Enterovirus infection and pregnancy. Why is the presence of enterovirus dangerous for a pregnant woman and fetus? Catarrhal and eczematous forms, herpangina

1

The data presented showed that the wide prevalence of viral infections, both acute and chronic, indicates the need for virological examination of newborns for a representative group of viruses, and not for a specific viral or specific taxonomic group of viruses. Chronic, predominantly enteroviral, infections occupy a leading place in the etiological structure of intrauterine viral infections and the associated pathology of the mother, fetus, and newborn. Failure of adaptation to viruses that persist in a woman’s body is the most common cause of antenatal fetal death, congenital and perinatal pathology, prematurity and perinatal mortality. The chronic form of congenital viral infection in newborns can be suspected already when collecting anamnesis in the presence of such high-risk factors for viral transmission as spontaneous miscarriages, premature births, chronic diseases in the mother and their exacerbation during pregnancy, as well as the complicated course of this pregnancy, which occurred with the threat of termination, gestosis, acute respiratory diseases, exacerbations of viral infections and contact with infectious patients.

placental insufficiency

enterovirus infections

pregnancy

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2. Glinskikh N.P., Patsuk N.B. Perinatal viral infections (etiopathogenesis, diagnosis, treatment and prevention). – Ekaterinburg: ENIZHI; AMB, 2001. – 128 p.

3. Kitsak V.Ya. Viral infections of pregnant women: pathology of the fetus and newborns - Koltsovo, 2004. - 70 p.

4. Samoilova A.V. Intrauterine infection in the structure of morbidity and mortality of newborns // Mother and Child: sat-ly II region, scientific forum. – Sochi, 2008. – pp. 252–253.

5. Giraldo P., Neuer A., ​​Korneeva I.L. Vaginal heat shock protein expression in symptom-free women with a history of recurrent enteroviruses an infection // Am.J.Obstet. Gynecol. – 2006. – Vol. 180, No. 3. – R. 524–529.

6. Kozovsky I. Cesarean section in modern obstetrics and methods of prophylaxis of prospective sepsis // Akush. Ginecol (Sofia). – 2007. – Vol. 39, No. 3. – R. 3–6.

Viral infections are considered probable cause development of about 80% of congenital malformations. Central nervous system defects account for 26-30% of all defects found in children. Congenital heart defects, which are included in the triad of defects in rubella, may be associated with various intrauterine viral infections. The results of a virological and clinical-epidemiological examination of 62 children with congenital heart defects indicated that congenital heart defects are etiologically associated with transplacental transmission of Coxsackie group enteroviruses from mothers with a persistent form of the corresponding infection. According to Kitsak V.Ya. , enteroviruses are found in 75% of children with congenital heart defects. It should be noted that the mothers of these patients had a history of chronic diseases in which the persistence of enteroviruses of the Coxsackie group was established.

A comprehensive study of the species composition of microorganisms in the birth canal, amniotic fluid, placenta, newborn, determination of antigens and antibodies to the putative pathogen in umbilical cord blood and amniotic fluid, histological examination of the placenta allows us to determine the route of infection of the child, the nature of the pathogen and clarify the scope of additional diagnostic procedures and treatment. preventive measures in the early neonatal period.

The purpose of the study is to provide a comparative assessment of the condition of newborns born to mothers with mixed viral infection in modern conditions Baku.

Materials and research methods

A comprehensive virological examination was carried out for the representation of the most common viruses using the enzyme immunoassay method (ELISA) and the method of indirect immunofluorescence of 54 newborns (main group) from mothers with a mixed viral infection and who had congenital and perinatal pathology: congenital anomalies of the development of internal organs (heart, kidneys, brain, liver), perinatal encephalopathies (hypertensive-hydrocephalic and convulsive syndromes), and 40 practically healthy newborns (control group).

The work was carried out on the basis of the Central Research Laboratory of the Azerbaijan Medical University. The entire procedure for diagnosing viral infections was carried out by laboratory specialists, which used ELISA and indirect immunofluorescence methods. Diagnosis of viral infections was carried out by determining class M and G antibodies to the corresponding viruses using the enzyme immunoassay method using standard test systems of Vector-Best JSC (Novosibirsk) on a Stat-Fax 2100 spectrophotometer (USA).

Grade functional state The “mother-placenta-fetus” system was carried out using ultrasound, Doppler studies and cardiotocography. All patients underwent ultrasound fetometry, placentography, assessment of the quality and quantity of amniotic fluid according to the generally accepted method, Doppler study of uteroplacental, fetal placental and fetal blood flow.

Statistical processing of the research results was carried out using generally accepted methods of variation statistics. The Student's reliability criterion, the reliability of differences, and the calculation of the arithmetic mean were determined. The significance of the differences (p) was determined by the parametric reliability criterion.

Research results and discussion

According to a retrospective analysis of medical records for the period from 2007 to 2011, 83 pregnant women were diagnosed with EVI of varying severity. It was found that most often the symptom complex of enterovirus infection (EVI) was determined in pregnant women in the first trimester - 41 (50.0%) sick women (subgroup IA), in the second trimester - 30 (37.0%) pregnant women fell ill (subgroup IB) and in the third trimester - 12 (13.0%) pregnant women (subgroup IC). 52.6% of pregnant women resorted to treatment at home, and only 47.4% of pregnant women were under the supervision of doctors in antenatal clinic(general practitioner and obstetrician-gynecologist), clinic, or were treated in a hospital (Fig. 1).

Rice. 1. Frequency of detection of the EVI symptom complex in examined women by trimester of pregnancy

During pregnancy, in addition to non-specific manifestations of EVI, there was a symptom complex with fever and acute pain in the lower abdomen, which was often interpreted as premature placental abruption or acute appendicitis, but in fact it was a symptom of acute viral mesadenitis. Of 83 pregnant women with EVI with a temperature of more than 37.1 to 39 °C, the disease progressed in 79 (65.0%) patients. In the first trimester, in 45 (37.0%) pregnant women the disease occurred with fever and sharp pains lower abdomen.

Analysis of medical documentation for 2007-2011. showed that the threat of miscarriage developed in 54 (65.0%) pregnant women with EVI: in the first trimester, the threat of miscarriage developed in 34 (41.0%) pregnant women with EVI, in the second trimester in 28 (22.0%) pregnant women with EVI, and in the third trimester in 4 (4.0%) pregnant women with EVI. 31.0% of pregnant women required inpatient treatment. According to ultrasound data, intrauterine infection of the fetus was suspected in 22 (27.0%) pregnant women. This complication was suspected in the first trimester in 14 (35.0%) pregnant women of subgroup IA, in the second trimester in 6 (17.0%) pregnant women of subgroup IB, and in the third trimester in 2 (17.0%) pregnant women of subgroup IC.

It is known that an indicator of a high risk of vertical transmission of viruses is intrauterine fetal hypoxia, in which the reproduction in its tissues of almost all viruses that enter the fetal body during pregnancy increases. All newborns were diagnosed with enterovirus infection, which was represented by Coxsackie A and B, Polio 1-3 and Entero 68-71 viruses. In 97.5% of patients, a mixed enteroviral infection was registered, and from 2 to 6 viral antigens were detected simultaneously. Cytomegaly viruses (87.5%), herpes simplex 1 and 2 (70.0%), influenza (62.5%) and rubella (32.5%) were detected in patients only against the background of enterovirus infection (Fig. 2).

Rice. 2. Etiological structure of viral infections in newborns of the main group. Legend: 1 - mixed enteroviral infection; 2 - cytomegaly viruses; 3 - herpes simplex viruses type 1 and 2; 4 - influenza viruses; 5 - rubella viruses

In healthy newborns of the control group, enteroviruses were found in 10%, and cytomegaly viruses (10%) and herpes simplex viruses (15%) were not associated with picornoviruses.

Among the 54 newborns we examined, 31 children had congenital malformations (heart defects in 21 patients, malformations of the urinary system in 6, malformations of the central nervous system in 4). All children with congenital malformations were diagnosed with enterovirus infection, which was often combined with cytomegalovirus, herpetic and influenza infections. In congenital heart defects, the rubella virus was also detected in 42.8% of cases.

Perinatal lesions of the central nervous system, occlusive meningoencephalitis and hydrocephalus were detected in 49 examined newborns. During a virological examination of newborns with lesions of the central nervous system, as well as with developmental defects, enteroviruses were most often found (in 100% of cases), herpes (in 62.5-75% of cases), cytomegalovirus (in 75.3-87.5 % of cases) influenza (59.4-87.5%) infections (table).

Etiology of congenital infections of viral origin in newborns with lesions of the central nervous system

Viral infections	Perinatal lesions of the central nervous system		Hydrocephalus occlusive	Inflammatory diseases
Number of patients	Hypertensive-hydrocephalic syndrome (n = 49)	Convulsive syndrome (n = 6)
Enteroviral
Flu-like
Herpes simplex
Cytomegaly
Rubella

Thus, the results obtained showed that in the etiology of perinatal lesions of the central nervous system and congenital malformations of the central nervous system, urinary system and heart, the leading role belongs to associations of viruses, among which highest value acquire enteroviruses. The above data suggest a relationship between anamnestic data, complications during pregnancy and childbirth, with the subsequent manifestation of intrauterine infection.

Conclusion

So, chronic predominantly enteroviral infections occupy a leading place in the etiological structure of intrauterine viral infections and the associated pathology of the mother, fetus, and newborn. Failure of adaptation to viruses that persist in a woman’s body is the most common cause of antenatal fetal death, congenital and perinatal pathology, prematurity and perinatal mortality. The main reasons for failure of adaptation: (1) - relatively high initial (before conception) level of activity of endogenous enterovirus infection, (2) - activation of endogenous enterovirus infection due to physiological restructuring of the immune system, (3) - acute infectious diseases during pregnancy.

The main links in the pathogenesis of chronic enterovirus infection in women, which determine the high risk of miscarriage, as well as congenital and perinatal pathology of the fetus and child: 1 - histotoxic hypoxia associated with the toxigenic activity of the virus, 2 - a virus-induced immunopathological process with pronounced autosensitization, 3 - immunodeficiency state, associated with the immunosuppressive activity of the enterovirus.

The widespread prevalence of both acute and chronic viral infections indicates the need for timely virological examination of newborns for a general group of viruses, and not for any specific taxonomic group of viruses. Directly when collecting an epidemiological history in the presence of corresponding high-risk factors for viral transmission, such as spontaneous miscarriages, chronic viral diseases mothers and their exacerbation during this pregnancy, premature birth, stillbirth, as well as the complicated course of this pregnancy, which occurred with gestosis, threat of miscarriage, exacerbation of herpetic diseases, acute respiratory infections and close contact with infectious patients, one can suspect a chronic form of congenital viral infection in newborns.

Reviewers:

Agaev I.A., Doctor of Medical Sciences, Professor, Head of the Department of Epidemiology of AMU, Ministry of Health of the Republic of Azerbaijan, Baku;

Niftullaev M.Z., Doctor of Medical Sciences, Professor of the Department of Epidemiology of the AMU, Ministry of Health of the Republic of Azerbaijan, Baku.

The work was received by the editor on February 18, 2014.

