Preface
Contents
Editors and Contributors
About the Editors
Contributors
Part I: Changes in Pregnancy: An Overview
1: Changing Epidemiology of Infections in Pregnancy: A Global Perspective
1.1 Introduction
1.2 Emerging Pathogens and Pregnancy
1.3 Mitigating Challenges in the Management of Emerging Pathogens
1.4 Rise of Antimicrobial Resistance and Syndromic Management Protocols
1.5 Immunization, Vaccines and their Untapped Potential in Pregnancy
1.6 Evolving Challenge of Maternal Sepsis
1.7 Conclusion
References
2: Pregnancy Changes Predisposing to Infections
2.1 Introduction
2.2 Anatomical and Physiological Changes of Pregnancy
2.2.1 Respiratory System
2.2.2 Cardiovascular System
2.2.3 Urinary System
2.3 Changes in Microbiome During Pregnancy
2.3.1 Gut Microbiome
2.3.2 Vaginal Microbiome
2.4 Modulated Immunology in Pregnancy
2.4.1 Immune Cell Types
2.4.2 Th1 to Th2 Shift
2.4.3 Clinical Implications of Altered Immunology in Pregnancy
2.5 Maternal-Fetal Interface
2.5.1 Structure and Location of Placenta
2.5.2 Antiviral Factors
2.5.3 Passive Immunity Transfer
2.5.4 Intracellular Defense
2.6 Microbiology
2.7 Pregnancy and Severity of Infection
2.7.1 Influenza Virus Infection
2.7.2 Herpes Simplex Hepatitis
2.7.3 Hepatitis E Infection
2.7.4 Varicella Infection
2.7.5 Coccidioidomycosis
2.8 Pregnancy and Increased Susceptibility to Infection
2.8.1 Malaria
2.8.2 Listeriosis
2.9 Conclusion
References
3: Microbiome in Pregnancy
3.1 Introduction
3.2 Gut Microbiome
3.2.1 Composition of Gut Microbiome in Healthy Individual
3.2.2 Gut Microbiome in Pregnancy
3.3 Oral Microbiome
3.3.1 Composition of Oral Microbiome of Healthy Individual
3.3.2 Oral Microbiome in Pregnancy
3.4 Placental Microbiome
3.5 Vaginal Microbiome
3.6 Composition of Vaginal Microbiome in Healthy Individual
3.7 Vaginal Microbiome in Pregnancy
3.8 Uterine Microbiome
3.9 Conclusion
References
Part II: Respiratory Infections in Pregnancy: Management and Challenges
4: Bacterial and Fungal Pneumonia
4.1 Introduction
4.2 Definitions
4.2.1 Community-Acquired Pneumonia (CAP)
4.2.2 Hospital-Acquired Pneumonia (HAP)
4.2.3 Ventilator-Associated Pneumonia (VAP)
4.3 Clinical Profile
4.3.1 History
4.3.2 Clinical Examination
4.4 Epidemiology and Microbiology
4.5 Diagnosis
4.5.1 Chest Radiograph
4.5.2 Computed Tomography (CT)
4.5.3 Thoracic Ultrasound
4.5.4 Microbiological Investigations
4.5.5 Ancillary Investigations
4.6 Severity Assessment and Site of Care Decision
4.7 Treatment
4.7.1 Supportive Management
4.7.2 Oxygen Therapy
4.7.3 Antibiotic Therapy
4.7.4 CAP
4.7.4.1 Non-Severe Cases Without Comorbidities for Outpatient Management
4.7.4.2 Hospitalized Non-ICU Cases
4.7.4.3 Hospitalized ICU Cases
4.7.5 Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia (HAP/ VAP)
4.8 Fungal Pneumonia
4.8.1 Management of Fungal Pneumonia
4.8.1.1 Candida
4.8.1.2 Invasive Aspergillosis
4.8.1.3 Pulmonary Mucormycosis
4.9 Conclusion
References
5: Influenza and Influenza-Like Illness
5.1 Introduction
5.1.1 Definitions
5.1.1.1 ILI Case Definition [3]
5.1.1.2 SARI Case Definition [3]
5.2 Causes
5.3 Clinical Manifestations
5.4 Diagnosis
5.5 Clinical Course in Pregnancy
5.5.1 Maternal Effects
5.5.2 Fetal Effects
5.6 Management
5.6.1 Symptomatic Patients
5.6.2 Healthy Term Newborns of Symptomatic Mothers
5.6.3 Infant Caregivers and Household Contacts
5.7 Breastfeeding
5.8 Protection of Pregnant Healthcare Workers
5.9 Therapeutics
5.9.1 Antiviral Medications
5.9.2 Antipyretics
5.9.3 Symptomatic Therapy
5.9.4 Role of Antibiotics
5.9.5 Management of ARDS
5.10 Obstetrical Management
5.11 Prevention
5.11.1 Vaccination
5.11.1.1 Benefits of Vaccination
5.11.1.2 Safety of the Vaccine
5.11.2 Antiviral Prophylaxis [12]
5.11.2.1 Candidates
5.11.2.2 Drug Regimen
5.12 Infection Control Measures
5.12.1 Precautions
5.13 Conclusion
References
6: Tuberculosis in Pregnancy
6.1 Introduction
6.2 Epidemiology
6.3 Etiology and Risk Factors
6.3.1 Risk Factors for TB
6.4 Clinical Features
6.4.1 Pulmonary Tuberculosis
6.4.2 Pleural Tuberculosis
6.4.3 Extra-Pulmonary Tuberculosis
6.4.4 Other Extra-Pulmonary Tuberculosis
6.5 Diagnosis
6.5.1 Hematological Changes
6.5.2 Tests to Identify Tubercular Bacilli
6.5.2.1 Microscopy
6.5.2.2 Culture
6.5.2.3 Molecular Detection: Nucleic Acid Amplification Tests
6.5.2.4 Tuberculin Skin Testing (TST)
6.5.2.5 Interferon-Gamma Release Assay (IGRA)
6.5.2.6 Chest X-ray
6.5.2.7 Tissue Diagnosis
6.5.2.8 Magnetic Resonance Imaging of Brain
6.5.2.9 ECG and Echocardiogram
6.5.2.10 CSF Examination
6.6 Effect of TB Infection on Pregnancy
6.7 Effect of Pregnancy on TB
6.8 Fetal Effects of Maternal TB
6.8.1 HIV and TB Coinfection
6.8.2 Classification of Tuberculosis
6.9 Treatment of TB in Pregnancy
6.9.1 CDC Recommendations for Treatment of Tuberculosis in Pregnancy
6.10 Breastfeeding
6.10.1 Pyridoxine Supplementation
6.11 Multidrug-Resistant TB (MDR-TB) in Pregnancy
6.12 Prevention of Tuberculosis
6.13 Conclusion
References
7: Pregnancy and COVID-19: Management and Challenges
7.1 Introduction
7.2 Testing and Triage
7.3 Antenatal Management
7.3.1 Medical Management
7.3.2 Fetal Monitoring
7.3.3 Monitoring for Preterm Labor
7.3.4 Discharge and Follow-Up
7.4 Labor and Delivery
7.4.1 Maternal and Fetal Monitoring During Labor
7.4.2 Labor Analgesia and Anaesthesia in Patients with Known or Suspected COVID-19
7.4.3 Use of Magnesium Sulfate in Patients with Respiratory Compromise
7.5 Postpartum Management
7.6 Management of Newborn
7.6.1 Newborn Testing
7.7 Breastfeeding and COVID-19 Infected Mother
7.8 Conclusion
Suggested Reading
Part III: Viral Infections
8: CMV Infection in Pregnancy: An Updated Overview
8.1 Introduction
8.2 Epidemiology
8.3 Classification of Maternal Infection
8.4 Transmission to Fetus
8.5 Clinical Features
8.6 Diagnosis of Maternal Infection
8.7 Diagnosis of Fetal Infection
8.8 Congenital CMV Infection
8.8.1 Differential Diagnosis of Congenital CMV
8.9 Prenatal Treatment
8.10 Vaccine
8.11 Prevention
8.12 Conclusion
References
9: Varicella, Rubella and Rubeola
9.1 Varicella Zoster Virus Infection
9.1.1 Epidemiology
9.1.2 Pathogenesis and Transmission
9.1.2.1 Transmission
