Infection in Pregnancy

Chickenpox and Pregnancy
Most people get chickenpox when they are a child, and once you have the disease you are immune to it and cannot get it again. Also, if you have had chickenpox and you get shingles while you are pregnant, your baby is not at risk from chickenpox. Symptoms of chickenpox in adults are a high temperature, aches and pains, and, a headache a day or so before the rash appears. A spotty rash develops on the body and turn into small itchy blisters. The incubation period is 10-21 days. You are infectious from about two days before the rash appears until about five days after.
If you are pregnant, and have been in contact with someone who has chickenpox, and you are not sure whether you had the disease as a child you should see your GP immediately. Your GP will arrange for you to have a test for antibodies, and if it proves negative, you will be given antibodies to try to stop the chickenpox from developing. You should avoid contact with other pregnant women and newborn babies.

Colds and Flu
During pregnancy your immune system does not work as well and this makes you more vulnerable to infections and illness. Try to avoid close contact with people with flu-like symptoms. If you do get a cold or flu there are some measures you may take.
Drink plenty of water
Get plenty of rest
Eat fresh fruit and vegetables which contain vitamin C to help fight infections
Paracetamol is safe to take in the recommended dosage

Cold remedies and cough medicines often contain decongestants and/or antihistamines, and should be avoided.
The flu jab is not usually recommended unless you are in a particularly high-risk group for developing complications, for example asthma.

Cytomegalovirus and Pregnancy
Cytomegalovirus (CMV) is caused by a virus from the herpes family of viruses. About 1 in 100 babies will catch this infection, but only 1 in 10 of these will develop any problems as a result. Potential problems can include learning difficulties, swollen liver or spleen, jaundice, or visual impairments.

GBS and Pregnancy

WHAT IS GBS?
Group B streptococcus (GBS) is a common type of the streptococcus bacterium. Approximately a third of men and women “carry” GBS in their intestines and a quarter of women carry it in their vagina.
Most of us are unaware it’s there, as GBS carried in this way can be difficult to detect and doesn’t cause problems or symptoms. GBS is one of a number of different bacteria that normally live in our bodies and carrying it is perfectly normal. Once GBS has ‘colonised’ the intestines, no antibiotics tested so far can reliably eradicate it.

CAN I FIND OUT IF I CARRY GBS?
Maybe, maybe not. And if you do carry GBS, that’s you and a third of the population, normally without any ill effects. But you may not be able to find out for sure, as no really reliable test is routinely available in the UK. And if you get a positive result, it tells you that you carried GBS at the time the culture was taken. But the tests used miss up to 50% of GBS carriers - so, if your test result was negative, would you believe it?
What you can do is make sure you know when it’s more likely for babies to develop GBS infection and what the signs of this infection in babies are.

WHAT SHOULD I KNOW ABOUT GBS?
Although GBS is the most common cause of bactenal infection in newborn babies in the UK, this happens relatively rarely. Around one in 1,000 babies in the UK develops a GBS infection, which is about 700 babies a year.
Babies are usually exposed to GBS shortly before or during birth. This happens to thousands of babies with no ill effects: just why some babies are susceptible to the bacteria and develop infection while others don’t is not clear. What is clear is that most GBS infections in newborn babies can be prevented by giving women in high-risk situations antibiotics intravenously (through a vein) from the onset of labour or waters breaking until the baby is born.
Caesareans are not recommended to prevent GBS infections in babies as they do not eliminate the risk of GBS to the baby.
Very occasionally GBS causes infection of the ‘waters’, womb or urinary tract in mothers of newborn babies.

WHO IS MOSTAT RISK OF GBS INFECTION?
There are 7 situations where a baby is more likely to be exposed to GBS and, if susceptible, to develop GBS infection:
Clinical factors: each increases the risk at least 3 times:
• where labour is preterm (prior to 37 completed weeks of pregnancy);
• where there is preterm premature rupture of membranes (prior to 37 completed weeks of pregnancy) with or without other signs of labour;
• where there is prolonged rupture of membranes (more than 18 to 24 hours before delivery) with or without other signs of labour; and
• where the pregnant woman has a raised temperature (37.8 degrees C or higher) during labour.
Mothers who have previously had a baby infected with GBS: multiplies the risk about 10 times:
• where the pregnant woman has had a baby who developed a GBS infection.
Mothers who carry GBS during the present pregnancy:
multiplies the risk at least 4 times:
• where the pregnant woman has been found to carry GBS during the present pregnancy; and
• where the pregnant woman has GBS bacteria in her urine at any time during the present pregnancy (this should be treated at the time of diagnosis).