Bibliographic link

Heydarova N.F. ASSESSMENT OF THE INFLUENCE OF ENTEROVIRUS INFECTION ON THE CONDITION OF NEWBORNS // Fundamental Research. – 2014. – No. 4-1. – P. 72-75;
URL: http://fundamental-research.ru/ru/article/view?id=33669 (access date: 02/22/2020). We bring to your attention magazines published by the publishing house "Academy of Natural Sciences"

IUI is one of the leading causes of perinatal morbidity and mortality. The frequency of IUI varies widely and depends on many factors: the type of pathogen, the condition of the fetus and newborn, gestational age, etc. Currently, the frequency of various manifestations of IUI is 10-53% (Fig. 102).

Rice. 102. Various manifestations of IUI

There are two concepts: IUI itself and intrauterine infection.

IUI is a disease in which the source of infection of the fetus is the body of the infected mother and which has a variety of clinical manifestations in the form of pyoderma, conjunctivitis, rhinitis, hepatitis, gastroenteritis, pneumonia, otitis, meningoencephalitis, even sepsis. Infection does not clinical manifestations in the fetus and is expressed only in the penetration of pathogens into its body

la. The disease in the fetus does not occur as a result of the mobilization of immunity and protective mechanisms in the mother-fetus system. In both cases, infection occurs in the antenatal period or during childbirth.

etiology of intrauterine infections

There is a well-known obstetric axiom: there is no parallelism between the severity of the infectious process in the mother and the fetus. A mild, mild or even asymptomatic infection in a pregnant woman can lead to severe damage to the fetus, including disability or even death. This phenomenon is largely due to the tropism of pathogens (especially viral ones) to certain embryonic tissues, as well as the fact that fetal cells with their highest level of metabolism and energy are an ideal environment for the reproduction (replication) of microbes. This is precisely what explains the great similarity of embryo- and fetopathies caused by various infectious agents.

To designate the IUI group, the abbreviation TORCH was proposed (based on the first letters of the names of infections, but the word “torch” carries a greater meaning - with in English it is translated as “torch,” which emphasizes the danger and severe consequences of IUI).

Abbreviation TORCH is deciphered as follows. Toxoplasmosis- toxoplasmosis.

Others- other infections (it is absolutely proven: IUI is caused by pathogens of syphilis, chlamydia, enteroviral infections, hepatitis A and B, gonococcal infection, listeriosis; the probable culprits of IUI are considered to be pathogens of measles and mumps; hypothetical - pathogens of influenza A, lymphocytic choriomeningitis, human papillomavirus) .

Rubeola- rubella.

Cytomegalia- cytomegalovirus infection. Herpes- herpes virus infection.

The listed infections are most widespread among the adult population, including pregnant women.

Toxoplasmosis is observed in 5-7% of pregnant women, while in 30% of cases infection of the fetus is possible (encephalitis and its consequences, chorioretinitis, a generalized process accompanied by hepatosplenomegaly, jaundice and damage to the cardiovascular system).

Infection of the fetus with syphilis occurs at 6-7 months of pregnancy; spirochetes can penetrate the intact placenta. The result is a miscarriage of a macerated fetus or birth dead child with signs of visceral syphilis (liver damage, interstitial pneumonia, osteomyelitis, osteochondritis).

During pregnancy, chlamydia is detected in 12.3% of cases; about 50% of children born to mothers with chronic endocervicitis have signs of chlamydial infection.

Enterovirus infections are quite common. The ECHO and Coxsackie viruses are of greatest interest as causative agents of IUI. Enteroviruses are transmitted to pregnant women through direct contact with patients who have lesions of the upper respiratory tract, lungs, or manifestations of intestinal infection. The experiment proved the etiological role of Coxsackie viruses of group A (serotypes 3, 6, 7, 13) and group B (serotypes 3,4), as well as ECHO viruses (serotypes 9 and 11).

Up to 1% of pregnant women are carriers of the Australian (HBsAg) antigen, while the risk of infection of the fetus and newborn is 10%.

Perinatal infection with listeriosis occurs transplacentally, less often through the ascending route and through the amniotic fluid in case of listeriosis pyelitis, endocervicitis or influenza-like disease; the child is usually born with a generalized form of infection (granulomatous sepsis).

Measles is one of the most common infections and occurs in 0.4-0.6 cases per 10 thousand pregnancies.

The rubella virus is able to penetrate the placental barrier. The probability of fetal infection depends on the duration of pregnancy and is 80% in the first 12 weeks, 54% in 13-14 weeks and no more than 25% by the end of the second trimester.

Cytomegalovirus - common reason IUI (intrauterine infection - in 10% of cases). The risk of infection of the fetus during recurrent cytomegalovirus infection in a pregnant woman is low due to the fact that the fetus is protected by antibodies circulating in the mother’s blood. Consequently, the risk group for congenital cytomegaly consists of children of seronegative mothers with seroconversion that occurred during this pregnancy.

Infection with the genital herpes virus is detected in 7% of pregnant women. Herpetic infection is characterized by lifelong carriage of the virus.

Particular relevance herpetic infection associated with the emergence of AIDS patients. It has been established that herpes viruses can activate the HIV genome, which is in the provirus stage, and are a cofactor in the progression of HIV infection. Up to 50% of children born to HIV-infected mothers become infected antenatally, intrapartum, or in the early neonatal period through mother's milk.

ARVI suffered in the second half of pregnancy is a risk factor for the development of IUI due to transplacental transmission of the virus to the fetus. Respiratory viruses, which cause perinatal damage in 11% of cases, can persist and multiply in the placenta, fetal brain and especially in the choroid plexuses of the lateral ventricles of the brain.

pathogenesis of intrauterine infections

The pathogenesis of IUI is diverse and depends on many factors, primarily on the course of the infectious process in the mother (acute, latent, stage of remission or exacerbation, carriage). In case of an infectious disease in the mother during pregnancy, the embryo and fetus are affected not only by pathogens, but also by toxic products formed when the mother’s metabolism is disrupted, during the breakdown of the infectious agent, and, in addition, hyperthermia and hypoxia that occur during an acute process.

Gestational age plays an important role in pathogenesis. During the preimplantation period (the first six days after fertilization), under the influence of an infectious agent, the zygote dies or completely regenerates. During the period of embryo- and placentogenesis (from the 7th day to the 8th week), hy-

embryo whiteness, development of deformities, primary placental insufficiency. In the early fetal period (from 9-10 to 28 weeks), the fetus and placenta become sensitive to the pathogen. The development of deformities (so-called pseudodeformities), as well as sclerotic changes in organs and tissues, is possible.

IUI leads to disruption of the further development of an already formed organ. Yes, infection urinary tract can lead to hydronephrosis, meningoencephalitis - to hydrocephalus due to narrowing or obliteration of the Sylvian aqueduct of the brain. After the 28th week of gestation, the fetus acquires the ability to specifically respond to the introduction of an infectious agent with leukocyte infiltration, humoral and tissue changes.

Outcome of intrauterine infection may be different: prematurity, intrauterine growth retardation, antenatal death or various manifestations of local and generalized infectious process, placental insufficiency, adaptation disorders of the newborn; clinical manifestations of IUI can be observed in the first days of life (in the first four days, and in some types of specific infection - after the 7th day and beyond).

The localization of the infectious process in the fetus and newborn depends on the route of entry of the pathogen. Considered classic four ways of intrauterine infection:upward path - through birth canal(bacterial and urogenital infection); transplacental (hematogenous) route(bacterial foci of inflammation; viral infections; listeriosis; syphilis; toxoplasmosis); descending path(with inflammatory processes in the abdominal organs); mixed path.

Bacterial IUI develops mainly due to the penetration of an ascending infection from the birth canal, and chorioamnionitis occurs first, the amniotic fluid becomes infected, and the fetus is affected due to the ingestion of amniotic fluid or its entry into the fetus. Airways. Infection is possible when the fetus passes through the birth canal, which is typical for bacterial and urogenital infections. In case of hematogenous infection of the fetus, there must be a purulent-inflammatory focus in the mother’s body. The pathogen infects the fetal part of the placenta, breaking the placental barrier, and penetrates

into the fetal bloodstream. With hematogenous infection, generalized damage to the fetus often occurs - intrauterine sepsis. All true congenital viral infections are characterized by a transplacental route of infection, including such specific ones as listeriosis, syphilis, toxoplasmosis and cytomegalovirus infection. Transdecidual (transmural), descending and mixed routes of infection are observed much less frequently; the pathogenesis of fetal damage does not differ from that of hematogenous and ascending infection.

clinical picture

Clinical manifestations of IUI are mainly nonspecific and depend on the gestational age during infection, the number and virulence of pathogens, and the route of infection.

It is noted that the shorter the gestational age during infection, the more severe the course and worse the prognosis of IUI. The most severe damage to the liver and brain, which is disseminated in nature, is caused by pathogens that penetrate the fetus transplacentally. Clinically, this is manifested by spontaneous abortion, death of the ovum, premature birth, delayed fetal development, abnormalities of its development and the birth of a sick child. Such lesions are typical for: measles, rubella, chickenpox, cytomegaly, mumps, influenza, parainfluenza, herpes simplex type II, Coxsackie, parvovirus B19 (in early pregnancy), as well as HIV infection and some bacterial infections (listeriosis, streptococcal infection).

If infected in the first trimester of pregnancy, the fetus may develop micro- and hydrocephalus, intracranial calcification, malformations of the heart and limbs, and in the second and third trimesters - chorioretinitis, hepatosplenomegaly and jaundice, pneumonia, malnutrition.

The ascending route of infection is characteristic of opportunistic microorganisms, gardnerella, protozoa, fungi, chlamydia, mycoplasmas, etc. Pathogens multiply and accumulate in amniotic fluid, which is clinically manifested by the syndrome of “infection” or “infection of amniotic fluid”. During pregnancy with such an infection, polyhydramnios, malnutrition and

fetal hypoxia, edematous syndrome, enlarged fetal liver and spleen, hyperbilirubinemia; possible miscarriage, premature birth.

At the same time, asymptomatic colonization of amniotic fluid by various microorganisms cannot be ruled out. Asymptomatic chorioamnionitis should be assumed if treatment with tocolytics is unsuccessful in cases of threatened preterm labor.

TO nonspecific clinical manifestations of IUI in newborns can be attributed respiratory distress syndrome, signs of asphyxia, hyaline membrane disease, congenital hypotrophy, jaundice, edematous syndrome, disseminated intravascular coagulation syndrome, as well as a symptom complex that requires careful differential diagnosis with manifestations of damage to the central nervous system of hypoxic-traumatic origin (general lethargy, decreased muscle tone and reflexes, regurgitation, refusal breasts, intense weight loss and slow recovery, breathing problems, bouts of cyanosis).

In some newborns, the manifestations of IUI are different, specific character: vesiculopustulosis at birth, conjunctivitis, otitis, intrauterine pneumonia, enterocolitis, meningoencephalitis, gastrointestinal syndrome.

It should be noted that the possibility of developing IUI in children in the late period of development is associated with the persistence of the virus (chlamydial conjunctivitis, progressive cataracts with infection with the rubella virus, hydrocephalus with the persistence of Coxsackie viruses, chronic pyelonephritis and juvenile diabetes mellitus with chronic congenital enterovirus infection).

Features of clinical manifestations of certain diseases in pregnant women

Flu. When contracting influenza in the first trimester, miscarriages occur in 25-50% of cases. However, the incidence of fetal malformations is not increased.