9.1.3 Clinical Features
9.1.4 Effect of Varicella on Pregnancy
9.1.5 Diagnosis
9.1.5.1 Congenital Varicella Syndrome
9.1.6 Management of Maternal VZV Infection
9.1.7 Post-exposure Prophylaxis
9.1.8 Pre-exposure Prophylaxis
9.1.8.1 Dosage
9.2 Rubella
9.2.1 Introduction
9.2.2 Epidemiology
9.2.3 Clinical Manifestations
9.2.4 Effect of Rubella Infection on Pregnancy
9.2.5 Diagnosis
9.2.5.1 Prenatal Diagnosis
9.2.6 Treatment
9.2.7 Prevention
9.3 Rubeola (Measles)
9.3.1 Introduction
9.3.2 Epidemiology
9.3.3 Pathogenesis and Transmission
9.3.3.1 Transmission
9.3.4 Clinical Features
9.3.5 Effect of Measles on Pregnancy
9.3.6 Diagnosis
9.3.7 Treatment
9.3.8 Measles/Rubella Vaccination
9.3.8.1 Summary and Recommendations
9.4 Conclusion
Appendix
References
10: Parvovirus B19 Infection: Significance and Implications in Pregnancy
10.1 Introduction
10.2 Epidemiology
10.3 Morphology of the Virus
10.4 Pathogenesis and Transmission
10.4.1 Virus Transmission
10.5 Clinical Presentation
10.5.1 Maternal
10.5.2 Fetal and Neonatal Manifestations
10.5.2.1 Hydrops Fetalis
10.5.2.2 Congenital Anemia
10.5.2.3 Thrombocytopenia
10.5.2.4 Myocarditis
10.5.2.5 Neurological Deficits
10.5.2.6 Congenital Anomalies
10.6 Diagnostic Evaluation
10.6.1 Prenatal Diagnostic Testing
10.7 Infection During Pregnancy
10.7.1 Exposure During Pregnancy
10.8 Treatment
10.8.1 Role of Immunoglobulins
10.8.2 Fetal Therapy
10.9 Prevention and Control
10.10 Advances in Vaccine Development
10.11 Conclusion
References
11: Viral Hemorrhagic Fever
11.1 Introduction
11.2 Pathophysiology
11.3 Etiological Agents
11.3.1 Filoviruses
11.3.2 Flaviviridae
11.3.3 Arenaviridae
11.4 Ebola Virus Disease (EVD) and Marburg Virus Disease (MVD)
11.4.1 Epidemiology
11.4.2 Pathogenesis of Ebola and Marburg Virus Disease in Pregnancy
11.4.2.1 Transmission
11.4.3 Diagnosis
11.4.4 Clinical Presentation and Disease Course
11.4.5 Management
11.4.5.1 Supportive Care
11.4.5.2 Delivery
11.4.5.3 Breastfeeding
11.4.6 Vaccine
11.4.7 Prevention
11.5 Yellow Fever
11.5.1 Epidemiology
11.5.2 Transmission
11.5.3 Pathogenesis
11.5.4 Clinical Presentation and Disease Course
11.5.5 Diagnosis
11.5.6 Treatment
11.5.7 Prevention
11.5.7.1 Vaccine
11.5.7.2 Vector Control
11.5.7.3 Epidemic Preparedness and Response
11.6 Lassa Fever
11.6.1 Epidemiology
11.6.2 Transmission
11.6.3 Diagnosis
11.6.4 Clinical Presentation and Course of the Disease
11.6.5 Treatment
11.6.6 Vaccine
11.7 Conclusion
References
12: Maternal Hepatitis: Important Considerations
12.1 Introduction
12.2 Hepatitis A
12.2.1 Virology
12.2.2 Epidemiology
12.2.3 Pathogenesis and Transmission
12.2.4 Clinical Presentation and Detection
12.2.5 Hepatitis A and Pregnancy
12.2.6 Management
12.3 Hepatitis B
12.3.1 Virology
12.3.2 Epidemiology
12.3.3 Pathogenesis and Transmission
12.3.4 Clinical Presentation and Detection
12.3.5 Hepatitis B and Pregnancy
12.3.6 Management
12.4 Hepatitis C
12.4.1 Virology
12.4.2 Epidemiology
12.4.3 Pathogenesis and Transmission
12.4.4 Clinical Presentation and Detection
12.4.5 Hepatitis C and Pregnancy
12.4.6 Management
12.5 Hepatitis D
12.5.1 Virology
12.5.2 Epidemiology
12.5.3 Pathogenesis and Transmission
12.5.4 Clinical Presentation in Pregnancy and Detection
12.6 Hepatitis E
12.6.1 Virology
12.6.2 Epidemiology
12.6.3 Pathogenesis and Transmission
12.6.4 Clinical Presentation and Detection
12.6.5 Hepatitis E and Pregnancy
12.6.6 Management
12.7 Hepatitis G
12.7.1 Virology
12.7.2 Pathogenesis and Transmission
12.7.3 Clinical Presentation in Pregnancy
12.8 Approach to Pregnant Woman with Viral Hepatitis
12.8.1 History
12.8.2 Examination
12.8.3 Laboratory Testing
12.8.4 Management of Acute Hepatitis in Pregnancy
12.9 Management of Fulminant Hepatic Failure in Pregnancy
12.10 Conclusion
References
13: Maternal Enterovirus Infection
13.1 Introduction
13.2 Enterovirus: Morphology
13.3 Epidemiology
13.4 Transmission
13.5 Clinical Features
13.5.1 Polio Enterovirus
13.5.2 Non-polio Enterovirus
13.6 Diagnosis
13.6.1 Enterovirus Infection and Pregnancy
13.6.1.1 Management of Pregnant Women with Unexplained Febrile Illness
13.6.1.2 Maternal Implications
13.6.1.3 Fetal/Neonatal Effects
13.7 Treatment
13.8 Prevention
13.9 Conclusion
References
Part IV: Parasitic Infections
14: Toxoplasmosis in Pregnancy
14.1 Introduction
14.2 Toxoplasma gondii: Life Cycle and Clinical Manifestations
14.2.1 Life Cycle
14.2.2 Clinical Manifestations
14.3 Toxoplasmosis in Pregnancy and Congenital Toxoplasmosis
14.4 Diagnosis and Management of Toxoplasmosis
14.4.1 Diagnosis of Congenital Infection in Pregnant Woman
14.4.2 Diagnosis of Congenital Infection in the Neonate
14.5 Management of Toxoplasmosis
14.5.1 Treatment of Acute Infection Diagnosed in Mothers with No Fetal Affection
14.5.2 Antenatal Management If Fetal Affection Has Been Confirmed
14.5.3 Management of Congenital Toxoplasmosis
14.6 Prevention from Toxoplasmosis
14.7 Conclusion
References
15: Cysticercosis, Schistosomiasis, and Leishmaniasis
15.1 Introduction
15.2 Cysticercosis
15.2.1 Cysticercosis in Pregnancy
15.2.2 Clinical Features Observed in Pregnant Ladies
15.2.3 Confounding Factors in Diagnosis
15.2.4 Diagnosis
15.2.4.1 Patient History
15.2.4.2 Imaging Studies
15.2.4.3 Serology
15.2.5 Management
15.2.5.1 Treatment of Taeniasis in Pregnancy
15.2.5.2 Treatment of Pregnant Symptomatic Neurocysticercosis Patients
15.2.6 Prevention
15.3 Schistosomiasis in Pregnancy
15.3.1 Infection and Transmission
15.3.2 Clinical Manifestations in Pregnancy
15.3.3 Adverse Pregnancy Outcome in Maternal Schistosomiasis
15.3.3.1 Transplacental Transmission and Effect on Neonates
15.3.4 Diagnosis
15.3.4.1 In Pregnancy
15.3.5 Management
15.3.6 Prevention and Control
15.4 Leishmaniasis
15.4.1 Transmission of the Disease
15.4.1.1 Vector
15.4.1.2 Life Cycle of Leishmania
15.4.2 Clinical Features
15.4.2.1 Congenital Transmission
Visceral Leishmaniasis (VL)
Cutaneous Leishmaniasis (CL)
Diffuse CL
15.4.3 Diagnosis
15.4.3.1 Non-specific Tests
15.4.3.2 Specific Tests
15.4.4 Differential Diagnosis
15.4.5 Treatment
15.4.5.1 Visceral Leishmaniasis
15.4.5.2 Cutaneous Leishmaniasis
15.5 Conclusion
