Book of Medical Disorders in Pregnancy - Tintash

where 'T' stands for toxoplasmosis 'R'
stands for rubella 'C' stands for
cytomega lo virus and 'H' stands for
Herpes, should become a part of routine
antenatal screening in all pregnant
women in this country.
Immunization:
A practicing obstetrician is often
confronted with a pre-gnant woman who
is susceptible to a disease against which
a particular vaccine is protective, and
has to make a decision whether to
vaccinate her or not. As a rule the use of
immunizing agents during pregnancy
should be reserved for high risk cases
only. Live virus vaccines, in particular,
should be avoided.
Prophylactic therapy: During
pregnancy, it is preferable to reduce
exposure rather than vaccinate,
especially hen. Live virus vaccines are
involved. A pregnant woman can avoid
certain diseases by not entering areas
endemic for those diseases. She should
be advised against travel in areas
endemic for plague, yellow fever, or
smallpox unless, it is absolutely
necessary for her to make such journey.
Sanitary precautions will decrease the
chance of exposure to typhoid, cholera,
and hepatitis.
Types of Vaccines: Generally three
different types of vaccines are used for
immunization purposes. These are
toxoids, killed bacterial and viral
vaccines, and live virus vaccines. The
toxoids are preparations of chemically
altered bacterial exotoxin. The killed
vaccines contain heated, chemically
inactivated microorganisms. The live
virus vaccines contain strains of virus
selected for their reduced virulence. The
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other type of immunizing agent is
gamma globulin, which is a protein
fraction of human plasma. This can
produce a transient, passive antibody
protection in the recipient. The pooled
gamma globulin is also useful but only
for protection against hepatitis or against
measles.
Criteria for vaccination:
Pregnancy should be confirmed in the
first trimester, since ten fetuses is most
vulnera-ble to the teratogenic effect of
maternal infections during this period. If
live virus vaccine is to be given, then
pregnancy must be prevented in the
following 2 months. As a rule live
vaccines such as rubella should not be
given during pregnancy.
Susceptibility should be determined:
Once it is established that the patient is
pregnant, her susceptibility to the
particular vaccine preventable disease,
should be determined. Serologic testing
should be used to confirm susceptibility.
If the test is positive, only then vaccine
should be given to the patient.
When it is determined that expo-sure is
likely or unavoidable and the patient has
been tested for susceptibility then the
Obstetrician must balance the hazards of
the disease against the pot-ential
deleterious effects of vaccination.
Risk from disease to the pregnant
woman - In the case of tetanus, the high
morbidity and mortality does not change
during pregnancy. Smallpox (variola
major), produces a significantly higher
mortality. According to one estimate it is
around 90% among pregnant females but
far less in non-pregnant women.