Rubella. Fetal infection occurs in women who become ill with rubella for the first time during pregnancy. Infection of the fetus in the first 12 weeks of embryogenesis leads to the development of hereditary rubella syndrome (cataracts, microphthalmia, hearing impairment, micro- and hydrocephalus and heart defects). If the disease occurs in the first trimester of pregnancy, the risk of miscarriages and congenital anomalies develops.

tia is high enough that the pregnancy should be terminated. If infected for more than later The organ of hearing is most often affected. After 16 weeks of gestation, the risk of infection decreases, but infection during this period can lead to the development of a chronic disease with impaired liver function, anemia, thrombocytopenia, central nervous system damage, immunodeficiency, and dental dysplasia. At the same time, the placenta is affected (inflammation of the villi and vasculitis), which disrupts the nutrition of the fetus. The risk of infection of the fetus by the rubella virus depends on the stage of pregnancy at which the mother was infected (Table 24).

Measles. The risk of miscarriage is increased (as with influenza), but fetal developmental abnormalities are not observed.

Polio. During pregnancy, the risk of the disease and its severity are increased. Up to 25% of fetuses from sick mothers suffer from polio in utero. This virus does not cause fetal developmental abnormalities.

Mumps. Characterized by low morbidity and mortality. Leaks in mild form. There is no risk of developmental abnormalities.

Hepatitis A (RNA virus). Oral-fecal route of infection. There are practically no complications during pregnancy if the disease is mild.

Hepatitis B (DNA virus). Routes of infection are parenteral, perinatal and sexual. Up to 10-15% of the population are chronic carriers of the hepatitis B virus. A pregnant woman infects the fetus during childbirth (the use of the fetal head for monitoring control during labor is not recommended).

Parvovirus. During pregnancy, the DNA virus passes through the placenta, causing non-immune edema syndrome in the fetus. Clinical picture in the mother it is characterized by the presence of rash, arthralgia, arthrosis, transient aplastic anemia. 50% of women have antibodies against parvovirus. If a pregnant woman does not have antibodies, then the greatest risk of miscarriage is observed before 20 weeks. Infection of the fetus occurs during the viremia phase. The virus has a tropism for erythrocyte progenitor cells. Clinical manifestations of IUI depend on the gestational age: early pregnancy - spontaneous abortion, late - non-immune fetal hydrops as a manifestation of a severe form of hemolytic anemia, intrauterine fetal death; The edematous syndrome that develops in the fetus occurs due to heart failure caused by anemia. An unfavorable outcome is observed in 20-30% of cases. In 70-80% of cases of serologically confirmed infection in the mother, no damaging effect on the fetus is observed, which can be explained by the neutralization of the virus by antibodies. There is no specific therapy.

Herpes. The greatest role in the pathology of pregnancy and intrauterine infection for the fetus is played by viruses of the family Herpesviridae.

Herpes viruses are transmitted in various ways, but the most important is the sexual route of infection. Primary genital herpes in the mother and exacerbation of chronic herpes are most dangerous for the fetus. If 0.5-1% of newborns are infected intranatally, then with acute genital herpes and exacerbation of chronic herpes (which is manifested by blistering lesions of the skin and mucous membranes of the genitals), the risk of infection of the fetus during childbirth reaches 40%. Adverse fetal outcomes are mainly associated with transplacental (hematogenous) transmission of the pathogen.

Infection of the fetus in the first trimester of pregnancy leads to hydrocephalus, heart defects, developmental anomalies of the gastrointestinal tract, etc. Spontaneous termination of pregnancy is often observed. Infection in the second and third trimesters is fraught with the development of hepatosplenomegaly, anemia, jaundice, pneumonia, meningoencephalitis, sepsis, and malnutrition in the fetus. With an ascending route of infection (from the cervix), the pathogen multiplies and accumulates in the amniotic fluid, and polyhydramnios is noted. Postnatal infection of newborns is also possible in the presence of herpetic manifestations on the skin of the mother, relatives or medical personnel.

Thus, infection of the fetus before 20 weeks of gestation leads to spontaneous abortion or fetal development anomalies in 34% of cases, in periods from 20 to 32 weeks - to premature birth or antenatal death of the fetus in 30-40% of cases, after 32 weeks - to the birth of a patient a child with damage to the skin (herpetic rashes, ulcerations, which are quite rare), eyes (cataracts, microphthalmia, chorioretinitis) and the central nervous system (microor hydrocephalus, cerebral necrosis). It should be noted the severity of the manifestations of the disease in a newborn when infected with the herpes simplex virus (meningoencephalitis, sepsis); death occurs in 50% of cases. Surviving children subsequently have severe complications (neurological disorders, visual impairment, delayed psychomotor development). Neonatal herpes occurs with a frequency of 20-40 cases per 100 thousand newborns.

Cytomegalovirus infection. Obstetric complications such as spontaneous miscarriages, premature birth, antenatal death and fetal abnormalities, polyhydramnios, and non-developing pregnancy are possible. The probability of infection during latent infection is practically absent; during reactivation and persistence it is 0.5-7% and during primary infection it exceeds 40%. Classic manifestations of cytomegalovirus disease are hepatosplenomegaly, thrombocytopenia, brain developmental disorders (microcephaly, intracranial calcification), encephalitis, chorioretinitis, pneumonia and intrauterine growth retardation. The mortality rate for congenital cytomegaly is 20-30%.

Coxsackievirus infection. In the first trimester of pregnancy, this infection is rare and leads to the formation of malformations of the gastrointestinal and urogenital tracts and the central nervous system. If infected in late pregnancy, a newborn may experience the following clinical manifestations: fever, refusal to eat, vomiting, hypotension, skin rashes, convulsions. Some newborns experience otitis media, nasopharyngitis, and pneumonia.

HIV infection. The possibility of intrauterine infection of the fetus from a mother infected with HIV is confirmed by cases of detection of virus antigens in fetal tissues and amniotic fluid. There are three ways for the virus to overcome the placental barrier: 1) transfer of free virus as a result of damage to the placental barrier and interaction with T4 receptors of fetal lymphocytes; 2) primary infection of the placenta, secondary infection of the fetus; carriers of the virus are

Hoffbauer cells of the placenta are formed, through which diaplacental transmission is possible; 3) the passage of the virus during childbirth from the affected cells of the cervix and vagina through the mucous membranes of the fetus. HIV infection is acquired by 20-30% of newborns from infected mothers. Children infected with HIV have skin lesions in the form of bacterial, fungal and viral exanthema.

Bacterial infection. The development of intrauterine bacterial infection is facilitated by the presence of focal foci (tonsillitis, sinusitis, carious teeth, pyelonephritis, chronic and acute lung diseases, etc.). Pathogens can penetrate the fetus through the placenta. Ascending infection most often occurs when the integrity of the amniotic sac during pregnancy or childbirth. In addition, ascending infection is facilitated by colpitis, cervicitis, invasive methods for assessing the condition of the fetus (amnioscopy, amniocentesis, etc.), numerous vaginal examinations during childbirth, isthmicocervical insufficiency, threat of miscarriage. With generalized microbial contamination of amniotic fluid, chorioamnionitis is manifested by fever, chills, tachycardia, purulent discharge from the genital tract and other symptoms. The fetus is diagnosed with incipient hypoxia.

Among IUIs of a bacterial nature, STDs prevail. The most common causative agents of urogenital infections include Chlamydia trachomatis. Chlamydia primarily affects columnar epithelial cells. More than half of infected women have no clinical manifestations.

Clinical manifestations of chlamydial infection in newborns are conjunctivitis, which occurs at a time atypical for IUI - 1-2 weeks, and sometimes 5 weeks after birth, and interstitial pneumonia, which develops within 2-4 months from birth. Such long-term timing of infection indicates the predominant route of infection of the fetus with chlamydia through direct contact with the mother's birth canal, although an ascending route of infection through intact fetal membranes cannot be ruled out.

Mycoplasma infection. Mycoplasmosis during pregnancy develops mainly in people with immunodeficiency conditions. Urogenital mycoplasmosis can lead to IUI, which is

cause of miscarriage, stillbirth; In premature newborns, mycoplasmas cause the development of pneumonia, meningitis, and generalized infection.

Congenital syphilis. The disease is multisystem, has various shapes. Its manifestations resemble secondary syphilis. Most children appear healthy at birth, some have vesicular bullous rashes on the palms and soles, but the following symptoms of the disease may appear 4 days to 3 weeks after birth.

Flu-like syndrome:

Meningeal symptoms;

Watery eyes (inflammation of the iris);

Discharge from the nose, the mucous membranes are hyperemic, edematous, eroded, replete with pale treponema;

Sore throat (there are papules on the mucous membrane of the pharynx);

Generalized arthralgia (due to pain, there is no active movement in the limbs - Parrot's psuedoparalysis, the x-ray shows signs of osteochondritis, periostitis is often detected, in particular, of the tibia (saber-shaped shins).

Enlargement of all groups of lymph nodes (cervical, elbow, inguinal, axillary, popliteal).

Hepatosplenomegaly (in severe cases - anemia, purpura, jaundice, edema, hypoalbuminemia).

Rashes:

Maculopapular;

Fusion of papular lesions with the formation of condylomas lata.

Listeriosis. In pregnant women, listeriosis can occur in the form of a flu-like illness, in a subclinical form with erased symptoms. Abortions or premature births, stillbirths or fetal deformities incompatible with life are observed. In fetuses, listeriosis manifests itself as granulomatous sepsis or septicopyemia with metastatic purulent meningitis; In newborns, sepsis and pneumonia are most common. The mortality rate of newborns with listeriosis reaches 60-80%.

Toxoplasmosis. The disease most often occurs through close contact with animals. Women are infected either by sporodonts from the soil (by

fallen there with the feces of animals, for example cats), from hands, furniture, floor, or cystozoids from Toxoplasma cysts contained in the tissues of intermediate hosts (when eating insufficiently heat-treated meat). The clinical picture is characterized by polymorphism (presence or absence of fever, enlarged lymph nodes, liver and spleen, myocarditis, pneumonia, etc.). With toxoplasmosis, the development of endometritis, damage to the placenta, threat of miscarriage, and fetal malnutrition are possible.

Candidiasis. Often develops during pregnancy urogenital candidiasis. This condition, like bacterial vaginosis, is a background for the addition of another bacterial and/or viral infection.

diagnostics

There are no reliable methods for diagnosing fetal IUI. One can only assume it based on indirect signs and establish infection of the fetus and gestational sac.

In a newborn, the infection manifests itself either from the moment of birth or within 3-4 days (with the exception of chlamydia and a number of other infections that may appear later). Its diagnostic signs depend on the localization or degree of generalization of the process.

In the diagnosis of IUI, the main ones are bacteriological and immunological methods. These include the detection of etiologically significant microorganisms in cultures in quantities exceeding 5x10 2 CFU/ml, and PCR, carried out to identify certain fragments of DNA or RNA of pathogen cells.

Cultures and scrapings (to identify intracellularly located pathogens) in pregnant women are taken from the vagina and cervical canal. In pregnant women at high risk of developing IUI, they resort to invasive methods of obtaining material for bacteriological study (chorionic aspiration in early pregnancy, study of amniotic fluid after amniocentesis and umbilical cord blood obtained by cordocentesis). Bacteriological studies must be combined with the identification of antigen in the blood using serological methods for determining IgM and IgG, which are specific for that

or other pathogen. It is advisable to repeat the studies at least once every 2 months.

Currently, great importance is attached to ultrasound, which can be used to determine indirect signs of fetal IUI.

Indirect ultrasound signs of IUI

Symptom of fetal growth restriction.

Abnormal amount of amniotic fluid (usually polyhydramnios).

Signs of premature or delayed maturation of the placenta. Violation of its structure (varicose dilatation of its vessels, the presence of hyperechoic inclusions, placental edema, contrasting of the basal plate).

