INFECTION IN PREGNANCY 11/27/2020

PERINATAL INFECTION  persalinan

 Hepatitis b
 Herpes Simplex type 1, 2
 HIV

IN UTERO INFECTION  vertical (kehamilan)

 Rubella
 Toxoplasmosis
 Cmv
 Parvovirus
 Varicella
 Syphillis

TOXOPLASMOSIS
 Transmisi
o Makanan kurrang masak
o Feses kucing
 Gejala : flu like
 Komplikasi : preterm labor
 Fetal :
 o The classic triad hydrocephalus, chorioretinitis, and
intracranial calcifications (uncommon)
o Spontaneus first trimester miscarriage
 Diagnosis:
o Ig M à 2 weeks after exposure; persist for 18 months
o IgG à 2 weeks after exposure and lifelong
 Treatment:
o After early detectionà the mother can be treated with
spiramycin (1500 mg every 12 hours) to prevent fetal
infection
o Fetal infection à refer to gynecology

RUBELLA INFECTION
 Transmisi
o direct contact or airborne droplets
o anak kecil yg tidak
 Gejala : Asymptomatis, demam, maculopapular rash
 Semakin awal infeksi, semakin parah
 Congenital rubella syndrome :
o Eyes (cataract, retinopathy, glaucoma, microopthalmia),
o heart ( PDA, VSD,ASD),
o ear (hearing loss)
o IUGR, neonatal hepatosplenomegaly, purpura, jaundice
 Diagnosis
 o Rubella IgM  muncul 4-8 minggu
 Vaksinasi
o 28 hari sblm konsepsi
o not recommend for the pregnant

CMV
 Transmisi
o Anak2 ke ibunya
o Direct contact : saliva, urine, asi
 Gejala : flu like
 Fetal infection :
o Congenital sensorineural deafness ( most common)
o Miscarriage, stillbirth, IUGR
o Cataract
 Diagnosis
o SULIT DI DETEKSI DINI
o IgM , IgG
o PCR
 Treatment
o Neonatal treatment with ganciclovir
o OG à ultrasoundà termination of pregnancy (?) etik
pengguguran janin yg cacat
Herpes simplex virus Infection
 HSV1 (oral), HSV 2 (genital)
 Transmisi : direct contact
 Neonatal infection : neonatal herpes
i. Skin lesions: vesicles, vesiculobullous, ulcer, pustular,
erythematous, and scarring.
ii. CNS lesions: calcification, encephalomalacia,
ventriculomegaly, microcephaly, hemorrhage, seizures,
meningoencephalitis, and hypertonia/spasticity
iii. Eye lesions: keratoconjunctivitis, chorioretinitis, cataracts,
retinal detachment
 Diagnosis :
o Gejala ruam (+)
o Urine, saliva, nasopharyngeal secretion
 Treatment
o Primary/ 1st episode infection :
 Acyclovir 400mg, 3x1 (7-10 hari)
 Valacyclovir 1gr, 2x1
o Symptomatic recurrent infection :
 Acyclovir 400mg, 3x1 (5hari)
 Valacyclovir 800mg, 2x1
o Daily Supression
 Acyclovir 400mg, 3x1 (36 minggu sampai persalinan)
SYPHILIS
 Treponema Pallidum
 Transmisi : direct contact, sexually
 Staging
o Primary stage* – appearance of the syphilitic chancre
and lymphadenitis.
o Secondary stage- rash on the hands and feet even after
2-10 weeks of chancre heals.
o Tertiary stage- neurological, cardiovascular, and
gummatous lesions (granuloma of the skin and
musculoskeletal system)
 Diagnosis
o dark-field microscopy or detected using direct
immunefluorescence assay
o VDRL
o MHA-TP
 Treatment
o Benzathine penicillin G 2,4 unit IM, 2nd dose 1 minggu
setelah

Varicella-zooster virus Infection (chicken pox)

 Transmisi : kontak, droplet
 Resiko tinggi 13-20 minggu
 foetal varicella syndrome (chorioretinitis, microphthalmia, ,
growth restriction, cicatricial skin lesions)
 Treatment:
o vaccine is not recommended for pregnant women or for
those who may become pregnant within a month following
each vaccine dose.
o Symptomatic treatment and hygiene
 o Oral acyclovir ( 5 x 800mg/day for 7 days)

HEPATITIS B
 Pengobatan : sebelum melahirkan
 Dicegah : vaccine <12 jam setelah persalinan

PARVOVIRUS B19
 Transmisi : darah, udara
 Symptom : slapped cheek appereance
 Cacat Kongenital : hidrosephali, efusi pleur, efusi pericardial
MALARIA IN PREGNANCY 11/27/2020

 Plasmodium Vivax, P. Malariae , P. Falciparum (morbiditas plg

tinggi pd ibu hamil )
 Utero placenta
 Effect
o IUGR
o Anemia
o Pertumbuhan janin terhambat
 Treatment
o Severe
 Artesunate IV 2.4 mg/kg at 0, 12 and 24 hours, then
daily thereafter.
 When the patient is well enough to take oral
medication à switched to oral artesunate 2 mg/kg (or
IM artesunate 2.4 mg/kg)once daily, plus
clindamycin.
o Uncomplicated
Oral quinine 600 mg 8 hourly and oral clindamycin
450 mg 8 hourly for 7 days (can be given together)
 With Vomiting : Quinine 10 mg/kg dose IV in 5%
dextrose over 4 hours every 8 hours plus IV
clindamycin 450 mg every 8 hours
 When the patient is well enough to take oral
medication à switched to oral quinine 600 mg 3 times
a day to complete 5–7 days and oral clindamycin if
needed be switched to 450 mg 3 times a day 7 days.
o NON FALCIPORUM
 Oral chloroquine (base) 600 mg followed by 300 mg
6-8 hours later.Then 300 mg on day 2 and again on
day 3.
 Preventing relapse DURING pregnancy à Chloroquine
oral 300 mg weekly until delivery
 Vomiting à symptom of malaria and adverse effect of
quinine à Metoclopramide inj.
11/27/2020