In higher-risk situations, giving pregnant women intravenous antibiotics at regular intervals from the start of labour or waters breaking through until delivery has been proven to be effective in stopping most GBS infections in newborn babies.
There are small but serious risks associated with taking antibiotics, so the decision must be considered carefully.

RECOMMENDATIONS:
Our medical advisory panel’s 6 key recommendations for preventing GBS infection in newborn babies are:
1. Women at increased risk should be offered antibiotics immediately at the onset of labour through until delivery (this includes women known to carry the GBS bacteria where no other risk factor is present and women not known to carry GBS but who have another risk factor present).
2. Women at particularly high risk should be strongly advised to accept intravenous antibiotics immediately at the onset of labour until delivery (this includes women known to carry the GBS bacteria and who have one or more risk factors, and women who have previously had a baby infected with GBS regardless of other risk factors. It also includes women not known to carry GBS who have multiple risk factors).

3. For women in labour, the recommended doses of penicillin G are 3 g (or 5 MU) intravenously initially and then 1.5 g (or 2.5 MU) at 4-hourly intervals until delivery (for women allergic to penicillin, it is recommended that clindamycin 900 mg intravenously every 8 hours until delivery be used).
4. Intravenous antibiotics should be given for at least 4 hours prior to delivery where possible.

5. Babies born in situations where there is increased risk and the mother has received at least 4 hours of intravenous antibiotics prior to delivery should be assessed carefully by a paediatrician and, if completely healthy, intravenous antibiotics should not be given to them.
6. Babies born in situations where there is increased risk and the mother has not received at least 4 hours of intravenous antibiotics prior to delivery should be investigated fully and initially commenced on antibiotics until it is established the baby is not infected.

SIGNS OF GBS INFECTION IN A BABY
Approximately 60% of GBS infection in babies is apparent at birth and 90% is apparent within the baby’s first 2 days, so these infections should be detected and treated in hospital.
Fortunately, aggressive intravenous antibiotic therapy successfully treats most babies who develop GBS infection but, even with the best medical care, sadly 10-20% of these babies die (typically from septicaemia, pneumonia or meningitis) and some suffer long-term problems.
In the unlikely event you need this information, typical signs of GBS infection in a new baby include:
• grunting;
• poor feeding;
• lethargy;
• low blood pressure;
• irritability; and/or
• high/low temperature, heart rates and/or breathing rates.
Around 10% of GBS infection develops after the baby is 2 days old (“late-onset” GBS infection), usually as meningitis with septicaemia. About 5-10% of babies who develop late-onset GBS die and approximately a third suffer long-term problems.
The warning signs of late-onset GBS infection may include:
• fever;
• poor feeding and/or vomiting; and/or
• impaired consciousness.
The warning signs of meningitis in babies may include, as well as any of those listed above, one or more of:
• shrill or moaning cry or whimpering;
• dislike of being handled, fretful;
• tense or bulging fontanelle (soft spot on head);
• involuntary body stiffening/jerking movements;
• floppy body;
• blank, staring or trance-like expression;
• altered breathing patterns; turns away from bright lights; and/or
• pale and/or blotchy skin.
If your baby shows signs consistent with late-onset GBS infection or meningitis, call your GP immediately. If your GP isn’t available, go straight to your nearest Casualty Department.
If your baby has late-onset GBS infection or meningitis, early diagnosis and treatment are vital: delay could be fatal.
The risk to a baby of developing GBS infection decreases with age - GBS infection in babies is rare after one month of age and virtually unknown after three months.
The GBS bacteria may be passed from the hands so everyone (including the parents), whether they carry GBS or not, should wash their hands and carefully dry them before handling a baby for its first three months of life.