Irregularly shaped expansions of the intervillous space that do not correspond to the centers of the cotyledons.

Early appearance of placental lobulation.

Extension collecting system fetal kidney.

Micro- and hydrocephalus.

Dilatation of the ventricles of the brain, increased echogenicity of brain tissue, cystic changes or foci of calcification (necrosis) in the periventricular zone of the brain, liver tissue.

Ascites, pericardial or pleural effusion, hepatomegaly, hypoechoic bowel, hydrops fetalis.

Screening tests for newborns at high risk of developing IUI include the study of smears of amniotic fluid, placenta, cord blood cultures and stomach contents of the newborn. In some cases, a blood culture test of the newborn is recommended, with capillary rather than umbilical cord blood collection being the most appropriate. The activity of alkaline phosphatase is determined, the number of platelets is counted (thrombocytopenia below 150x10 9 /l is considered a sign of infection), the ratio of young forms of leukocytes and neutrophils and radioisotope determination of B-lactamase (to detect infection with B-lactamase-producing microorganisms). Histological examination of the placenta is of great importance, although inflammatory changes do not always correspond to the child’s disease. Examination of formaldehyde-fixed placental tissue may be useful in diagnosing viral infections. PCR method. When conducting serological examination y new born child(IgG, IgM) the following principles should be remembered:

An examination of the newborn should be carried out before using donor blood products in the treatment of the child;

The results of the examination of the child should always be compared with the results of the examination of the mother;

The presence of specific immunoglobulins of class G in a titer equal to or less than the titer of the corresponding maternal antibodies does not indicate intrauterine infection, but the transplacental transfer of maternal antibodies;

The presence of specific immunoglobulins of class M in any titer indicates the primary immune response of the fetus or newborn to the corresponding bacterial/viral antigen and is an indirect sign of infection;

The absence of specific M immunoglobulins in the blood serum of newborns does not exclude the possibility of intrauterine or intrapartum infection.

A comparative analysis of the main methods for detecting IUI pathogens is shown in Table. 25.

prevention and treatment

Important importance in the prevention of IUI is given to identifying risk groups. Numerous risk factors can be divided into the following three groups.

Chronic infectious diseases: chronic infections of the respiratory system, digestive system, caries, tonsillitis; urogenital infections (pyelonephritis, colpitis, STDs); intestinal dysbiosis, bacterial vaginosis.

Complications of pregnancy: anemia, gestosis, miscarriage, isthmic-cervical insufficiency and its surgical correction, exacerbation chronic diseases and ARVI in the second half of pregnancy.

Complications of childbirth: ARVI during childbirth, prenatal rupture of water; weakness labor activity; protracted labor; multiple vaginal examinations; delivery operations and benefits; long water-free period.

Method	Sensitivity	Specificity	Subjectivity of assessment	Advantages	Flaws
Cultural		Close to absolute	Present	High accuracy. Detects only living microorganisms. High reliability positive result	High cost, labor intensive. Available only for large centers. Strict requirements for collection, transportation, and storage of material. Unacceptable against antibiotics
	Close to absolute	Close to absolute	Virtually absent	High accuracy. High reliability of negative results.	Detects both live and dead microorganisms - a limitation for cure control. Risk of false positive results due to contamination
Enzyme-linked immunosorbent assay (ELISA):	Satisfactory	Satisfactory	Absent	Satisfactory accuracy at low cost.	Sensitivity and effectiveness vary for different excitatory

Continuation of the table. 25

antigen detection				Convenient for mass research	calves, and therefore there are test systems for diagnosing a limited number of infections. Ineffective for latent and chronic infections
Immunofluorescence reaction (RIF)	Satisfactory	Satisfactory		Does not require stringent conditions for laboratory organization and expensive equipment Satisfactory accuracy at low cost	Subjectivity in assessment. Low interlaboratory reproducibility
Cytological				Cheap, fast	Subjectivity in assessment. Low accuracy
Enzyme-linked immunosorbent assay (ELISA): detection of antibodies	Satisfactory		Absent	Detects the presence of infection of any location. Detects acute, chronic and latent forms of infection (IgM, IgG in dynamics)	Retrospective diagnosis (for IgG). A false negative result is possible in cases of immunodeficiency. Immunological trace - after cure, IgG remains positive for a long time

Exist general principles prevention and treatment for IUI.

1. Etiotropic antimicrobial (antiviral) therapy, taking into account the stage, general and local symptoms, duration of the infectious-inflammatory disease, the presence of a mixed infection, gestational age, clinical and laboratory signs of IUI.

2. Prevention (treatment) of dysfunction of the fetoplacental complex at 10-12, 20-22 and 28-30 weeks of pregnancy, as well as at individual critical periods and in the complex of prenatal preparation (metabolic therapy, vasoactive drugs and antiplatelet agents).

3. Immunomodulatory, interferon-corrective therapy: plant adaptogens, viferon.

4. Correction and prevention of microbiocenosis disorders in the pregnant woman’s body: bifidumbacterin, lactobacterin (at least 15 doses per day), floradophilus (1 capsule 2 times) enterally for 10-14 days; in combination with acylact or lactobacterin vaginally.

5. Pre-gravid preparation.

6. Treatment of sexual partners with STDs.

A number of preventive measures in most economically developed countries of the world, including the Russian Federation, have long been legalized by the state (Wassermann reaction, determination of Australian antigen, HCV antibodies and antibodies to HIV in blood serum). Children should be vaccinated against hepatitis B immediately after birth, after a week, after a month and after 6 months of life to prevent the development of severe forms of the disease. There are no specific treatments for hepatitis A. To prevent severe disease, you can use immunoglobulin 0.25 ml per 1 kg of body weight.

Women who have not previously had rubella, have not received rubella vaccination and, therefore, do not have antibodies to the rubella virus, are recommended to be vaccinated before pregnancy. Vaccination should be performed 3 months before pregnancy. A pregnant woman, especially one at risk, should avoid any contact with a patient with exanthema infection. In case of rubella infection in the first 16 weeks of pregnancy, its interruption is indicated.

If the infection occurred at a later stage, the tactics are individual; it is advisable to conduct an IgM study of umbilical cord blood (cordocentesis), a virological or PCR study of amniotic fluid.

niotic fluid or chorionic villus sampling (amniocentesis). If infection of the fetus is confirmed, termination of pregnancy is desirable.

For women who refuse to terminate a pregnancy at >16 weeks, administration of specific IgG may be a measure to prevent infection in the fetus.

Administration of gamma globulin to patients with rubella during gestation slightly reduces the incidence of fetal abnormalities. Vaccination of pregnant women is not carried out.

If a pregnant woman gets chickenpox 5-7 days before birth or in the first 3-4 days after birth, immediate administration of Zoster immunoglobulin or Varicella-Zoster immunoglobulin to the newborn is indicated. If the disease develops in a newborn (despite preventive measures), treatment with acyclovir is recommended at a dose of 10-15 mg per 1 kg of body weight 3 times a day. Treatment of sick pregnant women with acyclovir is carried out only in severe cases of the disease.

For mumps and measles, vaccination of pregnant women is not carried out, since a live attenuated vaccine is used. There is an inactivated vaccine available against influenza, types A and B. There is no risk to the fetus during vaccination. It is recommended to vaccinate pregnant women according to strict epidemiological indications in the second and third trimesters.

Since there is no specific therapy for parvovirus infection, it is recommended to use immunoglobulin to prevent severe complications.

If a pregnant woman has a herpetic infection, the nature of preventive and therapeutic measures, obstetric tactics will depend on the type of disease, its form (typical, atypical, asymptomatic, duration), as well as on the presence of genital lesions, the condition of the membranes, etc.

In case of primary infection of a pregnant woman in the early stages of pregnancy, it is necessary to raise the question of its termination. If the pathology occurs at a later date or the woman was infected before pregnancy, preventive measures consist of dynamic ultrasound monitoring of the development and condition of the fetus, prescribing a course of therapy, including a metabolic complex, cell membrane stabilizers, and unithiol.

The basic antiviral drug is acyclovir (Zovirax). Despite the lack of evidence of its teratogenic and embryotoxic

clinical effects, it is advisable to limit the administration of acyclovir to pregnant women suffering from genital herpes the following readings: primary genital herpes; recurrent genital herpes, typical form; genital herpes in combination with a permanent threat of miscarriage or symptoms of IUI. Acyclovir is prescribed 200 mg 5 times a day for 5 days. The issue of longer use of the drug and repeated courses of treatment is decided individually. The drug is highly effective in preventing perinatal infection. Pregnant women with frequent relapses of infection have had positive experience with permanent therapy with acyclovir (suppressive therapy). In case of complicated herpetic infection (pneumonia, encephalitis, hepatitis, coagulopathy), treatment is carried out together with an infectious disease specialist. Intravenous administration of the drug is required at a dose of 7.5 mg/kg every 8 hours for 14 days. At the same time, it is advisable to use immunoglobulin therapy, interferon preparations, antioxidants (vitamins E and C). Among interferons, preference should be given to viferon; adaptogens of plant origin are also prescribed. It is possible to use laser blood irradiation, plasmapheresis and enterosorption. It is also necessary to treat bacterial diseases accompanying genital herpes (most often chlamydia, mycoplasmosis, trichomoniasis, candidiasis, bacterial vaginosis). After complex therapy, complications for the mother and fetus are reduced by 2-3 times.

The tactics of labor management in women with primary and recurrent herpes deserve special attention. C-section as a prophylaxis for neonatal herpes, it is necessary in the presence of herpetic eruptions on the genitals or primary genital herpes in the mother 1 month or less before birth. In the case of abdominal delivery due to rupture of the membranes, the anhydrous interval should not exceed 4-6 hours.

Treatment and prevention of cytomegalovirus infection is quite difficult. Treatment consists of courses of passive immunization. It is possible to use anti-cytomegalovirus immunoglobulin 3 ml intramuscularly once every 3 days, 5 injections per course. Treatment with human immunoglobulin is more effective (intravenous administration of 25 ml every other day, 3 infusions per course). Intraglobin-F is administered at the rate of 4-8 ml per 1 kg of body weight once every 2 weeks for prophylactic use. Number of preventive

infusions, as well as the preventive treatment regimen are determined individually. Cytotect for proven cytomegalovirus infection for therapeutic purposes is administered 2 ml per 1 kg of body weight every 2 days under the control of serological parameters. Preventive prenatal preparation includes infusion of 5 ml of cytotect 2 times a week for 2 weeks. In any case, the expected benefit from the use of immunoglobulins should exceed the risk of possible complications (allergic and pyrogenic reactions, production of antibodies - antigammaglobulins, exacerbation of infection). The specific antiviral drug ganciclovir is used according to strict vital indications for the mother and newborn. Viferon is also used to prevent complications.

Currently, zidovudine and other nucleoside analogs with antiviral activity are used to treat AIDS. No evidence of the teratogenic effect of these drugs has been established, but their use in HIV-infected people in the early stages of pregnancy should be strictly justified. The main purpose of prescribing drugs to seropositive pregnant women is to prevent transmission of the virus to the fetus (it occurs through the placenta or to the newborn - when passing through an infected birth canal, and especially often through breast milk and in close contact with the mother). Zidovudine is prescribed at a dose of 300-1200 mg/day. Although experience with its use is limited, the administration of zidovudine to HIV-infected pregnant women may be an effective method for preventing the development of HIV infection in young children. Breastfeeding stops.

