vertically transmitted infections

Definevertical transmission
of an infection
the transmission of a pathogen disease causingagent from a mothertoher
fetus during pregnancy childbirth
infections known toproducecongenital defects neonataldisease TORCH

congenital infections acquired at any T Toxoplasma gondii

time duringpregnancy up to including O Other infections
time of birth antenatal period R Rubella virus
perinatal period acquired during pregnancyfrom nine of C Cytomegalovirus
fetalviability 20weeks s to time of birth after birth H HerpesSimplexVirus
during the neonatal period

Routes of mother to childtransmission

Hematogenous route across the placenta
Toxoplasmagondii rubella cytomegalovirus syphilis

Why does risk increase but seventy decrease during pregnancy

Duringearly pregnancy placenta blood flow is low fetal organsgeneris notyet
completed birthdefects
During late pregnancy placentablood flow is high 9 transmission organogenesis
is complete
N B Excephon rubella virusinfection transmitted mostefficiently during 1st trimester

2 Ascending route
along birth canal
maternal genital infection may be transferred to the amniotic
sac the fetus by the ascending route
Herpessimplex virus
3 Infectionduringchildbirth
Exposure to infected maternal blood HIV Hep B or genital secretions in
the berth canal Herpes
Injuriesin fetusduring labour 9 risk of exposure
4 Post natal transmission
Breast feeding HIV H LTV human lymphotrophic rims
Exposure to non genital maternal herpetic lesions Herpes SV
infectionsacquired during pregnancy asymptomatic mild symp malaise fever tired
are likely to be overlooked
women may be unaware of pre existing chronic infections that has not
caused maternal symptoms

Antenatal screening
Early detection in apparently
healthy pregnant women so that
treatment can be implemented for vertical transmission
H Iv Hepatitis B syphilis at the end of the 1st trimester
Repeat screening later in pregnancy for women with risk factors can
get infected after antenatal screening

cytomegalovirus 1st trimester

CMV establishes latency periodically reactivates
CMV is a common pathogen
Cmv is an opportunistic pathogen immunocompetent
individuals pregnant women asymptomatic
in immunocompromised fetus significant disease pneumonia retinits
microcephaly
a B Baby's brain not
developedproperly
a

Diagnosis
test for antibodies Cmv lg m 1g 9 t
1g a avidity strength of
binding
in the fetus PCR n a amniotic fluid collected after 21 weeks
Amniocentesis US abnormalities women diagnosed with primary
Cmv
Group PCR
A
t
in baby's urine 1 saliva post birth Test must be done within
9 3 weeks of life Cdifferentiate congenital postnatal
Group B No test in asymptomatic no biomarkers
Diagnosed retrospectively when they develop symptoms lest neonatal
dned blood spotsfrom PCR

management
Termination of pregnancy high dose ral acyclovir antiviral
main arm of treatment improvement of hearing function

Herpes simplex virus

HSV cold sore 1 genitalherpes HSV genitalherpes
slain mucousmembrane a very common HSV establisheslatency is sensoryganglia
reactivation in first ten months after I infection
Painful mucocutaneous vesicular 1 ulcerative lensins
Treat with acyclovir nudesside analogue inhibits HSV DNA polymerase