Book of Medical Disorders in Pregnancy - Tintash

Varicella, (Chickenpox) - This is quite
uncommonly seen in pregnancy.
Incubation period is 14 to 16 days. The
period of contagiousness is from one day
before to two days after appearance of
the rash. Viremia is a regular feature but
transmission to the fetus is un
predictable. Prospective studies do not
indicate significant increase .in abortions
or con- genital anomalies following
maternal infection; although a number of
pub-lished case reports suggest that at
times there may be an association. When
varicella occurs near term, there is
greater risk of congenital infection. The
closer to the time of delivery the
maternal infection occurs, the greater
there is the risk of severe course
including death. In general, neonatal
infections are mild’ with few skin
lesions and no significant systemic
symptoms usually occur.
Fig13.8: Shows smallpox rash over the
face.
Variola (Smallpox) - This disease is
now very rare even in the general
population. Older reports indicate that
the mortality rate was significantly
higher in pregnant than non pregnant
women. Abortion, still birth and
premature labor were frequently
encountered. Immunization with
vaccinia virus is not without hazard,
since the vaccine contains live virus.
Viremia occurs in the course of primary
infection and like smallpox virus;
vaccinia can cause les-ions in the
placenta and be transmitted to the foetus.
172
Intrauterine infection and congenital
disease are seen chiefly in infants whose
mothers received their first
immunization during pregnancy,
although it has been reported after revaccination.
Vaccination whether pri-mary
or revaccination, thus continues to be
contraindicated in pregnancy.
Influenza: The available evidence at
present suggests that usually there are
adverse effects of influenza infection
during the first trimester of pregnancy.
Both abortion and congenital defects
have been reported. There is no
conclusive evidence that influenza
causes congenital defects. Anencephaly
and other CNS malformations have been
reported, but their significance has been
difficult to confirm. Other anomalies
reported are cleft palate and oesophageal
atresia. It has been reported that when
infection occurs late in pregnancy the
infant mortality rate is increased as a
result of the high incidence of premature
delivery. The infants born at term may
have low birth weight.
Echo viruses:
This group of virus does not appear to be
teratogenic to the foetus.
Coxsackie virus - Woman infected with
this virus may have no symptoms or may
complain of upper respiratory tract
infection. The virus may cross the
placenta to cause a fierce infection in the
neonate with fever, diarrhoea
tachycardia, circulatory collapse and
death. There is no evidence that the
disease is teratogenic.
Screening against viral infections in
pregnancy: The student will realize at
this stage that screening for (TORCH)