If there are signs of a bacterial intrauterine infection, intensive antibiotic therapy (penicillins, cephalosporins) is carried out. A newborn born with signs of IUI is prescribed antibacterial therapy, initially with the same antibiotics, and then depending on the isolated microflora and its sensitivity to antibiotics.

Prevention of congenital chlamydia is of a similar nature. During pregnancy, macrolides are used to treat the disease (erythromycin 500 mg orally 4 times a day for 10-14 days). Josamycin (vilprafen) is close in its spectrum of antimicrobial action to erythromycin, has virtually no side effects, is not destroyed in the acidic environment of the stomach, and has antichlamydial action.

equal to doxycycline. The drug is prescribed 2 g per day in 2-3 doses for 10-14 days. Spiramycin (rovamycin) is used at a dose of 3,000,000 units 3 times a day (at least 7 days). In case of individual intolerance to natural macrolides, it is permissible to prescribe clindamycin orally at 0.3-0.45 g 3-4 times a day or intramuscularly at 0.3-0.6 g 2-3 times a day.

Treatment of patients with urogenital infection caused by Mycoplasma hominis And Ureaplasma urealytica, it is necessary to begin immediately after confirmation of the diagnosis by laboratory methods. The pregnant woman and her husband are being treated. It does not differ significantly from that with urogenital chlamydia. During pregnancy, preference should be given to rovamycin and vilprafen. On the background antibacterial therapy It is advisable to prescribe eubiotics (acylact, lactobacterin). It should be noted that a more effective prevention of IUI caused by mycoplasmosis and chlamydia is the treatment of women outside pregnancy, when it is possible to use a wider range of antibacterial (tetracyclines, fluoroquinolones, etc.) and immunostimulating agents (decaris, prodigiosan, tactivin, etc.) .

Prevention of congenital toxoplasmosis

Identification of women infected for the first time during a given pregnancy (by an increase in antibody titer in paired sera), timely resolution of the issue of termination of pregnancy.

Treatment during pregnancy to prevent transmission of infection to the fetus.

Examination and treatment of newborns.

Serological monitoring of uninfected women throughout pregnancy.

Treatment is carried out with sulfonamides.

The drug of choice for the treatment of listeriosis is ampicillin (penicillin), used in doses of 6-12 g/day for severe forms of the disease and 3-4 g/day for minor manifestations - daily for 2-4 weeks. Pregnant and postpartum women should be isolated. Treatment of newborns with listeriosis is very difficult and should begin as early as possible. The drug of choice is ampicillin, prescribed intramuscularly at 100 mg/kg 2 times a day during the 1st week of life and 200 mg/kg 3 times a day at age

grow older than 1 week. The duration of treatment is 14-21 days.

Treatment of patients with syphilis during pregnancy is carried out according to the general principles and methods of treating this infection. With each subsequent pregnancy, a patient with syphilis must undergo specific treatment. A three-time serological examination of each pregnant woman is mandatory in the first and second half of pregnancy and after 36 weeks of pregnancy.

For urogenital candidiasis in pregnant women, it is preferable to use local therapy (clotrimazole, miconazole, isoconazole, natamycin). The feasibility of enteral administration of antifungal agents is determined by the presence or absence of gastrointestinal candidiasis. Recurrent vaginal candidiasis is an indication for examination for viral and bacterial sexually transmitted infections. Patients should be informed that they and their sexual partners are recommended to undergo examination and, if necessary, treatment, abstinence from sexual activity until recovery, or the use of barrier methods of contraception.

Bacterial vaginosis is a clinical syndrome characterized by the replacement of the normal vaginal microflora, which is dominated by lactobacilli, by opportunistic anaerobic microorganisms. When treating pregnant women, intravaginal administration of clindamycin phosphate in the form of 2% vaginal cream 5 g at night for 7 days or 0.75% metronidazole gel 5 g at night also 7 days from the second trimester of pregnancy is preferable. In case of insufficient effectiveness local therapy the following drugs can be administered orally: clindamycin 300 mg 2 times a day for 5 days or metronidazole 500 mg 2 times a day for 3-5 days. It is advisable to use eubiotics, vitamins and other agents that help normalize the microbiocenosis of the vagina and intestines.

Issues of prevention and treatment for IUI cannot be considered completely resolved. The validity of prophylactic antibiotics for pregnant women and newborns at high risk of developing IUI is still a subject of debate, although most clinicians consider such measures appropriate.

Due to the inability to carry out massive complex antibacterial therapy in pregnant women when planning

the child's family should be treated long before pregnancy married couple as pre-conception preparation.

Pre-gravid preparation scheme

1. Comprehensive examination with the study of immune, hormonal, microbiological status, diagnosis of concomitant extragenital diseases, consultations with related specialists.

2. Immunostimulating, immunocorrective and interferon-correcting therapy:

Drug therapy (pyrogenal, prodigiosan, taktivin, immunofan, specific immunoglobulin therapy and vaccine therapy, ridostin, larifan, viferon), laser therapy, plasmapheresis;

Herbal medicine (ginseng, eleutherococcus, aralia, lemongrass, etc.)

3. Etiotropic antibacterial or antiviral therapy according to indications:

Tetracyclines;

Macrolides;

Fluoroquinolones;

Clindamycin, rifampicin;

Cephalosporins;

Acyclovir, ganciclovir.

4. Eubiotic therapy:

For oral use - bifidumbacterin, lactobacterin, floradophilus, solcotrichovac;

For vaginal use - bifidumbacterin, acylact, lactobacterin, “Zhlemik”, “Narine”.

5. Metabolic therapy.

6. Correction of menstrual irregularities and concomitant endocrinopathies.

7. Mandatory treatment of a sexual partner in the presence of STDs, using individual regimens for chronic inflammatory diseases of the genitals.

Thus, the greatest danger of intrauterine infection faces those children whose mothers are primarily infected with IUI during pregnancy. For infections such as rubella and toxoplasmosis, primary infection of a pregnant woman is the only option for infecting the fetus. As calculations show, identifying women

Women at risk at the stage of pregnancy planning and implementation of appropriate preventive measures can reduce the risk of IUI with severe consequences by 80%.

Carrying out mass screening for IUI is currently hardly possible for financial reasons. However, in cases where the expectant mother approaches the birth of a child with full responsibility and turns to an obstetrician-gynecologist at the pregnancy planning stage, it is necessary to prescribe a minimum amount of research for IUI - determination of IgG to the main pathogens - cytomegalovirus, toxoplasma, herpes simplex virus, rubella virus . The results of the study will make it possible to find out whether a woman belongs to any risk group. Carrying out preventive measures (for example, vaccination in case of rubella), as well as compliance by a woman at risk with recommendations for preventing infection during pregnancy will significantly reduce the risk of IUI in the unborn child.

The second important aspect of examination for IUI before pregnancy is the possibility of proving primary infection of the pregnant woman. Its presence is indicated by IgG seroconversion, which requires the use of invasive methods of fetal examination or termination of pregnancy at early stages.. If a pregnant woman first applies for registration in the second or third trimester, the determination of IgG class antibodies to IUI loses its relevance; in this case, it is more informative to determine IgM class antibodies, which are an indicator of primary infection and reactivation of chronic infection, as well as PCR. study.

In this case, laboratory methods should be considered secondary to clinical examination (including ultrasound). For diagnosing genital herpes, chlamydia, mycoplasmosis in pregnant women, direct methods (PCR, etc.) are more effective.

Article prepared by:

Enterovirus during pregnancy easily affects the female body, since at this moment the woman’s immunity is significantly weakened. It is insidious because of its mild symptoms, which can easily be attributed to other causes, and women often do not pay attention to the diarrhea or sore throat that occurs. Meanwhile, the consequences of this infection can be very serious.

A pregnant girl can easily become infected with enterovirus

In this article you will learn:

What are enteroviruses

The name of the pathology indicates that it is viral in nature. In ancient Greek, ἔντερον means “gut.” From this we can conclude that enteroviruses are localized and multiply in small intestine, subsequently spread throughout the body. They are formed from protein and ribonucleic acid. Modern medicine 64 strains of enteroviruses are known. The most studied polioviruses are the causative agents of such an insidious disease as polio.

It is known that 70% of infectious diseases are provoked by less studied echoviruses and Coxsackie viruses, which also belong to the group of enteroviruses.

They are divided into 2 groups: A and B. In both cases, the number of people affected by serious illnesses is very high. Children are more often susceptible to infection with enterovirus.

These viruses first infect the intestines and then spread to all organs

Causes of enterovirus infection

Enterovirus is rapidly transmitted in areas with high density population and low level culture. Greatest danger For a pregnant woman, it is not the patients themselves who represent them, but healthy virus carriers, which people, as a rule, are not wary of.

The microorganism is spread by the fecal-oral route, through contaminated food or raw water. Some strains of enteroviruses fall by airborne droplets and lead to upper respiratory tract diseases. The development period for these microorganisms ranges from 2 days to 2 weeks. In the gastrointestinal tract, viruses penetrate into the lymphatic formations and begin to multiply intensively there.

Enterovirus infection during pregnancy poses a danger not only to the mother, but also to the fetus. There have been cases of infection of the fetus through the placenta.

Symptoms in pregnant women

Signs of enterovirus infection are varied and depend on their location. The symptoms of infection do not depend on the period of gestation of the baby. Enterovirus during pregnancy in the 1st trimester behaves exactly the same as in the last.

The virus can manifest itself in the form of herpetic sore throat

Enteroviral herpes sore throat reveals itself by redness of the throat mucosa. Separate bubbles appear on the tonsils, uvula and palate. After a day or two, they open up on their own, and painful erosions form in their place. After 5-6 days, all changes go away on their own. In this case, the infection manifests itself with the following symptoms:

• chills,
• enlarged lymph nodes in the neck,
• headache,
• painful sensation when swallowing.

Enteroviral diarrhea is accompanied by the following symptoms:

• pain around the umbilical cord and in the pit of the stomach;
• frequent loose stools 8-10 times during the day;
• flatulence;
• nausea and vomiting.

Often pregnant women vomit profusely

Myalgia occurs when muscle tissue is damaged.

Enteroviral fever is difficult to diagnose if there are no other symptoms. It usually goes away on its own within 3 days.

Enteroviruses often become causative agents of diseases such as:

• inflammation of the heart muscle (myocarditis);
• liver diseases (hepatitis);
• encephalitis;
• inflammation of the uvea (uveitis);
• acute plegia (immobility) of the limbs.

Enteroviruses infect the central nervous system, digestive system, muscles and lungs.

Risks to the fetus and mother

During pregnancy, immunity is somewhat reduced, and therefore women are easily infected with enteroviruses and other microorganisms. Reduced immunity causes a number of complications.

If the mother had enterovirus, the child may develop hydrocephalus

Enterovirus, which easily penetrates the placenta in the early stages of pregnancy, causes a delay in fetal formation, placental insufficiency and polyhydramnios. The shorter the duration of pregnancy, the greater the danger of enterovirus for pregnant women. At an early stage of fetal development, the possibility of spontaneous abortion and pathogenic development of organs cannot be excluded, for example:

• heart defects;
• pathologies of the genitourinary organs.

Group B Coxsackie viruses lead to abortion and defects in fetal development: digestive, genitourinary and cardiovascular systems. Acute infection with Coxsackievirus enterovirus doubles the likelihood of abnormalities in the fetus. It was found that when infected with the Coxsackie viruses V3 and B4, children experienced cardiovascular disorders, and when infected with the A9 virus, developmental defects of the gastrointestinal tract were observed. Poliovirus infection also increases the incidence of terminated pregnancies, stillbirths, and intrauterine growth retardation, especially when infection occurs early in pregnancy. Echoviruses also cause spontaneous miscarriages and stillbirths.

