INFECTIOUS DISEASES

Intrapartum
- MATERNAL AND FETAL IMMUNOLOGY
- VIRAL INFECTIONS
- BACTERIAL INFECTIONS
- PROTOZOAL INFECTIONS
- EMERGING INFECTIONS
-TRAVEL PRECAUTIONS DURING PREGNANCY
- BIOTERRORISM
- Infections
MATERNAL AND FETAL IMMUNOLOGY
 Pregnancy-Induced Immunological Changes
 Fetal and Newborn Immunology
Pregnancy-Induced Immunological Changes
It is known that pregnancy is associated with an
increase in CD4-positive T cells secreting Th2-
type cytokines—for example interleukins 4, 5,
10, and 13.
1. Maternal exposure
Bacteria: gonorrhea, chlamydia, group B
streptococcus, tuberculosis, mycoplasmas
Viruses: HSV, HPV, HIV, hepatitis B, hepatitis C
2. External contamination
Bacteria: staphylococcus, coliforms
Viruses: HSV, varicella zoster
Neonatal
Human transmission: staphylococcus, HSV
Respirators and catheters: staphylococcus,
coliforms
Neonatal infection, especially in its early stages,
may be difficult to diagnose because neonates
often fail to express classic clinical signs.

Th1-type cytokine production—for example, If the fetus was infected in utero, there may be
interferon gamma and interleukin 2—appears depression and acidosis at birth for no apparent
to be somewhat suppressed, leading to a Th2 reason.
bias in pregnancy.
Fetal and Newborn Immunology
This bias affects the ability to rapidly eliminate
certain intracellular pathogens during  active immunological capacity of the fetus
pregnancy. and neonate
 fetal cell-mediated and humoral immunity
--- the Th2 humoral immune response remains begin to develop by 9 to 15 weeks’
intact. gestation.
 The primary fetal response to infection is
TABLE 64-1. Specific Causes of Some Fetal and immunoglobulin M (IgM).
Neonatal Infections  Passive immunity is provided by IgG
transferred across the placenta
Intrauterine  neonate may suck poorly, vomit, or show
1.Transplacental abdominal distention
Viruses: varicella-zoster, coxsackie, human  Respiratory insufficiency may develop
parvovirus B19, rubella, cytomegalovirus, HIV (similarly to idiopathic respiratory distress
Bacteria: Listeria, syphilis, Borrelia syndrome)
Protozoa: toxoplasmosis, malaria  may be lethargic or jittery
The response to sepsis may be hypothermia
2. Ascending infection rather than hyperthermia,
Bacteria: group B streptococcus, coliforms
Viruses: HSV