References
16: Impact of Helminthic Infections in Pregnancy
16.1 Introduction
16.2 Disease Burden and Prevalence
16.3 Soil-Transmitted Nematodes
16.3.1 Hookworm Infestation
16.3.1.1 Clinical Features
16.3.1.2 Effects on Pregnancy
16.3.1.3 Treatment
16.3.2 Ascariasis (Roundworm Infection)
16.3.2.1 Clinical Features
16.3.2.2 Effects on Pregnancy
16.3.2.3 Treatment
16.3.3 Enterobiasis (Threadworm, Pinworm)
16.3.3.1 Clinical Features
16.3.3.2 Effect on Pregnancy
16.3.3.3 Treatment
16.3.4 Strongyloides (S. stercoralis)
16.3.4.1 Clinical Features
16.3.4.2 Effects on Pregnancy
16.3.4.3 Treatment
16.3.5 Trichuriasis (Whipworm)
16.3.5.1 Clinical Features
16.3.5.2 Effects on Pregnancy
16.3.5.3 Treatment
16.4 Cestodes
16.4.1 Cestode (Tapeworm)
16.4.1.1 Clinical Features
16.4.1.2 Effects on Pregnancy
16.4.1.3 Treatment
16.4.2 Hydatid Disease (Echinococcosis)
16.4.2.1 Clinical Features
16.4.2.2 Effects on Pregnancy
16.4.2.3 Treatment
16.4.3 Trematodes (Schistosomiasis)
16.4.3.1 Clinical Features
16.4.3.2 Effects on Pregnancy
16.4.3.3 Treatment
16.4.4 Tissue Nematodes (Filariasis)
16.4.5 Clinical Features
16.4.5.1 Effects on Pregnancy
16.4.5.2 Treatment
16.5 Impact of Helminthic Infections on Pregnancy
16.5.1 Helminthic Infections and Anaemia
16.5.2 Malnutrition
16.5.3 Helminthic Infections and Co-Infection
16.5.4 Immune Response Modulation Due to Helminthic Infections
16.5.4.1 Maternal Immune Response Modulation
16.5.4.2 Infant Immune Response Modulation
16.5.5 Premature Birth and Low Birth Weight
16.6 Conclusion
References
Part V: Obstetrical Considerations of Vector-Borne Infections
17: Maternal Malaria, Dengue, and Chikungunya
17.1 Introduction
17.2 Malaria Infection in Pregnancy
17.2.1 Global Burden
17.2.2 Malarial Parasite and Vector
17.2.2.1 Malarial Parasite [6]
17.2.2.2 Vector
17.2.2.3 Life Cycle of the Malarial Parasite
17.2.3 Transmission and Pathophysiology
17.2.3.1 Transmission
17.2.3.2 Pathophysiology
17.2.4 Clinical Features
17.2.4.1 Severe Malaria
17.2.5 Pregnancy and Malaria
17.2.5.1 Placental Preference of P. falciparum
17.2.5.2 Effect of Pregnancy on Malaria
17.2.5.3 Maternal Complications
17.2.5.4 Fetal Complications
Congenital Malaria
17.2.6 Laboratory Diagnosis
17.2.7 Differential Diagnosis
17.2.8 Management of Malaria in Pregnancy
17.2.8.1 General Management
Uncomplicated Malaria
Severe Malaria
17.2.8.2 Antimalarials
Treatment of Recurrences
Treatment Considerations in HIV Positive Women
17.2.8.3 Monitoring Response to Treatment
17.2.8.4 Follow-Up After Acute Phase
17.2.9 Prevention of Malaria
17.2.10 Malaria Vaccine
17.3 Dengue Fever
17.3.1 Introduction
17.3.2 Global Burden
17.3.3 Viral Genome and Vector
17.3.4 Transmission and Pathophysiology
17.3.4.1 Pathophysiology
17.3.5 Clinical Features
17.3.6 Dengue in Pregnancy
17.3.7 Laboratory Diagnosis
17.3.7.1 Interpretation of Tests
17.3.8 Treatment of Dengue in Pregnancy
17.3.8.1 Dengue Fever Without Warning Signs
17.3.8.2 Dengue Fever with Warning Signs
17.3.8.3 Dengue Fever with Shock on Admission
17.3.8.4 Management in Recovery Phase
17.3.8.5 Obstetric Care
17.4 Chikungunya
17.4.1 Introduction
17.4.2 Viral Genome
17.4.3 Epidemiology
17.4.4 Vector and Transmission
17.4.5 Clinical Features
17.4.6 Chikungunya in Pregnancy
17.4.6.1 Effect of Pregnancy on CHIKV Infection
17.4.6.2 Effect of CHIKV Infection on Pregnancy
17.4.6.3 Chikungunya in Neonates
17.4.7 Laboratory Diagnosis
17.4.8 WHO Criteria for Confirmed Case
17.4.9 Differential Diagnosis
17.4.10 Treatment
17.4.10.1 During Pregnancy
17.5 Prevention and Control of Mosquito Breeding
17.6 Conclusion
References
18: Zika, Lyme, and Chagas Disease
18.1 Introduction
18.2 Zika Virus Infection
18.3 Epidemiology
18.4 Clinical Features
18.4.1 Mode of Transmission
18.4.2 Clinical Presentation
18.5 ZIKV Infection in Pregnancy
18.5.1 Congenital Zika Virus Syndrome
18.6 Prevention
18.7 Diagnosis
18.7.1 Molecular Testing: Serum RT-PCR
18.7.2 Serological Testing
18.7.3 Testing During Pregnancy
18.8 Treatment
18.8.1 Fetal Evaluation and Pregnancy Management
18.8.2 Postnatal Management
18.8.3 Breastfeeding
18.9 Lyme Disease
18.10 Clinical Features
18.11 Lyme Disease in Pregnancy
18.11.1 Postpartum Considerations
18.11.2 Breast-Feeding
18.12 Diagnosis
18.13 Prevention
18.14 Treatment
18.15 Chagas Disease
18.16 Epidemiology
18.17 Transmission and Pathogenesis
18.18 Clinical Presentation
18.19 Pregnancy with Chagas Disease
18.20 Prevention
18.20.1 Primary Prevention
18.20.2 Preventing Congenital Transmission
18.21 Diagnosis
18.22 Treatment
18.22.1 Treatment of Neonates and Infants
18.22.2 Breastfeeding
18.23 Conclusion
References
Part VI: Sexually Transmitted Diseases
19: Herpes, Gonorrhea, Chlamydia, and HPV Infection
19.1 Herpes, Gonorrhea, Chlamydia, and HPV in Pregnancy (Prevention, Screening, Treatment, and Outcomes)
19.1.1 Introduction
19.1.2 Herpes
19.1.2.1 Pathogenesis
19.1.2.2 Clinical Features
Maternal Manifestations
Neonatal Manifestations
19.1.2.3 Diagnosis
19.1.2.4 Screening
19.1.2.5 Management
Management of Primary Genital Herpes in Pregnancy and Labor
Management of Recurrent Genital Herpes in Pregnancy and Labor
Special Circumstances
Management of Neonates of Mothers with Genital Herpes
19.1.3 Human Papilloma Virus
19.1.3.1 Pathogenesis
19.1.3.2 Clinical Manifestations
19.1.3.3 Diagnosis
19.1.3.4 Screening
19.1.3.5 Management
Management of Pregnant Woman with Genital Warts and Condylomas
Management of Pregnant Women with Invasive Disease
Management of Neonates
19.1.4 Chlamydia
19.1.4.1 Pathogenesis
19.1.4.2 Clinical Manifestations
Chlamydial Infection in the Newborn
19.1.4.3 Diagnosis
19.1.4.4 Screening for Chlamydial Infection
19.1.4.5 Management
Treatment of Sex Partner
19.1.5 Gonorrhea
19.1.5.1 Pathogenesis
19.1.5.2 Clinical Manifestations
19.1.5.3 Neonatal Manifestations
19.1.5.4 Diagnosis
19.1.5.5 Screening for Gonorrhea Infection
19.1.5.6 Management
19.1.5.7 Treatment of Partners
19.1.5.8 Treatment of Neonates
19.1.6 Prevention of STDs
19.1.6.1 HPV Vaccination During Pregnancy
19.1.7 Conclusion
References
20: Syphilis, Lymphogranuloma Venereum, and Granuloma Inguinale Infection in Pregnancy