Some viruses can cause miscarriages

Diagnostics

If a woman was already a carrier of an enterovirus at the time of conception, then the consequences of an enterovirus infection during pregnancy can be very sad for the unborn baby and result in the death of the fetus. Therefore, before planning a pregnancy, it is necessary to undergo a full examination, including the presence of intestinal virus strains in the body.

If an infection is suspected, diagnostic measures are carried out in the first days of infection, when the number of microorganisms in tissues and organs is maximum.

To differentiate the infection, serological testing methods are used:

• The presence of immunoglobulins to this group of viruses in the blood is determined. For this purpose, it is carried out linked immunosorbent assay(ELISA), which allows you to determine not only the nature adenovirus infection, but also to determine the serotype of the pathogen;
• Adenoviruses are isolated from feces. The study is scheduled no later than 3-5 days after the onset of the first symptoms;
• An immunofluorescent method is used, performed using special colored reagents. This diagnostic method allows you to detect infection at an early stage of infection;
• PCR diagnostics are carried out. The polymerase chain reaction is based on the isolation of enterovirus DNA from human blood. This method is the most accurate. It allows you to determine not only infection, but also virus carriage.

Accurate determination of enterovirus infection is necessary for differential determination of infection and targeted treatment. Modern methods make it possible to do this quickly and efficiently.

To identify a specific type of virus, a special blood test is performed

Treatment of pathology

There is no specific treatment against enterovirus infection. Nevertheless, therapeutic measures are necessary and can be carried out at any stage of pregnancy. For the purpose of antiviral therapy, Remantadine and Kagocel are prescribed.

The overall resistance of the body will be increased by immunostimulating drugs based on interferon: Grippferon nasal drops, Kipferon or Viferon suppositories. They will increase immunity and suppress enterovirus.

The immunomodulators Cytovir Amiksin and Cycloferon will have an anti-inflammatory effect and will stimulate the body's production of its own interferon, which will protect the body from the destructive effects of enteroviruses.

To lower the temperature, use Ibuprofen or Paracetamol. It is important to prevent the temperature from dropping below 38.5. Low temperature body in the early stages can cause miscarriage. Enterovirus infection in pregnant women in the 3rd trimester, accompanied by sudden changes body temperature, poses a risk of premature contractions and may result in childbirth. If your body temperature lasts longer than 3 days, you should consult a doctor.

Rehydron is an excellent remedy that is used for diarrhea.

Enteroviral diarrhea is fraught with dehydration. To avoid this, appoint saline solutions Regidron, Oralit, which should be drunk (1.5 liters), taking little by little throughout the day.

For herpangina, it is recommended to take disinfectants in the form of sprays and lozenges. The course of treatment is prescribed until the symptoms – cough and sore throat – completely disappear. Nasal rinsing is performed with a weak solution of sea salt.

Pathogenetic therapy, for example, for heart complications or inflammatory processes in the brain, should be prescribed by an appropriate specialist.

To avoid becoming infected with enterovirus, you should follow basic prevention rules.

Prevention of enterovirus infection

There are no special preventive measures against infection with enterovirus. A vaccine against this microorganism has also not been developed. Therefore, general preventive measures serve as protection against enterovirus strains.

How to protect yourself from enterovirus infection? Watch this video about it:

A pregnant woman needs:

1. Observe basic rules of personal hygiene.
2. Regularly carry out wet cleaning of premises and ventilate them.
3. Visit crowded places less often, especially during an epidemic of this type of infection.
4. Provide variety in diet. It must contain vegetables and fruits. Vitamin complexes must be present in the diet.

anonymous, Female, 37 years old

Good evening! I am 21 weeks pregnant, the conception was natural, there is no toxicosis, this Tuesday my temperature rose to 38.4 and my throat hurt badly, and since this Thursday I have an impossible itchy rash on my palms and soles, I didn’t sleep that night, it hurts to walk, today an infectious disease specialist diagnosed an enterovirus , there are small white ulcers in the mouth on the tonsils, the throat is almost gone, the temperature was only the first two days, the stool is normal, has not changed, there is an appetite, there is only one concern - how can this virus affect the fetus? I can’t take anything for allergies because I’m pregnant, it itches terribly - it’s painful, the doctors didn’t prescribe anything, they say there’s no cure, it goes away on its own. Tell me, please, how will this affect the baby, how long will the painful itching and rash last, what should I apply, what can I take orally? Thank you in advance! Sincerely, Anna (37 years old, weight 58.900, before pregnancy the weight was 52-53 kg for many years, height 170, blood type 1 positive, suffered from rubella and chickenpox in her youth, no AIDS, no hepatitis, congenital heart disease)

Good afternoon. Now there is no significant threat to the baby. Usually the 1st trimester is the most dangerous in terms of viral and bacterial infections. You have already had quite a long time, many organs and systems have already been formed, most likely everything will be fine. Now it is important not to overwork, rest more, drink a lot of warm liquids (so as not to irritate the throat), you can gargle, dissolve drugs such as Lizobakt. There are remedies for itching that are allowed for pregnant women after the 1st trimester, for example, Fenistil (gel and drops). Consult your doctor about this, if he allows, then the gel can be applied to the affected areas of the skin 2-4 times a day (if it is very severe itching- can be carefully combined with drops). The infection usually clears up within 3 to 10 days, depending on the activity of your immune system.

anonymously

Thank you, Olga Alexandrovna! We have already worked out the scheme with the doctor - it has started to help. Thanks for your recommendations. You matched my doctor. The itching began to go away by day 5 - the first three days from the onset of the rash, the main thing is to endure it, then it gets easier. And the infectious disease specialist wrote me a referral to the main infectious diseases hospital - and my instinct tells me that pregnant women should not go there even for a minute. What do you recommend? By the day I managed to make an appointment with them, my rash would have completely disappeared. So is there any point in going there at all?

Good afternoon. It’s good that a doctor has already examined you and given his recommendations. If now it is clearly getting better, the itching has gone away, nothing special is bothering you (maximum - slight weakness, fatigue, loss of appetite - this is a manifestation of asthenic syndrome, which can develop after any viral infection), then the need for an infectious diseases hospital is doubtful. You can go there for a consultation, but if at that time you do not have a rash or other manifestations of infection, then no one will admit you there (and they have no right if you refuse!).

anonymously

Thank you. They’re not going to put me in the hospital, it’s just that the infectious disease specialist suggested a consultation at the hospital, wrote out a referral, and I started thinking, is it even worth it for a pregnant woman to go to such a place?! Isn't it dangerous? Am I going to catch something else... I already feel good, the rash is turning pale and has practically disappeared.

Enterovirus infection is a group of diseases caused by intestinal viruses (enteroviruses). Manifestations of the disease are very diverse. Enteroviruses infect the central nervous system, digestive tract, lungs and muscles. What are the risks of enterovirus infection for a pregnant woman and her baby?

In recent years, there has been a trend towards an increase in enterovirus infection in the world. IN different countries outbreaks and even epidemics are being recorded all over the world. One of the reasons for such an active spread of infection is healthy virus carriage. It has been established that enteroviruses can exist in the human intestine for up to 5 months. The person does not experience any discomfort. The disease does not manifest itself, but active release of viral particles into the external environment occurs and infection of surrounding people occurs.

The causative agents of enterovirus infection are various representatives of the Enterovirus genus. This also includes the Coxsackie and ECHO viruses. More than 100 types of microorganisms pose a potential danger to humans.

The source of infection is a sick person or a virus carrier. Transmission of the virus occurs through airborne droplets or the fecal-oral route. Vertical transmission of infection is possible (from mother to fetus). The peak incidence occurs in summer and autumn. Young people under 25 years of age, including pregnant women, are at risk. After recovery, stable type-specific immunity is formed (to a certain type of enterovirus).

Symptoms

The virus enters the body through the mucous membranes of the digestive tract and upper respiratory tract. The proliferation of the microorganism leads to the development of local inflammation and the appearance of the first nonspecific symptoms of the disease:

• slight runny nose;
• pain and sore throat;
• fever.

After some time, the virus enters the blood and further into internal organs. One of the possible forms of enterovirus infection occurs:

Enterovirus herpangina

The disease manifests itself with the following symptoms:

• fever;
• headache;
• moderate soreness in the throat when swallowing;
• enlarged cervical lymph nodes.

Upon examination, redness of the mucous membrane of the throat is noteworthy. Bubbles up to 2 mm in size appear on the palate, uvula, and tonsils, but do not merge with each other. After 1-2 days, the vesicles open with the formation of slightly painful erosions. On the 5th-6th day of illness, all changes in the mucous membrane of the respiratory tract disappear on their own.

Enteroviral diarrhea

Typical symptoms:

• pain in the epigastric and umbilical region;
• nausea and vomiting;
• loose stool up to 7-10 times a day;
• flatulence.

Signs of enteroviral diarrhea are not specific and resemble the symptoms of any food poisoning. Quite often, diarrhea occurs against the background of a mild runny nose, sore throat and fever. All symptoms of the disease persist for 3-5 days. Pregnant women, due to a physiological decrease in immunity, enterovirus infection faces rapid progression with the development of severe intoxication and dehydration of the body.

Epidemic myalgia

With this form of the disease, severe muscle pain occurs in the anterior abdominal wall, lower abdomen, and limbs. The attack of pain lasts from 30 seconds to 15 minutes. Such symptoms are often mistaken for a threat of miscarriage (if pain is localized in the pubic area), which becomes the reason for hospitalization in an obstetric hospital.

Serous meningitis

A rare form of enterovirus infection. The disease begins with an increase in body temperature to 38-40 °C, severe chills, and severe headache. At the same time, other symptoms appear:

• muscle pain;
• abdominal pain;
• nausea and repeated vomiting;
• skin rashes;
• disturbance of consciousness;
• convulsions.

On days 2-3 from the onset of the disease, signs of damage to the membranes of the brain (stiff neck, etc.) appear. Meningitis with enterovirus infection usually occurs without complications and responds well to therapy.

Enteroviral fever

Other names: minor illness or three-day fever. A common but difficult to diagnose form of enterovirus infection. Characteristic is the appearance of moderate fever for 3 days with minimal changes in general condition. Goes away on its own without treatment.

Enteroviral exanthema

With this form of the disease, a rash appears on the skin after 1-2 days against the background of fever. The rash in the form of small reddish-pink spots is localized on the face, torso and limbs. The rash lasts for 1-2 days, after which it disappears without a trace.

Other forms of enterovirus infection

Enteroviruses can cause the following conditions:

• myocarditis (inflammation of the muscle tissue of the heart);
• encephalitis (brain damage);
• hepatitis;
• uveitis (inflammation of the choroid of the eye);
• acute paralysis of the limbs.

Complications of pregnancy and consequences for the fetus

Pregnant women are at high risk for infection with enteroviruses and the development of various complications. A decrease in immunity in anticipation of a baby leads to the fact that the virus easily penetrates a weakened body and spreads through the bloodstream. Penetrating through the placenta, enterovirus can cause the following conditions:

• placental insufficiency;
• delayed fetal development;
• polyhydramnios.

