Intrauterine infection

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at September 26, 2016
StartDiseasesIntrauterine infection

Also known as congenital infections, intrauterine infections are infections that a fetus acquires while still in the womb. They can be acquired through the transfer of pathogens from the bloodstream of the mother to the fetus. An infection can also be acquired through the birth canal (vagina). Recent research shows that congenital infections are associated with 40 percent of premature births.

Contents

Definition & Facts

Infections can affect a pregnant woman's uterus, cervix, and vagina. Invasive procedures may also cause infection in the placenta or the fallopian tube. When certain types of viruses or bacteria enter the placenta, fetal membranes may be infected and inflamed.

Trichomoniasiss, gonorrhea, bacterial vaginosis, HIV, chlamydia, and syphilis are some of the infections that can be passed onto the fetus. Toxoplasmosis, parvovirus infection, rubella, congenital cytomegalovirus infection, and neonatal herpes simplex are additional examples of infections that babies can be born with, having acquired them from the mother while fetuses.

A wide variety of health conditions can be transmitted to a fetus. Hepatitis B virus, hepatitis C virus, herpes simplex virus, enterovirus, human papilloma virus, chlamydia, and the human T lymphotropic virus are examples of intrauterine infections. Ureaplasma urealyticum is a group of bacteria that cause intrauterine infections. Fusobacterium and Mycoplasma hominis are additional pathogens that cause intrauterine infections.

Urinary tract infections (UTI) affect a high percentage of pregnant women. Often resulting from the Escherichia coli bacteria or E. coli bacteria, these infections can be transmitted from the kidneys to the womb.

Intrauterine infections can initiate an inflammatory response which promote premature labor. Also known as preterm birth, premature birth is a major cause of neonatal deaths, with the presence or the absence of intact fetal membranes. Stillbirth in which a dead child is delivered may occur as a result of intrauterine infection.

Symptoms & Complaints

The severity of the infection is determined by the causal bacteria or virus and the stage at which the infection occurs during pregnancy. Some cases are minor, while others are severe enough to lead to a miscarriage or lasting birth defects.

Because intrauterine infections are linked to premature birth, their symptoms involve those of premature birth more generally such as low birth weight, poor feeding, hypotension, and patent ductus arteriosus. Hypoglycemia, weakened immune system, and anemia are also symptoms of premature babies.

Intrauterine infections may also cause brain damage that results in developmental delays, intellectual disability, and physical disability. Certain mechanisms like increased maternal temperature can aggravate brain damage. Maternal infections intensify brain cytokines which can also cause brain injury. Cerebral palsy may result.

A baby with a congenital infection may also have vision loss. Intrauterine infections are known to lead to neonatal eye inflammation. Hearing problems may also result from intrauterine infections; babies with certain infections may be born deaf.

Chorioamnionitis is a complication of intrauterine infections that results in the inflammation of the membranes of the placenta.

Causes

Intrauterine infections can be acquired by the baby during pregnancy (through the fallopian tubes) or delivery (through the cervix). They can also result from contaminated needles or medical instruments during prenatal diagnostic procedures such as amniocentesis or chorionic villus sampling. Bacteria that grows naturally in the genital region of the pregnant mother can also ascend into the uterus, causing intrauterine infection.

Infections can be acquired by the mother in various ways. Hepatitis B is a sexually transmitted disease as well as a viral infection that can be acquired through intravenous drug use. Hepatitis C can be acquired through intravenous drug use. Cytomegalovirus (CMV) infection is most commonly transmitted through touching one's nose, mouth, or eyes after coming into contact with an infected person's bodily fluids.

Medical procedures can introduce bacteria or viruses into the urogenital tract of the mother such as endometrial biopsies, abortions, implantation of intrauterine devices (IUD's).

Diagnosis & Tests

The diagnosis of intrauterine infection is dependent on the laboratory tests carried out. During prenatal diagnosis, blood tests and cultures may be taken in order to identify the presence of various pathogens and/or antibodies. Congenital rubella can be diagnosed by the detection of specific antibodies. C-reactive protein tests may be conducted. A complete blood count of the mother will be taken to detect an increased amount of white blood cells (leukocytosis). It may also be necessary to test the amniotic fluid through amniocentesis.

Treatment and Therapy

Treatment depends on the nature of the infection as well as the stage at which it is diagnosed. If the infection is bacterial such as bacterial meningitis, Listeria, chlamydia, or gonorrhea, antibiotics will be used to treat the condition. If the infection is viral, antiviral drugs will be used to treat the infection. For example, ganciclovir is an antiviral drug that is used to treat cytomegalovirus infection.

Antifungal and antiparasitic drugs may also need to be administered if the infection is determined to be caused by fungi (such as candida albicans) or parasites like protozoa (such as toxoplasmosis or trichomoniasis). In cases where infections have progressed, labor may need to be induced since antibiotics may have little effect.

Treatment also involves addressing any complications or chronic conditions that ensue from the congenital infections. If the baby suffers brain damage, he or she may require physical therapy, occupational therapy, speech therapy, psychotherapy, special education, the use of mobility aids, or respiratory support – all of which depends on the nature of the brain damage.

Prevention & Prophylaxis

Prior to pregnancy, mothers wishing to conceive should be up to date on their vaccinations, including the rubella vaccine, hepatitis B vaccine, hepatitis C vaccine, hepatitis A vaccine, and HPV vaccines. It is usually unsafe for mothers who are already pregnant to receive vaccines, however.

Because many intrauterine infections are sexually transmitted, practicing safe sex is important in preventing them. Getting regular STD tests is another component of achieving sexual health and preventing a number of sexually transmitted infections that can then be passed onto a fetus if one becomes pregnant.

While pregnant, women should avoid coming into contact with cat feces to reduce the risk of toxoplasmosis. Pregnant women should also avoid traveling to countries with endemic diseases like malaria. Eating certain raw foods may also expose a pregnant woman to bacteria and parasites that could endanger the health of the fetus and thus should be avoided.

Regular doctor's visits are paramount in monitoring the health of the mother and fetus during pregnancy and addressing any infections or other health issues before they cause complications.