20.1 Introduction
20.2 Syphilis
20.2.1 Epidemiology
20.2.2 Etiology and Transmission
20.2.3 Clinical Manifestations
20.2.4 Diagnosis [17–20]
20.2.5 Syphilis in Pregnancy
20.2.5.1 Maternal Outcomes
20.2.5.2 Congenital Syphilis
Pathophysiology
Clinical Manifestations
Diagnosis
20.2.5.3 Antenatal Surveillance of the Pregnant Woman
20.2.5.4 Treatment of Syphilis in Pregnancy
Newer Alternatives to Penicillin
20.2.5.5 Mode of Delivery
20.2.5.6 Treatment of Congenital Syphilis
20.2.6 Prevention
20.2.6.1 Prenatal Care
20.2.6.2 Adequate Treatment
20.2.6.3 Treatment of Partner
20.2.6.4 Vaccine Development
20.3 Lymphogranuloma Venereum
20.3.1 Epidemiology
20.3.2 Pathophysiology
20.3.3 Clinical Features
20.3.4 Differential Diagnosis
20.3.5 Diagnosis
20.3.6 Treatment
20.3.7 LGV Infection in Pregnancy
20.3.7.1 Treatment During Pregnancy
20.3.8 Prevention
20.4 Granuloma Inguinale (Donovanosis)
20.4.1 Background
20.4.2 Epidemiology
20.4.3 Clinical Features
20.4.4 Diagnosis
20.4.5 Treatment
20.4.6 Donovanosis and Pregnancy
20.5 Conclusion
References
21: HIV in Pregnancy: A Comprehensive Update
21.1 Introduction
21.2 Global Burden of the Disease
21.3 HIV Virus
21.3.1 Structure of the Virus
21.3.2 Genetic Diversity of the Virus
21.3.3 Life Cycle of HIV Virus
21.4 Transmission and Pathogens
21.4.1 Transmission of HIV
21.4.1.1 Sexual Transmission
21.4.1.2 Transmission Through Infected Blood and Blood Products
21.4.1.3 Transmission of HIV by Other Body Fluids
21.4.1.4 Mother-to-Child Transmission
21.4.2 Pathogenesis
21.5 Clinical Manifestations and Disease Progression
21.5.1 Pattern of Disease Progression
21.6 HIV Diagnosis
21.6.1 Tests for HIV
21.6.1.1 Specific Tests
21.6.2 Non-specific Tests
21.6.3 Laboratory Tests Used for Monitoring Patients on Antiretroviral Therapy (ART) and Progress of HIV Infection
21.6.3.1 CD4 Count
21.6.4 HIV Viral (RNA) Load Assays
21.6.5 Newer Tests
21.7 Effect of HIV on Pregnancy
21.7.1 HIV 2 Infection in Pregnancy
21.7.2 Maternal to Child Transmission (MTCT)
21.7.2.1 Perinatal Transmission
21.7.2.2 Transmission During Breastfeeding
21.8 Screening for HIV in Pregnancy
21.8.1 Antenatal Screening for HIV
21.9 Management of HIV in Pregnancy
21.9.1 Antenatal Care
21.9.2 Intrapartum Care
21.9.2.1 To Prevent MTCT
21.9.2.2 Role of Cesarean Section
21.9.2.3 Safe Surgical Practices
21.9.3 Postpartum Care
21.9.3.1 Breastfeeding
21.9.3.2 Care of the Infants
21.9.4 Family Planning Counseling
21.9.5 Antiretroviral Therapy (ART)
21.9.5.1 Investigations Before Initiating ART
21.9.5.2 Recommended ART
21.9.6 Guidelines for Couples with HIV Planning Conception
21.9.6.1 Natural Conception Vs Artificial Reproductive Technology
21.10 Prevention
21.11 Conclusion
Suggested Readings
22: Vulvovaginitis in Pregnancy
22.1 Introduction
22.2 Normal Defense Mechanism of Vulva and Vagina
22.2.1 Vulvar Microflora
22.2.2 Normal Vaginal Flora
22.2.3 Vaginal Secretions
22.2.4 Other Factors
22.3 Types of Vaginitis
22.4 Bacterial Vaginosis
22.4.1 Pathophysiology
22.4.2 Clinical Features
22.4.2.1 Amsel’s Diagnostic Criteria
22.4.3 Laboratory Diagnosis
22.4.4 Obstetric Consequences of BV Infection
22.4.5 Treatment of Bacterial Vaginosis in Pregnancy
22.4.5.1 Rationale for Treatment
22.4.5.2 Antimicrobial Therapy
22.4.5.3 Supportive Treatment
22.4.5.4 Syndromic Approach
22.4.5.5 Test of Cure
22.4.6 Screening for BV in Pregnancy
22.5 Trichomoniasis
22.5.1 Pathophysiology
22.5.2 Clinical Manifestations
22.5.3 Laboratory Diagnosis
22.5.4 Obstetric Consequences of T. vaginalis Infection
22.5.5 Neonatal T. vaginalis Infection
22.5.6 Treatment
22.5.6.1 Antimicrobial Therapy
22.5.6.2 Douching
22.5.6.3 Syndromic Treatment
22.5.6.4 Treatment of Partner
22.5.6.5 Treatment in Breastfeeding Women
22.5.7 Follow-Up
22.5.8 Screening and Prevention
22.6 Vulvovaginal Candidiasis
22.6.1 Risk Factors
22.6.1.1 Host Related Factors
22.6.1.2 Behavioral Risk Factors
22.6.2 Classification of Vulvovaginal Candidiasis
22.6.2.1 Uncomplicated VVC
22.6.2.2 Complicated VVC
22.6.2.3 Recurrent VVC (RVCC)
22.6.3 Pathophysiology
22.6.4 Clinical Manifestations
22.6.5 Diagnosis
22.6.5.1 Clinical Diagnosis
22.6.5.2 Laboratory Diagnosis
22.6.6 Obstetric Consequences of VVC
22.6.7 Neonatal Complications
22.6.8 Treatment
22.6.8.1 Principles of Treatment
22.6.8.2 Antifungal Therapy
22.6.8.3 Use of Boric Acid
22.6.8.4 Douching
22.6.8.5 Alternative Therapy
22.6.9 Prevention and Screening
22.7 Mycoplasma and Ureaplasma Infection
22.7.1 Pathogenesis
22.7.2 Clinical Manifestations
22.7.3 Diagnosis
22.7.4 Obstetric Consequences of Mycoplasma Infection
22.7.5 Neonatal Infection
22.7.6 Treatment
22.7.6.1 Antibiotic Therapy
22.7.7 Screening and Prevention
22.7.8 Conclusion
22.8 Syndromic Approach to Management of BV, Trichomoniasis, and VVC in Pregnancy (Fig. 22.9).
Suggested Reading
Part VII: Other Important Infections
23: Group B Streptococcus Infection
23.1 Introduction
