I. TOXOPLASMOSIS
BACTERIAL VAGINOSIS
• Causative organism: protozoan Toxoplasma
gondii
• May contract organism by eating raw or
undercooked meat, drinking unpasteurized
goat’s milk, contact w/ feces of infected cats
Fetal-Neonatal Risks
 inflammation of the retina, blindness,
deafness, severe retardation
 severe disorders = convulsions, coma,
microcephaly, hydrocephalus
Diagnostic Test:
1. IgG and IgM fluorescent antibody tests (IFA)
2. Indirect hemagglutination test (IHAT)
3. Sabin-Feldman dye test
4. Ultrasound to detect fetal infection
Treatment (mother):
 combination of antiparasitic drugs Sulfadiazine
and Pyrimethamine
 Spiramycin in Europe
Treatment (newborn):
 combination of Sulfadiazine, Pyrimethmine,
Leucovorin for 1yr
II. SYPHILIS
• Causative organism: spirochete Treponema
pallidum
• Acquired through transpacental inoculation
(fetus); results from maternal exposure to
infected exudate during sexual contact
Signs and symptoms:
 Stage I – Primary: chancre appears (lasts about 4
weeks then disappears), w/ slight fever, weight
loss, malaise
 Stage II – Secondary: condylomata lata (wartlike
plaques), acute arthritis, enlargement of liver
and spleen, nontender enlarged lymph nodes,
chronic sore throat with hoarseness
Diagnostic Tests:
1. Blood tests – VDRL, RPR, FTA, ABS
2. Dark-field examination of spirochetes
Treatment:
 for pregnant and nonpregnant w/ Syphilis of
less than 1yr: 2.4 million units of Benzathine
penicillin G IM in single dose
 for Syphilis of more than 1 year duration: 2.4
million units of Benzathine penicillin G IM once a wk
for 3wks
Fetal-Neonatal Risks:
 Can be passed transplacentally to the fetus.
If untreated, one of the following can occur: 2nd
trimester abortion, stillborn infant at term,
congenitally infected infant, uninfected live infant
CARE OF THE WOMAN WITH PERINATAL INFECTION 1
III.
• Formerly referred to as nonspecific vaginitis or
Gardnerella vaginalis
• Causative organism: Gardnerella, mycoplasmas,
anaerobes
• Contributing factors: tissue trauma, sexual
intercourse
Symptoms:
 excessive amount of thin, watery, white or
gray vaginal discharge with a foul odor (“fishy”),
vaginal pH is usually >4.5
 wet-mount preparation reveals “clue cells”,
application of potassium hydroxide (KOH) to a
specimen of vaginal secretions produces a
pronounced fishy odor
Treatment: oral Metronidazole or oral Clindamycin
IV. VULVOVAGINAL CANDIDIASIS
• Also called moniliasis or yeast infection
• Causative organism: Candida albicans
• Contributing factors: oral contraceptives,
immunosuppressants, antibiotics, frequent
douching, pregnancy, DM
Symptoms:
 thick, curdy vaginal discharge, severe itching,
dysuria, dyspareunia
 On Physical Exam: labia may be swollen,
speculum exam reveals thick, white tenacious
cheeselike patches adhering to the vaginal
mucosa
Treatment (pregnant):
 intravaginal insertion of Miconazole,
Butoconazole or other topical azole
preparations for 7days
 Clotrimazole suppositories at bedtime for 1
week
 Cream may be prescribed for topical application
to the vulva if necessary
Fetal-Neonatal Risks: thrush if delivered vaginally
V. TRICHOMONIASIS
• Causative organism: Trichomonas vaginalis
• Most infections are acquired through sexual
intimacy
Symptoms:
 yellow-green frothy, odorous discharge
frequently accompanied by inflammation of the
vagina and cervix, vulvar itching, dysuria,
dyspareunia
 strawberry patches may be visible on vaginal
walls or cervix
Treatment: single 2g dose of Metronidazole orally
Implications for Pregnancy:
 Increased risk for PROM, preterm birth, and
LBW
 VI. GONORRHEA
• Causative organism: Neisseria gonorrhoeae
• Majority of women are asymptomatic
Symptoms:
 purulent, greenish yellow vaginal discharge,
dysuria, urinary frequency, inflammation and
swelling of the vulva
Treatment :
1. Nonpregnant women –Cefixime orally or
Ceftriaxone IM plus Doxycycline
2. Pregnant women -- Ceftriaxone IM or Cefixime
orally combined w/ Erythromycin or
Azithromycin to address risk of co-infection
w/ chlamydia
Fetal-Neonatal Risks: Infection at time of birth may
