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Infections in Pregnant Women

Infections in Pregnant Women

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Published by doctorrao
Infections in Pregnant Women
Infections in Pregnant Women

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Published by: doctorrao on Mar 31, 2014
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03/31/2014

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Pregnancy is a dynamic state of health and disease, shared by the pregnant woman and a growing foetus, a concern to the treating physician for timely diagnosis and necessary interventions. Infections with Viral, Bacterial, Parasitic and Fungi do occur in any pregnant woman like other non-pregnant woman of similar age. Most infections are not serious. But some infections are more important in pregnant woman than in non-pregnant woman because of the potential for vertical transmission to foetus or infant. There is a growing awareness on HIV, HBV, CMV, Rubella and Toxoplasmosis, on rare occasions Varicella and Listeriosis can do harm to the growing foetus. With advances in medical treatments and laboratory technologies we are more concerned with transmission of HIV, and HBV as we can still interfere with appropriate treatments. Now it is certain, every pregnant woman needs a successful screening for Rubella IgM, HBV surface antigen for HBV, and HIV antibodies apart from existing protocol for screening for Syphilis in all pregnant women with VDRL / RPR testing. WHY GOOD CLINICAL MICROBIOLOGY SERVICES ARE IMPORTANT No laboratory test for diagnosing a specific disease should be undertaken on a casual testing basis without knowing the implication of a positive value of test. Women are more willing to accept routinely offered testing as in screening for syphilis with, and made to accept the testing for HBV and HIV with concerns on the growing foetus. The situations to screen for antibodies to HIV turn to be entirely different and needs an informed consent, as every woman has a right to refuse any medical investigation or treatments. UNDERSTANDING MICROBIOLOGY REPORTS WITH IMPLICATIONS ON FETAL HEALTH There is an unlimited gap of understanding between the laboratory reports and the treating physician, which should be always brought down for improving our quality of services. 1, All requests for any particular serological or molecular testing should be based on clinical symptoms (May not necessary as in HIV, HBV, CMV and Syphilis which are symptom free in early stages.) 2. Writing a good clinical history will certainly guide the testing clinical microbiologist to use the right protocol in the laboratory methods.eg. Toxoplasmosis, CMV, Rubella to determine the active infection. INTERPRETATION OF RESULTS RUBELLA, CMV, TOXOPLASMOSIS, VARICELLA Infections. 1. Clinicians should request for IgG in all cases apart from IgM which is only positive in recent infections. 2.Best serological evidence of recent infections is IgG sero conversion (a change from a negative test to positive test) to understand all serological tests which turn out to be negative on first testing, do not exclude recent infections. Testing should be repeated up to three weeks after suspected contact, which may be extended up to 6 months in cases of diagnosis of HIV Infection for appearance of antibodies. 3. When a specific IgM is positive without IgG being positive results should be interpreted with caution. If IgG seroconversion do not occur the IgM result is likely to be a false positive
 
4. The question comes how recent is infection: can be clarified with newer generation of serological testing in accredited laboratories. The clinicians should ask for IgG avidity assays which will help confirm or exclude recent infection. (Eg, Toxoplasmosis, Rubella and CMV) As high avidity indicates that infection occurred several months previously. Interpretation depends on laboratory protocols and should be discussed with clinical microbiologists. HIV SCREENING OR TESTING The problems of screening all pregnant women for HIV antibody is a complex issue. It should be discussed and issue can be still be resolved if offered as testing with motive of offering antiretroviral therapy to both mother and new born if infected. SCREENING FOR SYPHILIS (WITH VDRL/RPR) A routine test done in every pregnant woman irrespective of consent is associated with biological false positives. Every positive test should be reconfirmed testing with TPHA, a specific test to detect active infection. Testing with FT Abs IgM IgG remains the best option before diagnosis of syphilis is ruled out. BACTERIAL INFECTIONS IN PREGNANT WOMEN Many bacterial infecti
ons have Major effect on women’s
 health with implications on the New born. URINARY TRACT INFECTIONS Urinary tract infections remain the most common infections at any stage of pregnancy. Many present with asymptomatic infections, Asymptomatic bactinuria which can only be identified on culturing the urine. It is ideal to order culturing in early pregnancy in the first Trimester to be followed up to the last trimester of pregnancy. Most neglected part of urine culturing remains with proper collection of specimen and often left to an inexperienced nursing staff. The treating physicians should instruct the staff how to collect a mid-stream and a clean catch sample. Less experienced Microbiologists give confusing reports but should not forget to specify the validity of report. A cut off point of 100,000 bacteria/ml is the minimal criteria in healthy pregnant women with isolation of a single species e.g. E.coli, Klebsiella species will strengthen the diagnosis of urinary tract infections. Missing of asymptomatic bacteraemia can cause premature labour and pyelonephritis in pregnant women. GROUP-B STREPTOCOCCAL INFECTION There is a growing awareness on infections with Group B Streptococci. CDC advices culturing for Streptococcus B group at 35-37 weeks of pregnancy is important which can help to prevent early neonatal infection particularly premature labour. Appropriate collection of specimen from cervix remains the minimal requirement. GONOCOCCAL AND CHLAMYDIAL INFECTION They need specific or specialized techniques for precise diagnosis but only ordered in high risk group of women as they can lead to pelvic inflammatory diseases. The physician should discuss with clinical microbiologist as routine testing is not possible in less equipped laboratories and will not serve the purpose BACTERIAL VAGINOSIS AND CANDIDIAL INFECTIONS

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