23.2 Pathogenesis of GBS Infection in Pregnancy
23.2.1 Neonatal GBS Infection
23.3 Burden of Disease
23.4 Risk Factors for EOD GBS [3, 7, 9]
23.5 Clinical Features of GBS Infection
23.6 Screening and Diagnosis
23.6.1 Timing
23.6.2 Specimen Collection
23.6.3 Transportation to Laboratory
23.7 Diagnosis
23.8 Intrapartum Antibiotic Prophylaxis (IAP)
23.8.1 Antimicrobial Agents
23.8.2 Women with Penicillin Allergy [15]
23.8.2.1 Low-Risk Penicillin Allergy
23.8.2.2 High-Risk Penicillin Allergy
23.9 Special Conditions
23.9.1 GBS Bacteriuria [14, 15]
23.9.2 Preterm Labor [14, 15]
23.9.3 Preterm Prelabor Rupture of Membranes (PPROM) [14, 15]
23.9.4 Elective Cesarean Birth
23.9.5 Unknown Culture Status at Term During Labor (Fig. 23.4) [15]
23.10 Neonatal Group B Streptococcus Disease
23.10.1 Recommendations for Neonatal Antibiotic Therapy [7]
References
24: Urinary Tract Infections in Pregnancy
24.1 Introduction
24.2 Classification of UTI in Pregnancy
24.3 Epidemiology of UTI in Pregnancy
24.4 Etiopathogenesis of UTI
24.5 Microbiology
24.6 Screening for Asymptomatic Bacteriuria in Pregnancy
24.7 Diagnosis of UTI in Pregnancy
24.8 Maternofetal Outcomes of UTI in Pregnancy
24.9 Management of Urinary Tract Infection in Pregnancy
24.9.1 Asymptomatic Bacteriuria (Fig. 24.3)
24.9.2 Acute Cystitis
24.9.3 Pyelonephritis (Fig. 24.5)
24.9.4 Recurrent Urinary Tract Infections in Pregnancy
24.10 Antibiotics Used for UTI in Pregnancy
24.11 Conclusion
References
25: Gastroenteritis in Pregnancy: Relevance and Management
25.1 Introduction
25.2 Anatomic and Physiological Changes During Pregnancy
25.3 Risk Factors
25.4 Etiology of Gastroenteritis
25.5 Symptoms and Pathophysiology of Infective Diarrhea
25.6 Diagnosis and Assessment
25.6.1 Laboratory Investigations
25.7 Treatment
25.7.1 Fluid and Electrolyte Replacement
25.7.2 Adsorbents
25.7.3 Digestive Enzymes
25.7.4 Antibiotics
25.7.5 Ultrasonography
25.8 Maternal and Fetal Outcomes
25.9 Novel Corona Virus
25.10 Conclusion
References
26: Listeriosis
26.1 Introduction
26.2 Epidemiology
26.2.1 Listeriosis in Pregnancy
26.3 Microbiology and Pathogenesis
26.3.1 Genomic Characterization of Strains of Listeria Monocytogenes
26.3.2 Pathophysiology
26.3.3 Placental Tropism
26.4 Clinical Manifestations (Table 26.1)
26.4.1 Maternal Manifestations
26.4.2 Fetal Infection
26.4.3 Listeria in Newborn Period (0–28 Days) or Neonatal Listeriosis
26.4.4 Granulomatosis Infantiseptica
26.5 Diagnosis
26.6 Treatment
26.7 Prevention and Surveillance
26.7.1 Infection Prevention in Pregnancy (Table 26.3)
26.8 Conclusion
References
27: Dermatological Infections During Pregnancy
27.1 Introduction
27.2 Viral Infections
27.2.1 Herpes Simplex Virus Infection
27.2.1.1 Introduction and Etiology
27.2.1.2 Epidemiology
27.2.1.3 Pathogenesis
27.2.1.4 Clinical Features
27.2.1.5 Diagnosis
27.2.1.6 Management
27.2.2 Varicella Zoster Virus (HHV-3)
27.2.2.1 Introduction
27.2.3 Varicella in Pregnancy
27.2.3.1 Epidemiology
27.2.3.2 Clinical Features
27.2.3.3 Diagnosis
27.2.3.4 Differential Diagnosis
27.2.3.5 Management
27.2.3.6 Congenital Varicella Syndrome (CVS)
27.2.3.7 Seronegative Woman with Potential Exposure to Varicella
27.2.4 Herpes Zoster (HZ) in Pregnancy
27.2.4.1 Epidemiology
27.2.4.2 Pathogenesis
27.2.4.3 Clinical Features
27.2.4.4 Complications
27.2.4.5 Diagnosis
27.2.4.6 Differential Diagnosis
27.2.4.7 Management
27.2.5 Human Papilloma Virus (HPV)
27.2.5.1 Introduction
27.2.5.2 Epidemiology
27.2.5.3 Clinical Features
27.2.5.4 Special Considerations and Complications During Pregnancy
27.2.5.5 Diagnosis
27.2.5.6 Differential Diagnosis
27.2.5.7 Management
27.2.6 Molluscum Contagiosum
27.2.6.1 Introduction
27.2.6.2 Clinical Features
27.2.6.3 Diagnosis
27.2.6.4 Differential Diagnosis
27.2.6.5 Management
27.3 Bacterial Infections
27.3.1 Gram-Positive Bacterial Infections
27.3.1.1 Mycobacterial Infections
Leprosy
Introduction
Clinical Features
Considerations During Pregnancy
Management
Cutaneous Tuberculosis
Introduction
Clinical Features
Diagnosis
Management
27.3.1.2 Lymes Disease
Introduction
Clinical Features
Special Considerations During Pregnancy
Diagnosis
Management
27.3.1.3 Sexually Transmitted Disorders
27.4 Fungal Infections
27.4.1 Non-Dermatophytic Infections
27.4.1.1 Vulvovaginal Candidiasis (VVC)
Introduction
Clinical Features
Diagnosis
Management
27.4.2 Dermatophytic Infections
27.4.2.1 Introduction
27.4.2.2 Clinical Features
27.4.2.3 Diagnosis
27.4.2.4 Management
27.4.3 General Measures
27.4.4 Antifungals
27.4.4.1 Terbinafine
27.4.4.2 Itraconazole
27.4.4.3 Fluconazole
27.4.4.4 Griseofulvin
27.5 Parasitic
27.5.1 Scabies
27.5.1.1 Introduction
27.5.1.2 Clinical Features
27.5.1.3 Diagnosis
27.5.1.4 Differential Diagnosis
27.5.1.5 Management
27.5.2 Cutaneous Leishmaniasis
27.5.2.1 Introduction
27.5.2.2 Clinical Features
27.5.2.3 Management
27.6 Conclusion
References
