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Infections

During pregnancy
By: SUMEET.SOLANKI
General considerations:
Pregnancy predisposes to infection
because of the following reasons:
1. A depression of the immune system.
2. Hormonal changes during pregnancy.
3. Procedures performed
on a pregnant woman.
 Obstetric infections are generally
considered as ascending infections.

Lower genital tract

Cervix

Endometrium
Transmission Viral COMPLICATION OF
VIRUS:
1.CONGENITAL RUBELLA
Rubella: VIRUS,WHICH INCLUDES
CONGENITAL
Transplacenta Cytomegalo virus: BLINDNESS,DEAFNESS.
Varicella Zoster: MENTALLY RETARTED
2.CYTOMEGALO VIRUS
HIV: VARCELLA
ZOSTER,HERPES
ZOSTER,CAUSE
CONGENITAL ANAMOLIES.

Bacterial Parasitic

Syphilis Malaria
Listeriosis Toxoplasmosis
Chorioamnionitis
Transmission Viral Bacterial Parasitic

External Staphylococcus
Contamination Coloforms

Neonatal Staphylococcus
Human
Salmonella Typhi
Trans-
Mission Virus

Respiratory Staphylococcus
equipment and Coliforms
Catheters
Factors that promote infection:
 Prolonged labor
 Premature rupture of membranes
 Multiple vaginal examinations
 Anemia
 Low social economic status
 Occupation/ Lifestyle
Transmission of infection to neonate
occurs at different stages of pregnancy:

 After implantation- causes fetal


infection via transplacental
invasion after gaining access to
the maternal circulation.
2. Perinatally acquired infections- result
from indirect inoculation on the
newborn as it passes the infected
passages, or from external
contamination by human transmission
or through equipment in the neonatal
environment.
Clinical signs indicating the
presence of infection:
 Significant elevation of temperature
 Abnormal discharge or specific lesions
 Tenderness and/or swelling of the
pelvic organs
 Inflammatory mass or abscess
 Other hemodynamic(B.P,PULSE,R/R,TEMP)
Confirmatory diagnostic tests
include:
 Culture
 Immunology
 Serology
 Ultrasonography
Management :
1. Administration of appropriate antibiotics.
2. Eradication of the septic focus.
3. Surgical Management.
Eg. “Pelvic clean-up”, drainage by ultrasound-
guided aspiration, peritoneal lavage, and
drainage of abscess by laparoscopy or
laparotomy, or I/D of the abscess through
the cul de sac (culdotomy).
HOMOEOPATHIC DISCUSSION

 SILECEA & HEPAR SULPH HAS SAME


ACTION,IF THEY ARE GIVEN LOW
DOSE,THEY CAN ABSORBED PUS,THEN
WHY TO DO I&D ?
 -:IT DEPEND UPON HEMODYNAMIC STATUS
OF PERSON & QUANTITY.
MATERNAL
INFECTIONS
Upper Genital Tract Infections:
1. Intraamniotic Infection
(Chorioamnionitis)
 Intra amniotic fluid infection
 The infectious agent passes directly
through intact or ruptured
membranes into the amniotic fluid
space.
 Neutrophils
move through
the decidua,
into the
chorion,
and,
eventually,
will invade
the amnion.
 Maternal white cells eventually reach
the amniotic fluid where they may be
swallowed and aspirated by the fetus.
Intraamniotic bacteria may cause
congenital pneumonia gastroenteritis,
sepsis, otitis media and meningitis.

This 24 week fetus died shortly after


delivery. This section of the lungs is
low power, but emphasizes the diffuse
nature of aspiration pneumonia. The
arrows point to intraalveolar
neutrophils. These are generally
considered to be inspired, and
primarily maternal in origin, but some
fetal inflammatory cells (possibly
exudates from the fetal pulmonary
parenchyma itself).
 On the fetal side, fetal neutrophils can
be recruited from either umbilical or
chorionic arteries or veins.
 When infection is longstanding, lysis
and calficiation of fetal neutrophils in
Wharton's jelly can lead to "sclerosing
or necrotizing funisitis"
Sclerosing (necrotizing) funisitis is the result of
a long standing infection to which the fetus
has responded with the resultant inflammatory
cells undergoing lysis and ultimately
calcification. Though frequently related to
syphilis, other chronic bacterial infections and
viral etiologies should be sought.
 severe infection will result in
opacification, discoloration and,
depending upon the organisms, a foul
odour of the placenta.

Gross pus, discoloring the


chorionic plate. You would
hardly need a microscopic
examination to identify this
process.
Infected membranes, filled with
neutrophils containing digestive
enzymes and releasing prostaglandins

stimulate uterine contractions

Premature spontaneous rupture of


membranes for greater than 18 hours
may be associated with acute
ascending infection

Premature Labor
Effect on fetus:

 Poorer fetal well-being (as assessed


by biophysical profile score),
abnormal fetal heart rate, and at
least in some populations, increased
umbilical systolic/diastolic ratio are
associated with acute ascending
infections.
Clinical diagnosis:
 Maternal fever (38ºC or 100.4ºC)

2 of the following Criteria:


 Maternal Tachycardia

 Fetal Tachycardia

 Uterine tenderness

 Purulent and foul-smelling amniotic


fluid
 Maternal Leucocytosis (total blood
(leukocyte count >15,000-18,000
cells/mL)
Amniotic fluid neutrophils can be
obtained by amniocentesis to diagnose
subclinical intra-amniotic infection.
Management:

 Antibiotics initiated before delivery.


 The infant should be monitored
carefully for signs of sepsis.
APPROCH
 THE MANGEMENT & Rx DEPENDS UPON SEVERITY OF
SYMPTOMS,PROPER DIAGNOSIS ALONG WITH ITS
COMPLICATION.
INVESTIGATION
+
EXAMINATION=GRADE OF
DISEASES.

WHICH DECIDE LINE OF Rx.


HOMOEOPATHIC Rx
 SEE FOR VITAL DATA.
 1.B.P LESS THAN 90/60 mm/hg.
 2.HIGH TEMP,LONG STANDING.
 3.DISCHARGES OFFENSIVE.
 4.WBC MORE THAN 25,000.
 TREAT URGENTLY WITH HOMOEOPATHIC REMEDY,IF
CHARACTERISTIC ARE PRESENT,
 IF PATIENT IS SEPTIC SHOCK THEN
HOSPITALISATION IS NEEDED.
ALLOPATHY Rx.
 VITAL PARAMETER WILL GUIDE US
TO TAKE JUDICIOUS DISSION.
 1.ANTIBIOTICS.
 2.ANTIPYRETICS.
 3.I.V FLUIDS.