WHAT SHOULD I DO NEXT?
You should discuss GBS with your midwife and obstetrician and agree a pregnancy and birth plan which includes what should happen about GBS.
Proven methods exist which stop most GBS infections from developing in newborn babies. In the vast majority of cases, pregnancy can be managed so the babies of women who carry GBS are protected - and are born healthy and free from GBS.
Genital warts and Pregnancy
Genital warts are caused by a virus called the human Papilloma virus (HPV). Genital warts can sometimes grow larger during pregnancy, making urination difficult and sometimes causing problems during birth. In rare cases, the virus can cause the newborn baby to develop a condition called laryngeal papillomatosis, when warts grow inside the larnx (voice box) or throat. It is very important therefore, that they are monitored carefully at antenatal check ups.

German Measles and Pregnancy
German measles (also called rubella) can cause miscarriage, stillbirth, or birth defects such as deafness, brain damage, heart defects and cataracts. Like measles, rubella is now rare in the UK as it is routinely vaccinated against in childhood.
If you are pregnant and develop rubella, or you have come into contact with someone who has rubella, you should speak to your GP or midwife immediately.

Herpes and Pregnancy
There are two types of the herpes simplex virus (HSV). The first causes cold sores (blisters usually around the mouth) and the second causes genital sores (blisters around the genitals). Both types can be easily passed on through contact with the sores when they are active, such as through sex and oral sex. Once you’ve caught the virus it remains in your body and may reactivate at any time.
Most women with genital herpes have a normal pregnancy and a healthy baby. However if you have genital herpes when pregnant it is important that you see you GP or midwife.
If you have your first ever attack of herpes during early pregnancy, you may be given antiviral drugs (aciclovir) to clear up the infection before the baby is born. There is no evidence of any risk to the baby from these drugs.
If you have an attack of herpes during pregnancy and it’s not your first attack, there is a much smaller risk of your baby being infected (8%) because you and your baby have already had a chance to develop immunity to the virus. Unless you have symptoms of genital herpes Caesarean section is not normally considered.
If you contract genital herpes in the last six weeks of pregnancy, there is a 40-50% risk that you will pass the virus to your baby.
You may need to take antiviral drugs (aciclovir) for the last four weeks of your pregnancy to try to clear up the sores before the baby is born. However it is likely you will have a Caesarean section so your baby does not come into contact with the active sores.
There is also a very rare chance your baby will develop a condition called neonatal herpes. This only affects 1-2 in 100,000 babies but can cause various complications including damage to the skin, eyes and brain.
Speak to your midwife about breastfeeding if you have active herpes.
Useful links: (Health Encyclopaedia) http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=173

Hand, Foot and Mouth disease (HFMD) and Pregnancy
HFMD is a virus usually caused by the coxsackievirus A virus. It is common in children but rare in healthy adults. It’s very contagious and is spread through coughs and sneezes and contact with faeces. HFMD is not the same thing as foot and mouth disease that affects animals. The early symptoms are a fever and sore throat, followed by sores in the mouth and on the hands and feet. There is no specific treatment other than relieving symptoms. If you catch HFMD during pregnancy there is normally no risk to your baby. However, if you catch the virus shortly before having your baby, the virus can pass to the baby and they may need hospital treatment to avoid developing further problems. The risk of infection is low, and any complications you may suffer in pregnancy as a result of the infection are likely to be caused by the high temperature you may develop and not the infection. To avoid the risk of catching the disease always wash your hands after going to the toilet or handling nappies, and make sure the toilet is clean. Avoiding children with the virus may reduce the risk.

HIV (Human Immunodeficiency Virus) and Pregnancy
HIV attacks the part of the blood that fights illness making you very vulnerable to infections. All pregnant women should be offered a blood test for HIV as part of their routine antenatal care. An unborn baby is at risk of contacting HIV if its mother is HIV positive before she gets pregnant, or is exposed to HIV during pregnancy. For example, sexual contact with an HIV positive person, or being injected with an infected needle. If HIV infection is diagnosed, steps can be taken to help reduce the likelihood of passing the infection to the baby. These include the use of antiretroviral drugs for the mother and newborn baby, delivery by Caesarean section, and avoiding breastfeeding. When the baby is born they will have some HIV antibodies which come from the mother, but it does not mean it has HIV. A proper diagnosis, detecting the active virus in the blood, can usually be made around 18 months.