28: Evaluation and Management of Leprosy in Pregnancy
28.1 Introduction
28.2 New Case Detection in a Maternity Unit or Antenatal Clinic
28.2.1 Diagnosis of Leprosy
28.2.2 Differential Diagnosis
28.2.3 Management of Suspected New Cases
28.2.4 Classification for Chemotherapy Purposes
28.2.5 Anti-leprosy Chemotherapy
28.2.6 Second Line Anti-leprosy Drugs
28.2.7 Public Health Concerns
28.2.8 Epidemiology
28.3 Recognition of Reactional Episodes in Leprosy-Affected Women
28.3.1 Immunological Basis and Manifestations
28.3.2 Clinical Recognition & Management
28.3.3 Anti-reaction Drugs
28.3.4 Epidemiology
28.4 Mitigating Effects of Disability in Leprosy Affected Women (During or After MDT)
28.4.1 Common Disabilities in Leprosy
28.4.2 Management Options
28.4.2.1 Self-care
28.4.2.2 Surgery
28.4.2.3 Epidemiology
28.5 Detection of Relapse in Women with Previously Completed Course of MDT
28.5.1 Recognition
28.5.2 Epidemiology
28.6 Consequences for the Child of Maternal Leprosy During Pregnancy
28.7 The Leprosy-affected Woman After Delivery and Her Family
28.7.1 Post-partum Review: Breast-feeding
28.7.2 Risk of Reactions and Disability
28.7.3 Protection for Children
28.7.4 Prospect of Future Pregnancies
28.8 Conclusion
References
Recommended Further Reading
29: Common Surgical Conditions Encountered During Pregnancy
29.1 Acute Appendicitis
29.1.1 Relevant Anatomy
29.1.2 Introduction
29.1.3 Incidence
29.1.4 Etio-Pathophysiology
29.1.5 Clinical Presentation
29.1.6 Diagnosis
29.1.7 Complications
29.1.8 Treatment
29.1.9 Differential Diagnosis
29.1.10 Prognosis
29.1.11 Conclusion
29.2 Acute Cholecystitis
29.2.1 Relevant Anatomy of Gallbladder
29.2.2 Introduction
29.2.3 Incidence
29.2.4 Clinical Presentation
29.2.5 Pathophysiology
29.2.6 Diagnosis
29.2.7 Differential Diagnosis
29.2.8 Complications
29.2.9 Management
29.2.9.1 Nonoperative Management
29.2.9.2 Minimally Invasive Procedures
29.2.9.3 Surgical Management
29.2.10 Prognosis
29.2.11 Conclusion
29.3 Intestinal Obstruction
29.3.1 Relevant Anatomy
29.3.1.1 The Small Intestine
29.3.1.2 The Large Intestine
29.3.2 Introduction
29.3.3 Pathophysiology
29.3.4 Clinical Features
29.3.5 Diagnosis
29.3.6 Management
29.3.7 Prognosis
29.3.8 Conclusion
29.4 Hernia in Pregnancy
29.4.1 Introduction
29.4.2 Incidence
29.4.3 Classification of Hernia
29.4.4 Types of Hernias Common in Pregnancy
29.4.4.1 Groin Hernia
29.4.4.2 Umbilical Hernia
29.4.4.3 Incisional Hernia
29.4.4.4 Parastomal Hernia
29.4.5 Diagnosis
29.4.5.1 Blood Investigations
29.4.5.2 USG
29.4.5.3 CT Scan
29.4.5.4 MRI
29.4.6 Treatment
29.4.7 Pregnancy, Hernia Recurrence, and Recommendations for Repair
29.5 Conclusion
References
30: Oral Health during Pregnancy
30.1 Introduction
30.2 Oral Microbiome
30.3 Physiological Adaptations during Pregnancy Relevant to Oral Health
30.3.1 Rise in the Circulating Levels of Estrogen/Progesterone
30.3.2 Respiratory System
30.3.3 Gastrointestinal System
30.3.4 Renal System
30.3.5 Cardiovascular Changes
30.3.5.1 Dental Chair Position in Pregnancy
30.3.6 Tooth Mobility
30.4 Oral Manifestations during Pregnancy
30.4.1 Gingivitis
30.4.1.1 Pathogenesis
30.4.1.2 Clinical Features
30.4.1.3 Treatment
30.4.2 Periodontitis
30.4.2.1 Pathogenesis
30.4.2.2 Clinical Features
30.4.2.3 Treatment
30.4.3 Pyogenic Granuloma (Granuloma Gravidarum)
30.4.3.1 Pathogenesis
30.4.3.2 Clinical Features
30.4.3.3 Treatment
30.4.4 Perimolysis or Acidic Erosion of Teeth
30.4.4.1 Pathogenesis
30.4.4.2 Clinical Features
30.4.4.3 Treatment
30.4.5 Dental Caries
30.4.5.1 Risk Factors
30.4.5.2 Pathogenesis
30.4.5.3 Clinical Features
30.4.5.4 Treatment
30.5 Effect of Periodontal Diseases on Pregnancy
30.6 Management of Dental Conditions during Pregnancy
30.6.1 General Guidelines
30.6.2 Guidelines for Management during Different Trimesters of Pregnancy
30.6.2.1 First Trimester (Conception to 12th Week of Pregnancy)
30.6.2.2 Second Trimester (13th–28th Week of Pregnancy)
30.6.2.3 Third Trimester (29th Week Till Parturition)
30.6.3 Management of Dental Pain
30.6.4 Pharmacotherapy
30.6.4.1 Antibiotics
30.6.4.2 Antifungal Drugs
30.6.4.3 Local Anesthetics
30.6.4.4 Steroids
30.7 Dental Radiography in Pregnancy
30.8 Obstetrical Emergencies in Dental Office
30.9 Prevention of Oral Diseases in Pregnancy
30.9.1 Preconception Counseling
30.9.2 Diet for Good Oral Health
30.10 Conclusion
References
31: Management of Animal Bite
31.1 Introduction
31.2 Rabies in Pregnancy
31.2.1 Introduction
31.2.2 Etiology and Transmission
31.2.3 Diagnosis [3]
31.2.4 Effect of Rabies on Pregnancy
31.2.5 Treatment
31.2.5.1 General Considerations
Antibiotic Prophylaxis for Uninfected Animal Bites
Tetanus Immunization
31.2.5.2 Specific Treatment of Rabies in Pregnancy
Safety of Post Exposure Prophylaxis of Rabies in Pregnant Woman
Post-Exposure Prophylaxis (PEP)
Rabies Immune Globulin (RIG)
Antirabies Vaccine
Short Rabies Prophylaxis for Previously Vaccinated Women [15]