cause ophthalmia neonatorum in the newborn
VII. CHLAMYDIAL INFECTION
• Causative organism: Chlamydia trachomatis
• Symptoms: thin, purulent discharge, burning
and frequency of urination, and lower
abdominal pain
• Laboratory detection: antigen detection, DNA
probe assays, polymerase chain reaction (PCR)
tests
• TREATMENT: Erythromycin or Amoxicillin
followed by repeat culture in 3 weeks
• Implications for pregnancy: if untreated, infant
may develop newborn conjunctivitis which is
treated with Erythromycin ointment, chlamydial
pneumonia, fetal death
VIII. HUMAN PAPILLOMA VIRUS
• Condylomata acuminata is a relatively common
sexually trasmitted condition
• Also called venereal warts
Signs and symptoms:
 Soft, grayish pink lesions on the vulva, vagina,
cervix, or anus
Treatment: based on client preference, available
resources, and experience of healthcare provider
Client-applied therapies: Podofilox solution or gel or
Imiquimod cream (not used during pregnancy)
 Provider-administered therapies: Cryotherapy w/
liquid nitrogen or cryoprobe, topical
podophyllin, trichloroacetic acid (TCA),
bichloroacetic acid (BCA), intralesional
interferon, surgical removal by tangential scissor
excision, shave excision, curettage,
electrosurgery, laser surgery
 Implications for pregnancy: Large doses of
Podophyllin have been associated with fetal
death
IX. HEPATITIS B
• Causative organism: Hepa B virus
• Predisposing factors: illegal IV drug users,
homosexuals, prostitutes, multiple sex partners,
occupational exposure to blood
Treatment: Hepa B immune globulin soon after birth
(newborn)
CARE OF THE WOMAN WITH PERINATAL INFECTION 2
X. RUBELLA (German Measles)
• Best Therapy is PREVENTION
• Prenatal laboratory screening --
Hemagglutination inhibition (HAI) test (the
presence of positive titer 1:16 or greater is
evidence of immunity while a negative titer less
than 1:8 indicates susceptibility to rubella)
Clinical Therapy:
 Women of childbearing age should be tested for
immunity and vaccinated if susceptible once it is
established that they are not pregnant.
 All women of childbearing age who receive the
rubella vaccine should carefully avoid pregnancy for
at least 3 months following vaccination.
 Vaccine is made with attenuated virus thus
pregnant women are NOT vaccinated.
Fetal-Neonatal Risks: period of greatest risk for the
teratogenic effects of rubella on the fetus is the
First Trimester
 Most common clinical signs of congenital
infection: congenital cataracts, sensorineural
deafness, congenital heart defects particularly PDA,
mental retardation, cerebral palsy
 Expanded Rubella Syndrome – relates to the
effects that may develop for years after the
infection (increased incidence of insulin-dependent
diabetes mellitus, sudden hearing loss, glaucoma,
slow and progressive form of encephalitis)
XI. CYTOMEGALOVIRUS (CMV)
 CMV belongs to the herpes virus group and
causes both congenital and acquired infections
referred to as cytomegalic inclusion disease
(CID)
Transmission: placenta, cervical route during birth,
through body fluids; between human by any close
contact e.g. kissing, breastfeeding, and sexual
intercourse
• Accurate Dx in pregnant women: depends on
presence of CMV in the urine, rise in IgM levels
and identification of the CMV antibodies w/in
the serum IgM fraction
XII. HERPES SIMPLEX VIRUS (HSV-1 or HSV-2)
Fetal-Neonatal Risks:
 Primary infection – spontaneous abortion, LBW,
preterm birth
 If antiviral therapy is not used, SEVERE infection
– microcephaly, mental retardation, seizures,
retinal dysplasia, apnea, coma
 Infected infant is often asymptomatic at birth but
develops – fever (or hypothermia), jaundice,
seizures, poor feeding after an incubation
period of 2-12 days
Treatment: Acyclovir, Valacyclovir, Famciclovir
(Acyclovir has been shown to be effective and safe
during pregnancy, but NOT well absorbed as the
other two drugs)
Mode of Delivery: NSD (if no evidence of genital
infection), CS (active genital lesions or presence of
prodromal symptoms of infection