Measles and Pregnancy
Measles is a highly infectious disease that may be caught at any age. It can be very serious, so it is important that children are vaccinated. If you catch measles during pregnancy, especially towards the end of pregnancy and you’re not immune, this may result in your baby being born premature. Measles caught earlier in pregnancy increases the risk of miscarriage and stillbirth. If you are pregnant and you develop measles, or you have come in contact with someone with measles, you should speak to your GP or midwife immediately. If you’re planning on becoming pregnant and you’re not sure if you’ve had measles or the vaccination check with your GP to make sure you’re immune. You cannot have the vaccine while pregnant as it would cause infection in the baby, and you should avoid becoming pregnant for at least one month after having the MMR jab.

Mumps and Pregnancy
Mumps in pregnancy is not known to cause problems for the unborn baby, but it can increase the risk of miscarriage during the first 12-16 weeks of pregnancy. Like measles and German measles, mumps is now rare in the UK as it is routinely vaccinated against in childhood. If you are pregnant and you develop mumps, or have come in contact with someone who had mumps, speak to your GP or midwife immediately.

Parvovirus and Pregnancy
Erythema infectiosum, (also known as Slapped cheek syndrome, parvovirus infection, or Fifth Disease) is an infection caused by the virus parvovirus. Research suggests that up to 60% of all adults in the UK have been infected with this virus at some stage. One infection is thought to give lifelong immunity. Most unborn babies are unaffected by exposure to parvovirus, but if a pregnant woman develops the infection in the first 20 weeks of pregnancy, it increases the risk of miscarriage. If infection occurs in weeks 9-20 there is a small risk that the baby will develop heart failure and anaemia and can be fatal in about half of all cases.

Shingles and Pregnancy
If you have had chickenpox as a child, the varicella virus remains inactive in your body and you may get shingles (herpes zoster) in later life if the virus is reactivated. This can happen if your immune system is low. Shingles usually lasts for 2-4 weeks. It starts with a tingling sensation and pain in the area affected and tends to follow the nerve lines, for example the face, chest or abdomen. You may feel unwell and have a fever. The rash usually appears 2-3 days later as red blotches and develop into itchy blisters similar to chickenpox. Shingles during pregnancy can be serious. If you are pregnant, and you have not had chickenpox, you should avoid contact with someone who has shingles. If you are pregnant and know you are not immune to chickenpox (because you did not have it as a child) it is important to avoid anyone with chickenpox or shingles. If you do come in contact see your GP immediately.

Thrush and Pregnancy

Thrush is a yeast infection caused by a type of fungus, called Candida Albicans. It can be present in the vagina and not cause any symptoms as normal bacteria present prevents its growth. This yeast is commonly found in the vagina in up to 16% of non pregnant women and 32% during pregnancy. Sometimes if you are run down, under stress or taking antibiotics the fungus can grow, causing itching,redness, soreness, and swelling of the vagina and vulva. Sometimes there maybe a thick creamy vaginal discharge present. Pregnant women often get thrush in the late stages of pregnancy, and it is common in diabetic women. It can be treated effectively with a pessary and cream (Canesten), which contains an antifugal drug and is inserted into the vagina. The tablet treatment (Diflucan) is not advised during pregnancy.

http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=1101
http://www.womenshealthlondon.org.uk/leaflets/thrush/thrushrisks.html
http://www.patient.co.uk/showdoc/23068842/

Urinary Tract Infections and Pregnancy

Around 1 in 25 women get a UTI during pregnancy,mostly because of a slowing down of the urine flow on its way from the kidnay to the bladder. The common symptoms being a discomfort or burning sensation on passing urine, an aching pain over the bladder, or needing to pass water very frequently. This last symptom is very common in pregnancy anyway and is not very reliable in making the diagnosis. If the infection passes up to the kidneys it causes loin pain, a fever, vomiting, and may start premature labour, therefore, by treating UTI’S early complications can be prevented. A mid stream sample of urine is examined under the microscope to see if bacteria is present. This can also confirm which antibiotic is the best to use. A mild infection is treated with a course of antibiotic tablets for at least a week, a more severe one would need admission to hospital, intravenous antibiotics and rest. Oral fluids should be encouraged also. After one UTI, further infections may occur so it is important that the urine is checked at antenatal check ups before symptoms appear.

©2003 - 2011 Dr Paul Fogarty