31.3 Snake Bite in Pregnancy
31.3.1 Introduction
31.3.2 Snakes and Their Species
31.3.2.1 Snake Venom
31.3.2.2 Characteristics of Bites
31.3.3 Complications of Snake Bite in Pregnancy
31.3.3.1 Maternal
31.3.3.2 Fetal
31.3.4 Diagnosis
31.3.4.1 Detailed History
31.3.4.2 Laboratory Investigations (Table 31.5)
31.3.4.3 Other Nonspecific Tests
31.3.5 Treatment of Snakebite [37]
31.3.6 Initial Management (at Site of Snakebite)
31.3.6.1 Care at the Hospital
Emergency Care
31.3.6.2 Specific Treatment
Anti-Snake Serum
Indications for Anti-Snake Venom
31.3.6.3 ASV Reaction
31.4 Lymphocytic Choriomeningitis Virus (LCMV)
31.4.1 Introduction
31.4.2 Epidemiology
31.4.3 Virus Morphology and Transmission
31.4.4 Clinical Manifestations
31.4.5 LMCV in Pregnant Women
31.4.5.1 Maternal Effects
31.4.5.2 Fetal Effects
31.4.6 Differential Diagnoses
31.4.7 Diagnosis
31.4.8 Treatment of LCM in Pregnancy
31.5 Pre-Exposure Prophylaxis of Animal Bites in Pregnancy
31.6 Conclusion
References
Part VIII: Puerperal Infections
32: Puerperal Sepsis and Septic Shock
32.1 Introduction
32.2 Definitions
32.3 Risk Factors for Puerperal Sepsis and Septic Shock
32.3.1 Delivery-Related Risk Factors
32.3.2 Patient-Related Risk Factors
32.3.3 Community-Related Risk Factors
32.4 Strategies for Prevention of Puerperal Sepsis
32.5 Pathogenesis of Sepsis and Septic Shock
32.6 Infective Etiological Agents in Puerperal Sepsis
32.7 Diagnosis of Puerperal Sepsis and Septic Shock
32.7.1 Clinical Features Suggestive of Puerperal Sepsis and Septic Shock
32.7.2 Investigations
32.7.3 Identification of Critically Ill Patients with P.sepsis
32.8 Management of Puerperal Sepsis and Septic Shock
32.9 Conclusion
References
33: Postpartum Endometritis
33.1 Introduction
33.2 Incidence of Postpartum Endometritis
33.2.1 Incidence of Infection Following Incomplete or Complete Abortion
33.3 Risk Factors for PPE [25]
33.4 Microbiology of PPE
33.4.1 Chronic Endometritis [33]
33.5 Pathophysiology [12]
33.5.1 Inflammation in Chronic Endometritis
33.6 Clinical Presentation
33.7 Diagnosis
33.8 Differential Diagnosis of PPE
33.9 Treatment
33.10 Reproductive Failure and Chronic Endometritis
33.10.1 Pregnancy Outcome After Antibiotic Treatment for Chronic Endometritis [33]
33.11 Prevention of Postpartum Endometritis
33.11.1 WHO Guidelines for Prevention of Postpartum Endometritis
33.12 Conclusion
References
34: Episiotomy Site Infection
34.1 Introduction
34.2 Episiotomy—Historical Perspective
34.3 Relevant Anatomy
34.4 Prevention of Episiotomy Infection
34.4.1 Care of Episiotomy after Repair
34.5 Episiotomy Site Infections
34.6 Prevalence
34.7 Risk Factors
34.8 Etiology
34.9 Clinical Presentation
34.10 Differential Diagnosis
34.11 Management
34.11.1 Evaluation at Admission
34.11.2 Antibiotic Therapy
34.11.3 Pain Relief
34.11.4 Wound Debridement and Perineal Care
34.11.5 Good Diet and Psychological Support
34.11.6 Resuturing
34.11.7 Principles of Resuturing
34.11.8 Follow up
34.12 Role of Prophylactic Antibiotics
34.13 Recommendations to Reduce Episiotomy Infections.
34.13.1 For Health Professionals—During Intrapartum and Postpartum Period:
34.13.2 For Puerperal Woman:
34.14 Conclusion
References
35: Skin and Soft Tissue Infections in Pregnancy
35.1 Introduction
35.2 Mastitis and Breast Abscess
35.2.1 Epidemiology
35.2.2 Etiopathogenesis
35.2.3 Microbiology
35.2.4 Clinical Features
35.2.5 Investigations
35.2.6 Management
35.3 Cellulitis and Abscess
35.3.1 Etiology and Risk Factors
35.3.2 Microbiology
35.3.3 Clinical Features
35.3.4 Investigations
35.3.5 Management
35.4 Necrotizing Fasciitis
35.4.1 Etiology and Risk Factors
35.4.2 Pathogenesis
35.4.3 Microbiology
35.4.4 Clinical Features
35.4.5 Investigations
35.4.6 Management
35.5 Conclusion
References
Part IX: Fetal Outcomes of Maternal Infection
36: Role of Maternal Infection in Miscarriages
36.1 Introduction
36.2 Etiology of Miscarriage
36.3 Bacterial Infections and Miscarriages
36.3.1 Bacterial Vaginosis
36.3.2 Brucellosis
36.3.3 Listeriosis
36.3.4 Syphilis
36.3.5 Coxiella burnetii
36.3.6 Mycoplasma genitalium
36.3.7 Chlamydia trachomatis
36.4 Viral Infections Implicated in Miscarriage
36.4.1 Cytomegalovirus
36.4.2 Flavivirus
36.4.3 Human Immunodeficiency Virus
36.4.4 Rubella
36.4.5 Human Papillomavirus
36.4.6 Herpes Simplex Virus
36.4.7 Parvovirus B19
36.4.8 BK Virus
36.4.9 Hepatitis B Virus and Hepatitis C Virus
36.4.10 Covid 19 Virus
36.5 Protozoal Infections
36.5.1 Malaria
36.5.2 Toxoplasmosis
36.6 Etiopathogenesis of Infections Leading to Miscarriage
36.7 Conclusion
References
37: Infections and Preterm Labor
37.1 Introduction
37.2 Risk Factors for Infection
37.2.1 Is Pregnancy a Risk Factor for Infection?
37.3 Mode of Transfer of Microorganisms
37.4 Microbiology and Sites of Infections
37.4.1 Sites of Infection
37.5 Pathology
37.6 Pathophysiology of Preterm Labor
37.7 Diagnosis of Preterm Labor
37.7.1 Laboratory Tests
37.8 Management
37.8.1 Tocolysis
37.8.2 Antibiotics
37.8.3 Steroids
37.8.4 Magnesium Sulfate and Neuroprotection
37.8.5 Acetaminophen
37.9 Delivery
37.10 Complications
37.10.1 Maternal
37.10.2 Neonatal
37.11 Prevention
References
38: Fetal Manifestations of Infections in Pregnancy
38.1 Introduction
38.2 Fetal Manifestations of Congenital Infections
38.3 Diagnosis of Maternal Infection
38.4 Cytomegalovirus (CMV)
38.4.1 Diagnosis of Fetal Infection
38.5 Rubella
38.6 Varicella Zoster Virus
38.7 Toxoplasma
38.8 Human Parvovirus B 19
38.9 COVID-19
38.10 Summary
References
39: Maternal Infections and Allergic Disorders in Offspring
39.1 Introduction
39.2 Pathogenesis and Etiology of Allergic Disorders in Children
39.2.1 Pathogenesis
39.2.2 Etiology
39.2.2.1 Normal and Abnormal Immune Development
39.3 Environmental Factors in Antenatal and Early Neonatal Period as a Cause of Allergic Disorders in Children
39.3.1 Antenatal Environmental Factors
39.4 How Maternal Infections Cause Allergic Disorders in Offspring
39.4.1 Fetal Programming
39.4.1.1 How Maternal Infections Influence Fetal Immune Programming
39.4.2 Specific Maternal Infections
39.4.3 Gestational Age at Maternal Infection and Risk of Childhood Allergies
39.5 Impact of Special Factors During Pregnancy on Allergic Disorders in Children
39.5.1 Antibiotic Use in Pregnancy
39.5.2 Fetal Gut Microbiota
39.5.3 Mode of Delivery
39.5.4 Breast Feeding and Use of Antibiotics in Early Postnatal Life
39.5.5 Maternal Diet
39.5.5.1 Role of Polyunsaturated Fatty Acids (PUFA)