In the early stages of pregnancy, enterovirus infection can lead to embryo death and miscarriage. There is a very high probability of developing various defects of internal organs and the nervous system, including:

• hydrocephalus (impaired outflow of fluid from the membranes of the brain);
• heart defects;
• genitourinary defects.

The shorter the gestational age at the time of infection, the higher the likelihood of an unfavorable outcome. In the later stages, enterovirus infection can cause premature birth and the birth of a low birth weight baby.

The likelihood of fetal infection increases in women who are carriers of enterovirus. The virus circulating in the body is often activated during gestation due to physiological changes in the immune system. Women who first encountered the virus only during pregnancy are also at high risk for developing complications. The lack of protective antibodies leads to the rapid spread of infection and the penetration of a dangerous microorganism through the placenta.

Principles of treatment

Specific antiviral therapy is not prescribed. To increase the body's overall resistance, interferon-based drugs are used. Treatment is carried out at any stage of pregnancy. The duration of therapy is determined by the doctor taking into account the severity of the condition expectant mother.

When enteroviral diarrhea develops, it is important to prevent dehydration. For this purpose, glucose-saline solutions (Regidron, Oralit, etc.) are prescribed. The drug is diluted with water according to the instructions. The solution should be taken throughout the day in small sips (volume up to 1.5 liters per day) until the general condition improves. If signs of dehydration increase, treatment continues in the hospital.

To alleviate the condition of herpangina, antiseptic agents in the form of lozenges and sprays are used. The choice of drug will depend on the stage of pregnancy. The course of therapy is 5-7 days until the cough and sore throat disappear completely. To rinse the nose, you can use solutions based on sea water.

If the body temperature is high, antipyretics (paracetamol or ibuprofen) are used. Reducing the temperature below 38.5 °C is not recommended. Antipyretic drugs in the first trimester of pregnancy can lead to miscarriage and impaired fetal development, and in the third trimester they can cause premature birth. The course of therapy should not last more than 3 days. If the fever persists, you should definitely consult a doctor.

Prevention

Specific prevention of enterovirus infection has not been developed. Vaccination is not carried out for this pathology. Nonspecific prevention includes:

1. Compliance with personal hygiene rules.
2. Regular ventilation of premises, wet cleaning.
3. Refusal to visit crowded places during an epidemic of enterovirus infection.
4. Rational nutrition, taking vitamins.
5. Increasing the body's overall resistance to infections (hardening, walking, physical activity).

If you suspect an enterovirus infection during pregnancy, you should definitely consult a doctor.

Article prepared by:

Vasily Babkinsky

Enterovirus during pregnancy easily affects the female body, since at this moment the woman’s immunity is significantly weakened. It is insidious because of its mild symptoms, which can easily be attributed to other causes, and women often do not pay attention to the diarrhea or sore throat that occurs. Meanwhile, the consequences of this infection can be very serious.

A pregnant girl can easily become infected with enterovirus

What are enteroviruses

The name of the pathology indicates that it is viral in nature. In ancient Greek, ἔντερον means “gut.” From this we can conclude that enteroviruses are localized and multiply in the small intestine and subsequently spread throughout the body. They are formed from protein and ribonucleic acid. Modern medicine knows 64 strains of enteroviruses. The most studied polioviruses are the causative agents of such an insidious disease as polio.

It is known that 70% of infectious diseases are provoked by less studied echoviruses and Coxsackie viruses, which also belong to the group of enteroviruses.

Coxsackie viruses are divided into 2 groups: A and B. In both cases, the number of people affected by serious illnesses is very high. Children are more often susceptible to infection with enterovirus.

These viruses first infect the intestines and then spread to all organs

Causes of enterovirus infection

Enterovirus is rapidly transmitted in areas with high population density and low culture. The greatest danger to a pregnant woman is not the patients themselves, but healthy virus carriers, whom people, as a rule, are not careful about.

The microorganism is spread by the fecal-oral route, through contaminated food or raw water. Some strains of enteroviruses enter by airborne droplets and lead to upper respiratory tract diseases. The development period for these microorganisms ranges from 2 days to 2 weeks. In the gastrointestinal tract, viruses penetrate into the lymphatic formations and begin to multiply intensively there.

Enterovirus infection during pregnancy poses a danger not only to the mother, but also to the fetus. There have been cases of infection of the fetus through the placenta.

Symptoms in pregnant women

Signs of enterovirus infection are varied and depend on their location. The symptoms of infection do not depend on the period of gestation of the baby. Enterovirus during pregnancy in the 1st trimester behaves exactly the same as in the last.

The virus can manifest itself in the form of herpetic sore throat

Enteroviral herpes sore throat reveals itself by redness of the throat mucosa. Separate bubbles appear on the tonsils, uvula and palate. After a day or two, they open up on their own, and painful erosions form in their place. After 5-6 days, all changes go away on their own. In this case, the infection manifests itself with the following symptoms:

• chills,
• enlarged lymph nodes in the neck,
• headache,
• painful sensation when swallowing.

Enteroviral diarrhea is accompanied by the following symptoms:

• pain around the umbilical cord and in the pit of the stomach;
• frequent loose stools 8-10 times during the day;
• flatulence;
• nausea and vomiting.

Often pregnant women vomit profusely

Myalgia occurs when muscle tissue is damaged.

Enteroviral fever is difficult to diagnose if there are no other symptoms. It usually goes away on its own within 3 days.

Enteroviruses often become causative agents of diseases such as:

• inflammation of the heart muscle (myocarditis);
• liver diseases (hepatitis);
• encephalitis;
• inflammation of the uvea (uveitis);
• acute plegia (immobility) of the limbs.

Enteroviruses infect the central nervous system, digestive system, muscles and lungs.

Risks to the fetus and mother

During pregnancy, immunity is somewhat reduced, and therefore women are easily infected with enteroviruses and other microorganisms. Reduced immunity causes a number of complications.

If the mother had enterovirus, the child may develop hydrocephalus

Enterovirus, which easily penetrates the placenta in the early stages of pregnancy, causes a delay in fetal formation, placental insufficiency and polyhydramnios. The shorter the duration of pregnancy, the greater the danger of enterovirus for pregnant women. At an early stage of fetal development, the possibility of spontaneous abortion and pathogenic development of organs cannot be excluded, for example:

• hydrocephalus;
• heart defects;
• pathologies of the genitourinary organs.

Group B Coxsackie viruses lead to abortion and defects in fetal development: digestive, genitourinary and cardiovascular systems. Acute infection with Coxsackievirus enterovirus doubles the likelihood of abnormalities in the fetus. It was found that when infected with the Coxsackie viruses V3 and B4, children experienced cardiovascular disorders, and when infected with the A9 virus, developmental defects of the gastrointestinal tract were observed. Poliovirus infection also increases the incidence of terminated pregnancies, stillbirths, and intrauterine growth retardation, especially when infection occurs early in pregnancy. Echoviruses also cause spontaneous miscarriages and stillbirths.

Some viruses can cause miscarriages

Diagnostics

If a woman was already a carrier of an enterovirus at the time of conception, then the consequences of an enterovirus infection during pregnancy can be very sad for the unborn baby and result in the death of the fetus. Therefore, before planning a pregnancy, it is necessary to undergo a full examination, including the presence of intestinal virus strains in the body.

If an infection is suspected, diagnostic measures are carried out in the first days of infection, when the number of microorganisms in tissues and organs is maximum.

To differentiate the infection, serological testing methods are used:

• The presence of immunoglobulins to this group of viruses in the blood is determined. For this purpose, an enzyme-linked immunosorbent assay (ELISA) is used to determine not only the nature of the adenovirus infection, but also the serotype of the pathogen;
• Adenoviruses are isolated from feces. The study is scheduled no later than 3-5 days after the onset of the first symptoms;
• An immunofluorescent method is used, performed using special colored reagents. This diagnostic method allows you to detect infection at an early stage of infection;
• PCR diagnostics are carried out. The polymerase chain reaction is based on the isolation of enterovirus DNA from human blood. This method is the most accurate. It allows you to determine not only infection, but also virus carriage.

Accurate determination of enterovirus infection is necessary for differential determination of infection and targeted treatment. Modern methods make it possible to do this quickly and efficiently.

To identify a specific type of virus, a special blood test is performed

Treatment of pathology

There is no specific treatment against enterovirus infection. Nevertheless, therapeutic measures are necessary and can be carried out at any stage of pregnancy. For the purpose of antiviral therapy, Remantadine and Kagocel are prescribed.

The overall resistance of the body will be increased by immunostimulating drugs based on interferon: Grippferon nasal drops, Kipferon or Viferon suppositories. They will increase immunity and suppress enterovirus.

The immunomodulators Cytovir Amiksin and Cycloferon will have an anti-inflammatory effect and will stimulate the body's production of its own interferon, which will protect the body from the destructive effects of enteroviruses.

To lower the temperature, use Ibuprofen or Paracetamol. It is important to prevent the temperature from dropping below 38.5. Low body temperature in the early stages can cause miscarriage. Enterovirus infection in pregnant women in the 3rd trimester, accompanied by sudden changes in body temperature, poses a risk of premature contractions and can result in childbirth. If your body temperature lasts longer than 3 days, you should consult a doctor.

Rehydron is an excellent remedy that is used for diarrhea.

Enteroviral diarrhea is fraught with dehydration. To avoid this, saline solutions Regidron and Oralit are prescribed, which should be drunk (1.5 liters), taking little by little throughout the day.

For herpangina, it is recommended to take disinfectants in the form of sprays and lozenges. The course of treatment is prescribed until the symptoms – cough and sore throat – completely disappear. Nasal rinsing is performed with a weak solution of sea salt.

Pathogenetic therapy, for example, for heart complications or inflammatory processes in the brain, should be prescribed by an appropriate specialist.

To avoid becoming infected with enterovirus, you should follow basic prevention rules.

Prevention of enterovirus infection

There are no special preventive measures against infection with enterovirus. A vaccine against this microorganism has also not been developed. Therefore, general preventive measures serve as protection against enterovirus strains.

How to protect yourself from enterovirus infection? Watch this video about it:

A pregnant woman needs:

1. Observe basic rules of personal hygiene.
2. Regularly carry out wet cleaning of premises and ventilate them.
3. Visit crowded places less often, especially during an epidemic of this type of infection.
4. Provide variety in diet. It must contain vegetables and fruits. Vitamin complexes must be present in the diet.
5. Pay attention to your health, spend more time in the fresh air, take walks, do simple dancing, and do physical exercise.

Fruits and vegetables that are not subject to heat treatment, after you wash off the top dirt from them, it is recommended to put them in a hot (60-70 ° C) solution of baking soda for 10 minutes, which is prepared at the rate of 1 teaspoon per 1 liter of water. Hot water will melt the existing wax, and the soda will have a disinfecting effect.

Vasily Babkinsky

Hello, my name is Vasily. For 7 years now I have been helping people with intestinal problems, working in the first private clinic in Brno. I will be happy to answer your questions about the article in the comments; you can ask our doctors other questions on this page.

Sooner or later, every woman makes an important decision in life to become a mother. And, as a rule, she becomes it. However, not every such pregnancy proceeds in the way we would like. Various complications and infections can significantly disrupt both the plans of the expectant mother and the course of pregnancy as a whole.

For example, an enterovirus infection in a pregnant woman may well be a cause for serious concern. And then there will be a serious risk for both the woman and the fetus. But how serious is it and is it really worth worrying? It’s worth looking into in more detail.

