Prenatal Transmission

TORCH

Toxoplasmosis

  • Toxoplasma gondii in cat feces, raw meat, unpasteurized milk

    • First trimester infection ➔ ↑ risk of preterm/spontaneous abortion

      • Triad: Chorioretinitis (posterior uveitis), intracranial calcifications (with ring-enhancement), hydrocephalus

    • Second trimester infection ➔ dz later in life (epilepsy, ID, vision dz, sensorineural HL

  • DX with PCR

  • TX mom with spiramycin to ↓ transmission (doesn't tx fetus)

      • Once confirmed: pyrimethamine AND sulfadiazine AND folinic acid

Other

Syphilis

  • In utero syphilis ➔ miscarriage/hydrops fetalis

  • Early congenital syphilis (onset of sx before 2yo)

    • Hepatomegaly/jaundice

    • White/bloody rhinorrhea "snuffles”

    • Maculopapular rash - palms and soles

  • Late congenital syphilis (onset of sx after 2yo)

    • Saddle nose, frontal bossing, short maxilla (from skeletal abnormalities)

    • Notched, wide spaced teeth (Hutchinson's) and poorly developed molars

    • Interstitial keratitis, sensorineural HL, cranial nerve palsies

  • DX with RPR/VDRL, confirmed with dark-field microscopy

  • TX with IV PCN G

Listeriosis

  • Listeria monocytogenes in contaminated food ➔ granulomatosis infantiseptica

    • Newborn develops systemic infection with disseminated abscesses in any organ system

      • Can develop listeria meningitis/encephalitis 5d - 3wks after birth

  • DX with blood/CSF cultures

  • TX with IV ampicillin AND gentamicin (mom and newborn)

Varicella

  • Infection during first and second trimester ➔ limb, eye, CNS defects

  • Maternal exanthem <5d before birth: pneumonia, hemorrhagic exanthem, encephalitis

  • TX with acyclovir and give newborn varicella-zoster immune globulin

    • C-section if lesions present at delivery

Parvo B19

  • Parvovirus B19 (Fifth dz aka slapped cheek) ➔ fetal anemia, miscarriage/hydrops fetalis

  • DX with PCR

  • TX severe fetal anemia with intrauterine blood transfusion

Rubella

  • Rubella virus infection ➔ miscarriage, preterm birth, IUGR (↑ risk in first trimester infection)

  • Congenital rubella syndrome (can be asx at birth)

    • Triad: Cardiac (PDA, pulmonary artery stenosis), cataracts, cochlear (b/l sensorineural HL)

    • Early SSX: Hemolytic anemia, jaundice, thrombocytopenia, PNA, meningitis/encephalitis, petechiae/purpura (blueberry muffin rash)

    • Late SSX: Microcephaly, ID, encephalitis

  • DX with PCR (mom and newborn)

    • DX fetus (chorionic villi, amniotic fluid) IgM antibody serology or PCR

  • TX

    • PREGNANT WOMEN DO NOT GET MMR VACCINE

    • Consider termination discussion for intrauterine rubella infection < 16wks

    • >16wks: Reassure and monitor for complications

Cytomegaly (CMV)

  • Cytomegalovirus infection ➔ ↑ risk of fetal demise, IUGR, placental abnormalities

  • Most are subclinical infections but can develop b/l sensorineural HL later in life

  • Newborn infection resembles rubella infection

    • Hydrocephalus, periventricular calcifications (without ring enhancement) intraventricular hemorrhage

  • DX with CMV IgM antibodies or or PCR (mom and newborn)

  • TX severe fetal anemia with intrauterine blood transfusion

    • TX newborn with ganciclovir OR valganciclovir OR foscarnet

    • TX mom with valacyclovir (only approved tx during pregnancy)

Herpes simplex virus (HSV)

  • HSV-2 (MC), HSV-1 (rare)

  • Intrauterine infection ➔ low birth weight, microcephaly, small orbits, vesicular skin lesions

  • Peri/postnatal transmission

    • Skin, eye, mouth disease

    • CNS (meningoencephalitis)

    • Disseminated resembles sepsis

  • DX newborn with viral culture

  • TX with IV valacyclovir (mom and newborn)

Neonatal Group-B Streptococcal Infection

GBS

  • Risk factors

    • Maternal GBS colonization (GBS bacteriuria/rectovaginal cultures during pregnancy)

    • Delivery of an infant with GBS disease

    • Delivery at <37wks

    • PPROM or prolonged ROM (≥18hrs before delivery)

    • Chorioamnionitis

    • Intrapartum fever

  • Swab at 36wks

  • SSX of early onset (birth - 6d) neonatal GBS infection

    • Sepsis (MC), PNA, meningitis

  • SSX of late onset (1wk-5wks) neonatal GBS infection

    • Bacteremia ➔ fever, URI, irritability, lethargy, poor feeding, tachypnea

    • Meningitis (more common in late onset)

    • Bone/joint infection ➔ ↓ movement of affected extremity

    • Cellulitis/adenitis ➔ face/submandibular swelling

  • DX with blood cultures

  • TX empirically until cultures comeback then switch to PCN G IV