39.5.6 Maternal Allergen Exposure
39.6 Prevention Strategies
39.6.1 Recommendations for Clinical Practice
References
40: Genetic Syndromes Mimicking Congenital Infections
40.1 Introduction
40.2 What Are Pseudo-Torch Syndromes?
40.3 Types of Pseudo-Torch Syndromes
40.3.1 Aicardi Goutières Syndrome
40.3.1.1 Clinical Presentation
40.3.1.2 Neuroimaging
40.3.1.3 Laboratory Findings
40.3.1.4 Molecular Diagnosis
40.3.2 Band-Like Calcification with Simplified Gyration and Polymicrogyria
40.3.2.1 Clinical Presentation
40.3.2.2 Neuroimaging
40.3.2.3 Laboratory Findings
40.3.2.4 Molecular Diagnosis
40.3.3 Pseudo-TORCH Syndrome 2
40.3.3.1 Clinical Presentation
40.3.3.2 Neuroimaging
40.3.3.3 Laboratory Findings
40.3.3.4 Molecular Diagnosis
40.3.4 Pseudo-TORCH Syndrome 3
40.3.4.1 Clinical Presentation
40.3.4.2 Neuroimaging
40.3.4.3 Laboratory Findings
40.3.4.4 Molecular Diagnosis
40.3.5 Hemorrhagic Destruction of the Brain, Subependymal Calcification, and Cataracts
40.3.5.1 Clinical Presentation
40.3.5.2 Neuroimaging
40.3.5.3 Laboratory Findings
40.3.5.4 Molecular Diagnosis
40.3.6 Leukoencephalopathy, Cystic, Without Megalencephaly
40.3.6.1 Clinical Presentation
40.3.6.2 Neuroimaging
40.3.6.3 Laboratory Findings
40.3.6.4 Molecular Diagnosis
40.3.7 Conditions with Unknown Genetic Loci
40.4 Shared Pathophysiology of Torch Infection and Pseudo-Torch Syndromes
40.5 Recognition of Pseudo-Torch Syndromes in the Clinic
40.6 Confirmation of Diagnosis of Pseudo-Torch Syndrome
40.7 Significance and Practical Implications
40.8 Conclusion
References
Part X: Infection Prevention Strategies in Obstetrics
41: Vaccination in Pregnancy
41.1 Introduction
41.2 Innate and Adaptive Immunity
41.3 Immunology of Pregnancy
41.4 Vaccination
41.4.1 Live Attenuated Vacccines
41.4.2 Killed Vaccines
41.4.3 Purified Macromolecules
41.5 Specific Vaccines and Their Use in Pregnancy
41.5.1 Bacillus-Calmette–Guerin (BCG)
41.5.2 Measles, Mumps, and Rubella (MMR)
41.5.3 Varicella Vaccine
41.5.4 Human Papillomavirus Vaccine
41.5.5 Influenza Vaccine
41.5.6 Tetanus, Diphtheria, and Pertussis Vaccine (Tdap)
41.5.7 Tetanus Toxoid (TT)
41.5.8 Hepatitis A
41.5.9 Hepatitis B
41.5.10 Meningococcal Vaccine
41.5.11 Pneumococcal Vaccine
41.5.12 Typhoid
41.5.13 Rabies Vaccination
41.5.14 Yellow Fever Vaccine
41.6 Breastfeeding and Vaccination
41.7 Summary
References
42: Prevention of Post-Cesarean Infection
42.1 Introduction
42.2 Endometritis (Organ Space Infection)
42.2.1 Vaginal Cleansing Prior to Surgery
42.2.2 Administration of Prophylactic Antibiotics
42.2.3 Removal of the Placenta
42.3 Wound Infection (Surgical Site Infection)
42.3.1 Preparation of the Surgical Site
42.3.2 Preoperative Prophylactic Antibiotics
42.3.3 Closure of the Subcutaneous Layer of the Abdomen
42.3.4 Closure of the Skin
42.4 Urinary Tract Infection
42.5 Conclusions
References
43: Overuse of Antibiotics in Pregnancy: Beyond Antimicrobial Resistance
43.1 Introduction
43.2 AMR: A Big Challenge
43.3 Antibiotics and Pregnancy
43.4 Antibiotic Overuse During Pregnancy
43.5 Main Conditions for Which Antibiotics Are Misused
43.5.1 Prophylaxis in Cesarean Sections and Operative Vaginal Deliveries
43.5.2 Prevention of Neonatal Group B Streptococcus (GBS) Sepsis
43.5.3 Prevention of Preterm Birth
43.5.4 Chorioamnionitis
43.5.5 Urinary Tract Infection
43.5.6 Genital Infections
43.6 Short- and Long-Term Negative Effects of Antibiotics During Pregnancy
43.6.1 Gut Microbiome, Obesity, and Immunity
43.6.2 Asthma
43.6.3 Impact on Fetal Brain
43.6.4 Maternal Anaphylaxis
43.6.5 Childhood Infections
43.6.6 Multi-Resistant Bacteria
43.7 Conclusion
References
44: Bacteriophage Therapy in Pregnancy: An Alternative to Antibiotics
44.1 Introduction
44.1.1 Pharmacokinetic and Pharmacodynamic Changes in Pregnancy
44.1.2 Pharmacokinetics and Pharmacodynamics of Common Antibiotics in Pregnancy
44.1.3 Placental Drug Transmission
44.2 Antibiotic Use in Pregnancy
44.2.1 Bacterial Infections
44.2.2 Antibiotic Safety in Pregnancy
44.2.3 Antibiotic Resistance
44.2.4 Microbial Dysbiosis
44.3 Introduction to Bacteriophages
44.3.1 Definitions
44.3.2 Mechanism of Action
44.3.3 Bacteriophages and Antibiotics
44.4 Potential Targets of Bacteriophages in Pregnancy
44.4.1 Urinary Tract Pathogens
44.4.2 Group B Streptococcus
44.4.3 Respiratory Tract Pathogens
44.4.4 Listeria Monocytogenes
44.5 Routes of Bacteriophage Administration
44.5.1 Oral
44.5.2 Inhaled
44.5.3 Intravenous
44.5.4 Topical
44.5.5 Placental Transfer
44.6 Challenges in the Implementation of Bacteriophage Therapy
44.7 Summary
References
45: Engineering Design and Administrative Control for Infection Prevention in Obstetrics
45.1 Introduction
45.2 Infrastructure Design for Better Infection Control
45.2.1 General Guidelines
45.2.1.1 Floor
45.2.1.2 Fixtures and Fittings
45.2.1.3 Decorative Waterfalls and Fountains
45.2.1.4 Washbasins
45.2.1.5 Lighting
Natural Lighting
Electric Ceiling Light Fittings
Concealed Light Fittings
Ultraviolet Light
Focused Lights
45.2.1.6 Air Quality and HVAC (Heating Ventilation and Air Conditioning)
Air Entry and Exhaust
Air Quality Control
Air Handling Considerations for Different Types of Rooms
45.2.2 Layout Design of Labor Room
45.2.2.1 Patient, Staff and Material Flow Pathways
Entry of Staff, Patient and Materials
45.2.2.2 Zoning
Protective Zone
Clean Zone
Sterile Zone
Disposal Zone
45.2.2.3 Clean Utility/Clean Store
45.2.2.4 Soiled/Dirty Utility
45.2.2.5 Infant Resuscitation Area
45.2.3 Infrastructure Recommendations
45.2.3.1 Flooring
45.2.3.2 Walls
45.2.3.3 Corners
45.2.3.4 Ceiling
45.2.3.5 Work Surfaces
45.2.3.6 Ventilation and Air Conditioning
45.2.4 Operation Theatre Complex
45.3 Layout Stacking of the Hospital Building
45.4 Processes Essential for Infection Control
45.4.1 Hand Hygiene
45.4.1.1 Washbasin Design Types
Type A-Clinical Basin: Large
Type B-Clinical Basin: Medium
Type C-Non-clinical Basin: Small/Medium
Scrub Sink/Trough
45.4.2 Personal Protective Equipment
45.4.3 Support Services
45.4.3.1 Sterilisation and Central Sterile Supplies Department (CSSD)
45.4.3.2 Housekeeping
45.4.3.3 Laundry
45.4.3.4 Biomedical Waste Management
45.5 Quality Control and Outcome Analysis
45.5.1 Quality Control Data
45.5.2 Housekeeping Monitoring Data
45.5.2.1 Direct Performance Observations
45.5.2.2 Visual Assessment
45.5.2.3 Fluorescent Markers
45.6 Data Analysis, Interpretation, and Corrective Action
45.7 Conclusion
References