Sources of infection and symptoms

Enterovirus infection is not an independent disease. This is a whole group of illnesses and symptoms that are usually caused by intestinal viruses. The most common methods of infection with enterovirus infection are airborne transmission of enterovirus followed by infection through the fecal-oral route.

Why are these viruses so scary and can they cause harm both to the woman herself and to her unborn child? How does the infection affect the body and what are the primary symptoms of the disease?

Enterovirus infection most often enters the body through the mucous canals of the digestive system or through the respiratory tract. In this case, the infection, once in a comfortable environment for it, begins to actively multiply, thereby causing local inflammation in the body. This process is accompanied by a number of completely nonspecific symptoms: chills, fever, painful sensations sore throat and minor runny nose.

The named manifestations are characteristic only at first, until enteroviruses penetrate into the blood and with it into all internal organs. When the infection spreads, one of the forms of enterovirus infection occurs.

Forms of the disease

As already mentioned, the causes of enterovirus infection are quite common and infection can occur even if all precautions and disinfection are observed on the part of the woman. Today, more than a dozen forms of varieties of this infection are distinguished. Let's look briefly at each of them:

1. Herpangina caused by an enterovirus attack. It manifests itself as a cold: headache, chills and fever, pain in the throat when swallowing and a slight increase in lymphatic nodes. At the same time, tiny bubbles are formed on the tonsils and palate, similar to the manifestation of a sore throat, but after 5 days these symptoms disappear, although the disease progresses further.

2. Enteroviral diarrhea. The flow is very similar to food poisoning against the background of cold symptoms. However, this form is characterized by: flatulence, strong loose stools 9-10 times a day, vomiting, nausea and abdominal pain.

Agree, pregnancy is not a very attractive state of health. Which, on top of everything else, will worsen further and cause dangerously severe intoxication and dehydration of the body as a whole. This happens due to physiologically low immunity during pregnancy.

3. Epidemic myalgia. One of the dangerous forms of the disease during pregnancy. Characterized by severe attacks of muscle pain in the limbs and abdomen lasting from half a minute to 15 minutes. The sensations and symptoms are very similar to the threat of miscarriage in a woman. Therefore, with this form, expectant mothers often end up in an obstetric hospital.

4. This form is very rare, but it cannot be ruled out - serrous meningitis. It is characterized by: high body temperature up to 40 degrees, repeated vomiting, convulsions, severe chills, abdominal pain, skin rashes.

Already on the 3rd day, it becomes clear that the membranes of the brain are affected by enterovirus infection, manifested in the rigidity of the neck muscles. However, this form is very treatable and usually has no consequences for the expectant mother and fetus.

5. You can recover from enterovirus infection within 3 days. This is the so-called enteroviral fever. Which is very similar to the flu and goes away on its own after 3 days without treatment.

Enteroviral exanthema occurs in approximately the same way. The same fever, but also a rash of small pinkish spots all over the body. For 2 days all this continues and then disappears without a trace. As you can see, such infections are very alarming and pregnant women are unlikely to want to have them while carrying a child.

6. Other forms of the disease that can be caused by enteroviruses. Against the background of infection, the following may occur: myocarditis, encephalitis, uveitis, acute paralysis of the limbs. Everything will depend on where exactly the enterovirus infection has penetrated and where its final breeding ground will be.

Dangerous periods and possible treatment for expectant mothers if infected

Speaking about dangerous periods of the disease with enterovirus infection, it is worth immediately saying that in general, in principle, contact of a pregnant woman with a patient with enterovirus infection is in itself a risk and it is better to avoid it in principle.

Such contacts are most unfavorable in the first trimester of pregnancy. Because the consequences that such viruses can provoke can pose a serious danger to the mother and child.

What are the consequences?

The fact is that enterovirus infection easily penetrates the placenta and can cause: placental insufficiency, delayed development of the fetus as a whole, polyhydramnios, embryonic death, hydrocephalus in the baby, and can also cause heart defects or genitourinary tract defects in the baby.

That is why it is not permissible for a woman to have contact, and especially to be infected, during pregnancy. The risk of miscarriage and the development of all kinds of defects in the unborn baby is very high.

Invisible virus

Expectant mothers should also be wary of another terrible enterovirus attack. This is the so-called coxsackie virus, which may not manifest itself in any way during pregnancy, but may appear directly during childbirth or immediately after it.

What kind of infection is this and why does it manifest itself differently compared to other enteroviruses? And is there a treatment for enterovirus in pregnant women?

We cannot talk only about such infections, because during the period of waiting for a child, any infection can cause damage to health. But still, it’s worth knowing more about coxsackie. It is this infection that can provoke itself like all the forms described above and manifest itself in any of the forms. It is not easy to detect such infections during pregnancy, but their detrimental effect on the placenta is nevertheless very great.

How to detect that a woman is infected with an infection?

For this, the patient must undergo blood and urine tests and undergo a brain EMR. A blood test reveals markers produced by the body in the blood that act as a protective shield against such infections. Comprehensive diagnostics gives a one hundred percent answer to the presence or absence of the disease.

How to fight?

If a girl during pregnancy in the initial trimester does not receive treatment on time, the harm to the placenta can be significant. The treatment itself is symptomatic depending on the location of the lesion and the organ of localization. Self-medication is unacceptable.

As a preventive measure it is worth:

Temper yourself

Get a good night's sleep

Check with your doctor regularly

Eat well and drink strictly boiled water

Spend less time in crowded places

Ventilate your room more often.

But even if you follow all the measures, there is still a risk, so do not neglect meetings with your gynecologist!

Enterovirus infection is spread by airborne droplets, fecal-oral route, or through contact with a patient. The pathogen can also be transmitted from mother to child. Enterovirus can become more active at the end of pregnancy when the immunity of the virus-carrying woman decreases. Primary infection cannot be ruled out.

Enterovirus is very stable in the external environment, so it is not advisable for expectant mothers to have contact with sick and recovered people. They can remain carriers of infection for up to 5 months after illness. The peak incidence of enterovirus infection occurs in summer and autumn.

The danger of enteroviruses

During pregnancy, the expectant mother is more defenseless due to a physiological decrease in protective reactions in the body. Coxsackie viruses, ECHO and others, which have the ability to multiply in intestinal cells, can cause enterovirus infection. They are very dangerous for pregnant women, especially if their immunity is reduced. The disease often manifests itself as ARVI, which is also accompanied by intestinal manifestations.

Fortunately, the pathology does not always develop in a severe form, but this cannot be ruled out. Women who experience such an infection during the first trimester are at risk of miscarriage and may not be able to carry a child to term. In addition, for several months after recovery they remain carriers of infection.

If the disease becomes severe, the central nervous system and internal organs are affected. Heart problems are especially dangerous: myocarditis, pericarditis, endocarditis. Infectious myocarditis sometimes complicated by autoimmune disorders.

With enterovirus infection, due to the active reproduction of pathogens, the stomach, intestines, lungs and other organs can also be affected. Such conditions often take a long time to resolve, are poorly treated and complicate the process of delivery.

Enterovirus infection sometimes causes complications in other organs: kidneys, liver and pancreas. If there are problems with the latter, the risk increases diabetes mellitus 1 type.

Symptoms

Having overcome the mucous membranes, viral agents penetrate the human body. They multiply and cause local inflammatory foci. Early signs of infection appear in the form of the following conditions:

• runny nose;
• sore throat and sore throat;
• febrile manifestations.

Then the infection further spreads throughout the body. One of the pathologies caused by the virus may occur: enteroviral diarrhea, epidemic myalgia, serous meningitis, enteroviral exanthema and others.

Complications of pregnancy due to enteroviruses

In the third trimester, with enterovirus, there may be a risk of premature birth and underweight in the newborn. At the beginning of pregnancy, the virus can cause miscarriage. The risk of infection of the fetus increases many times if a woman is a carrier of an enterovirus; the pathogen can become active during gestation.

The second trimester is usually the safest for the fetus.

Pregnant women are especially at risk of becoming infected with enteroviruses due to weakened immunity. At the same time, various complications are very possible not only for the expectant mother, but also for the baby. By crossing the barrier of the placenta, enteroviruses cause the following pathologies:

• placental insufficiency;
• anomalies and delay in fetal development;
• polyhydramnios.

An enterovirus infection during pregnancy that occurs in the first trimester can result in complications. There is a high probability of various pathologies:

• hydrocephalus;
• heart disease;
• defect of the genitourinary system.

The shorter the gestational age, the more fatal the infection is, and this often leads to an unfavorable outcome. When the mother is a virus carrier, the child is often born infected as well. If a pregnant woman is sick for the first time, then, most likely, complications for her or the baby cannot be avoided, since the woman does not yet have protective antibodies. Without any obstacles, the enterovirus instantly spreads throughout her body and penetrates the placenta.

The danger of enterovirus for a newborn

When an enterovirus develops in a nursing mother, the baby acquires antibodies to the pathogen in advance. They enter his body with milk, and are formed in the first minutes after a woman meets the antigen. It is these antibodies that protect the child from infection.

The immune system of the infant natural feeding develops protection against viruses, so it is recommended not to stop breastfeeding when sick.

For infants, Coxsackie viruses are considered the most dangerous. They can lead to severe infections. This is, for example, encephalomyocarditis in children. It can occur in epidemics in maternity hospitals. The course of the disease is severe and can lead to the death of the baby. The disease usually progresses rapidly.

How to avoid illness

To reduce the risk of contracting enterovirus infection, pregnant women must follow the following rules:

• do not visit places where there are many people;
• carefully observe personal hygiene;
• process vegetables and fruits well;
• do not swim in rivers or lakes with dirty water, where swimming is prohibited;
• try not to have contact with sick family members;
• breathe fresh air, walk more;
• don't get too cold.

To prevent complications in both mother and baby, you need to monitor hygiene and maintain correct image life.

Treatment

Treatment of enterovirus infection is carried out at different stages of pregnancy, but only the attending physician prescribes the drugs and duration of therapy. A pregnant woman should not self-medicate.

To improve immunity, treatment is carried out using drugs containing interferon. If you have diarrhea, the main thing is to avoid dehydration. For this purpose, glucose-saline solutions (Regidron) are prescribed.

If there is no improvement after taking the drugs, therapy is continued in a hospital setting.

To relieve enterovirus herpangina, one of the types of infection, use antiseptic agents (lozenges, sprays). Medicines are chosen taking into account the duration of pregnancy. The drugs are usually taken for about a week until the symptoms disappear.

Saline solutions are effective means for nasal rinsing. If the body temperature rises to 39 C, then take medications that lower the temperature. It is not advisable to use them in the early stages of expecting a child - they can cause miscarriage and fetal pathologies. Such treatment should last no more than 3 days. If you have a prolonged fever, you should urgently call a doctor.

Prevention

There are no special preventive measures for enteroviral diseases. Vaccination is not usually carried out. To avoid infection, you need to follow some rules:

• maintain personal hygiene;
• regularly ventilate rooms and carry out wet cleaning;
• do not visit crowded places during epidemics;
• eat right, take vitamins;
• increase immunity.

If you follow basic rules during pregnancy, you can protect yourself from dangerous illnesses and keep your baby healthy.

Conclusion

Enteroviral infections are a whole group of diseases that are provoked by intestinal viruses. These pathogens are very dangerous during pregnancy, as they can harm the mother and baby or even lead to the loss of the baby.

Enteroviruses can affect a variety of organs, including the central nervous system and digestive tract, lungs and muscles. You should try to avoid infection and follow the usual rules healthy image life. At the first symptoms, it is advisable to immediately consult a doctor.