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Maternal Exposure / Infectious Agents
 
RUBEOLA (MEASLES)
  • Not teratogenic.
  • May cause placental damage.
  • With subsequent stillbirth may increase in perinatal mortality.
  • As a febrile illness, it may induce uterine contractions causing preterm deliveries.
  • Mothers with active disease may deliver the newborn with severe infection.
  • Suggested association between in utero exposure to measles and postnatal development of Crohn’s disease.
 

RUBELLA (GERMAN MEASLES)
  • Maternal infection during pregnancy may result in:
    • Spontaneous abortion
    • Congenital rubella syndrome:
Eye defects (cataract, retinopathy, microphthalmia, glaucoma), heart defects, ear defects leading to deafness, fetal and neonatal growth retardation, psychomoter retardation, hepato-spleno-megaly, thrombocytopenia, meningoencephalitis, microcephaly, brain calcification, hepatitis, myocardial necrosis, radiolucency of long bones.
 
  • Late onset features of the syndrome include:
    • Chronic rubella - like rash
    • Interstitial pneumonitis
    • Chronic diarrhea
    • Hypogammaglobulinemia
    • Diabetes mellitus
    • Progressive central nervous system impairment.
 
  • Late sequelae of in utero rubella infection:
    • Deafness
    • Diabetes
    • Subacute sclerosing panencephalitis
 


CYTOMEGALOVIRUS (CMV)
  • Maternal infection may cause congenital infection with the following features:
    Hepatosplenomegaly, thrombocytopenia with petechiae, purpura, hepatitis, pneumonitis, chorioretinitis, microcephaly, optic atrophy, microphthalmia, intrauterine growth retardation, intracranial calcification with mental retardation, neonatal death if severe infection.
  • Late sequelae:
    Mental retardation, auditory deficiency and deafness, visual difficulties (optic atrophy, cataract, microphthalmia, optic neuritis, chorioretinitis).
 

PARVO VIRUS B19 INFECTION
  • Maternal infection during pregnancy may result in
    • Fetal loss
    • Still birth
    • Fetal hydrops
    • Intrauterine growth retardation
 
TOXOPLASMOSIS
 
  •  Maternal infection during pregnancy may result in:
    • Abortion
    • Stillbirth or neonatal death
    • Congenital infection:
      Chorioretinitis, hydro cephalus, intracranial calcification, hydrops fetalis, hepatosplenomegaly
  • Late sequelae include:
    Mental retardation, motor defects, spasticity, seizures, hearing and visual impairment.
 
 
VARICELLA (CHICKENPOX)
  • Primary maternal infection in pregnancy can be associated with preterm delivery.
  • Congenital varicella syndrome may occur with maternal infection before 20 weeks gestation
  • Features of congenital varicella syndrome are:
    • Skin scarring, eye defects (microphthalmia, chorioretinitis, cataract), hypoplasia of the limbs, neurological abnormalities (microcephaly, cortical atrophy, mental retardation, dysfunction of bowel and bladder sphincters), hydrops fetalis, hyperechogenic foci in the liver, polyhydramnios, low birth weight.
  • Neonatal varicella can occur.
  • Infection occurring one to four weeks before delivery manifests as pneumonitis hepatitis and disseminated intravascular coagulation (DIC).
  • In utero exposure to varicella may result in herpes zoster in infancy.
 
 
GENITAL HERPES
  • Abortion may occur if maternal infection occurs before 20 weeks of gestation.
  • Preterm delivery may occur if maternal infection occurs after 20 weeks of gestation.
  • Fetal infection may occur causing microcephaly, microphthalmcia, hydranencephaly, skin lesions and scars at birth.
  • Neonatal infection during vaginal delivery if the patient has active genital herpes.
  • Features of neonatal infection:
    • Disseminated disease: lethargy, irritability, apnea, seizures, coagulopathy, cardio vascular compromise, liver involvement, death, Involvement of adrenal glands, larynx, trachea, lungs, esophagus, stomach, intestine spleen, oral and ocular lesions, encephalitis.
    • Central nervous system infection with encephalitis, seizures.
    • Local infection of the skin, mouth, eyes and pneumonia.

HIV
Can cause:
  • Preterm deliveries.
  • Low birth weight infants
  • HIV embryo pathy- growth
  • Retardation, craniofacial abnormalities microcephaly.
  • Fetal infection.
     

SYPHILIS
May cause
  • Still births.
  • Preterm labor.
  • Growth retardation.
  • Fetal hydrops.
  • Congenital syphilis.
  • Neonatal infection.
 

Early congenital syphilis manifested as:
  • Asymptomatic at birth
  • Meningeal signs, lacrimation as a result of iritis, Nasal discharge, sore throat-pharynx, generalized arthralgia, splinting of arms and legs, osteochondritis, periostitis.
  • Generalized adenopathy, hepatosplenomegaly, anemia, purpura, jaundice, edema, hypoalbuminemia.
  • Maculopapular, papular, bullous eruption.

Late congenital syphilis:
Hutchinson’s teeth, mulberry mollars interstitial keratitis, eighth nerve deafness, saddle nose saber shin and cardio vascular lesions.

HEPATITIS B
May cause:
  • Low birth weight infants.
  • Infection of the neonate and possible late sequelae of chronic HBV infection, hepatic cirrhosis and hepatocellular carcinoma.

LISTERIOSIS
May cause:
  • Abortion.
  • Fetal and neonatal infection.
     
Early onset neonatal infection manifested as sepsis.

Late onset neonatal infection manifested mainly as meningitis.

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