detection of the pathogen, the pregnant woman is prescribed antibiotic treatment. The sexual partner should also be treated.

The fetus can be infected, both during development inside the mother, and already during the birth process. Pathologies in newborns as a result of infection have not been identified, some minor consequences are possible with a decrease in appetite, frequent defecation, which is eliminated without medical intervention.

Rubella - this is the so-called childhood disease. If a woman did not get sick with it, then when planning a pregnancy, it is imperative to get vaccinated 3 months before the intended conception. The defeat of the body of a pregnant woman with the rubella virus can lead to the development of serious pathologies in the baby or to the termination of pregnancy. In a newborn, such an intrauterine infection can appear only after 1 to 2 years, if the baby has undergone an infection during childbirth.

What is the danger of intrauterine infection during pregnancy?

The mother develops immunity to most pathogens that cause intrauterine infections if she has ever met this pathogen. At the second meeting of the organism with the pathogen, the immune response prevents the virus from developing. If the meeting occurs for the first time during pregnancy, then the virus infects the body of both the mother and the child.

The degree of influence on the development and health of the fetus depends on when the infection occurs.

If infected before 12 weeks of gestation, intrauterine infection can lead to interruption or malformations of the fetus.

When the fetus is infected at 12 - 28 weeks of pregnancy, intrauterine development of the fetus is delayed, as a result of which it is born with low weight.

Infection of the fetus in the womb at a later date can pathologically affect the already formed organs of the baby. The most vulnerable in this case is the brain, since its development continues until birth. Also negative impact intrauterine infections during pregnancy can affect the baby's liver, lungs and heart.

Signs of intrauterine infections

During pregnancy, a woman is repeatedly tested for blood and urine. These measures are taken by doctors to check the general condition of the pregnant woman or to detect infections in the woman's body.

The presence of intrauterine infections in a woman's body is shown by tests. But even when examined on a gynecological chair, which is performed when registering for pregnancy, inflammatory processes in genitourinary system... Most often, there is inflammation of the vagina and cervix. But in most cases, the development of infection in the body is not accompanied by any symptoms. Then it remains to rely only on analyzes.

A baby may have the following signs of intrauterine infection, which appear before or after birth:

• developmental delay;
• enlargement of the liver and spleen;
• jaundice;
• rash;
• disorder of the respiratory system;
• cardiovascular insufficiency;
• disorders of the nervous system;
• lethargy;
• lack of appetite;
• pallor;
• increased regurgitation.

If signs of infection are observed in a baby long before childbirth, the baby is born with an already developing disease. If the fetus is infected before childbirth, then the child's infection may manifest itself with pneumonia, meningitis, enterocolitis, or other diseases.

All these signs can appear only on the third day after the birth of the baby. Only in case of infection during the passage through the birth canal, the signs become apparent immediately.

Methods of infection with intrauterine infections

Infection of the fetus occurs in two ways: through the mother's blood or during the passage through the birth canal.

The way the infection penetrates to the fetus depends on the type of pathogen. Harmful viruses can enter the fetus through the vagina or fallopian tubes if a woman is sexually infected. Also, the infection gets through the amniotic fluid, blood or amniotic fluid. This is possible if a woman is exposed to rubella, endometritis, placentitis.

A woman can contract all of the above infections from a sexual partner through contact with a sick person, drinking raw water or poorly processed food.

Treatment

Not all intrauterine infections are treated. Antibiotic treatment is prescribed in especially dangerous cases, depending on the type of infection and the condition of the child and mother. A woman may be prescribed immunoglobulins to increase the immune response to the pathogen. Vaccination can be carried out already during pregnancy (this applies to herpes vaccination). Treatment is chosen depending on the duration of pregnancy and the type of pathogen.

Prophylaxis

The best prevention of intrauterine infections is planning a pregnancy. In this case, both partners must undergo a complete examination and treat all identified infections.

During pregnancy, it is worth observing all hygiene standards, both in relations with sexual partners and in everyday life: wash hands, vegetables, fruits thoroughly, handle food before eating.

Proper nutrition and healthy image life will also have a beneficial effect on the course of pregnancy and the body's resistance to infections.

The expectant mother should be very attentive to her health. Having heard about the possibility of an intrauterine infection, you should not panic. Modern methods of treatment, timely diagnosis of disorders in the health of the mother or baby, in most cases, give positive results for the preservation of pregnancy and the birth of healthy children.

Intrauterine infections during pregnancy

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