5. ALTERATIONS IN CERVICOVAGINAL
MICROBIAL FLORA DURING PREGNANCY
• Number of bacterial species in vagina decreases
• Prevalence and quantity of lactobacilli increase
• Rate of carriage of Enterobacteriaceae, group B streptococci , and
other facultative bacteria remains unchanged
Changes in the vaginal pH, glycogen
content, and vascularity of lower genital tract
6. • Herpes simplex virus
• Human papillomavirus
infection
• Hepatitis B virus
• HIV
• Syphilis
• Gonoccocal infection
• LGV(Chlamydial)
• Donovanosis
• Bacterial vaginosis
• Chancroid
Bacterial
Classification Of STIs In Pregnancy
Viral
Fungal : Candidiasis
Protozoal : Trichomoniasis
Parasitic : Pubic lice &
13. EFFECT OF PREGNANCY ON SYPHILIS
• Primary chancre : Small size
• Cervical chancre more common
• Increased spirachaetemia
Pregnancy has no known effect on the clinical course of syphilis
14. EFFECT OF SYPHILIS ON PREGNANCY
Mother can transmit the infection transplacentally to fetus
or during passage through birth canal
15. EFFECT OF SYPHILIS ON PREGNANCY
Kassowitz’s Law
Colle’s Law
Profeta’s Law
Thumb Rules :
16.
17. Factors influencing fetal outcome
• Gestational age
• Stage of maternal syphilis
• Maternal treatment
• Immunological response of fetus
18. SCREENING & DIAGNOSIS
Screening
Non Treponemal Test ( RPR/VDRL )
If positive
• To be done in all
pregnant women at
first visit
• Repeat at 28-32
weeks and again at
delivery for high
risk femalesConfirmatory Test
Treponemal Test ( FTA-ABS or MHA-TP
Treat
19. • Biological false positive reactions were detected in
0.59% of the general population, 0.72% of pregnant
women
• The rate of BFP reactors among pregnant women did
not differ significantly from the general population
20. TREATMENT
Indication of treatment :
1. Women with a positive treponemal test who do not
have clear documentation of previous adequate
treatment
2. Women with an epidemiologic history of recent
exposure to an individual with proven syphilis
regardless of serologic results.
3. If clinical or serologic relapse or reinfection occurs
4. If doubt exists about the adequacy of previous
therapy
21. TREATMENT
Penicillin – G
Only therapy with documented efficacy for syphilis during
pregnancy
Patients allergic to penicillin
Desensitization
Oral
Intraveno
us
22. • Penicillin skin testing with the major and minor
determinants of penicillin
30. TREATMENT
• Ceftriaxone 250 mg I/M + Azithromycin 1 gm
oral stat
Spectinomycin 2gm I/M Stat
If cephalosporin allergic
Prophylaxis : Erythromycin (0.5%) oint stat
Treatment : Ceftriaxone 25-50mg IV/IM Stat
• Evaluation for concomitant chlamydial infection
• Partner management
Do not use quinolones/tetracyclines in pregnant
females
Ophthalmia Neonatorum
32. Prevalence of chlamydia trachomatis infection in
pregnant patients
Public Health Rep.1991;106(5):490–493.
Prevalence : 2 to 37 %
Prevalence of CT infection of the cervix of prenatal clinic
women : ~8%
Prevalence Of Chlamydia Trachomatis Infection In
Parturient Women In Northern Spain. Springerplus.2016;5:566.
Overall age adjusted prevalence : 1%
• < 25 years - 6.4 %
• 25–29 years – 2%
• 0.5 % in older women
33. Effect of Chlamydia on Pregnancy
Effect of Pregnancy on Chlamydial Infection
Increased viral shedding
34. • Vertical transmission of infection to neonate
• Post partum endometritis, salpingitis or pelvic
inflammatory disease
• Obstetric complications
Consequences of Untreated Infections
36. TREATMENT
Recommended Regimen
Azithromycin 1gm stat
Alternative Regimens
Amoxicillin 500mg TDS X 7 days
Erythromycin base 500mg QID X 7days or 250mg QID X
14 days
Erythromycin ethylsuccinate 800mg QID X 7 days or
400mg QID X 14 days
37. • Test of cure ( preferably NAAT) : 3-4 weeks after
completion of therapy
• Retest 3 months after treatment
38. • Prevalence : Same as in non-pregnant females
• Routine screening not recommended
• Pregnancy has no effect on natural course of
bacterial vaginosis
BACTERIAL VAGINOSIS
40. Treatment indicated in symptomatic patients
only
Treatment regimen :
• Metronidazole 500mg BD X 7 days or
• Metronidazole 250mg TDS X 7days or
• Clindamycin 300mg BD X 7 days
43. Effect of HSV infection on pregnancy ?
• Transmission : Mostly intrapartum
• In Utero transmission : in ~5%
• ~75-90% of infants with neonatal HSV :
Asymptomatic infected mothers with no prior
history of genital HSV
44. • Antibodies to HSV-2 : detected in ~ 20 percent of
pregnant women
• ~5 percent : history of symptomatic infection
45. Risk of transmission from infected mother to
child ?
• If infection acquired near delivery : High risk (30-
50%)
• History of recurrent herpes preconception/
during first half of pregnancy : Low (<1%)
46.
47. TREATMENT
• Acyclovir : safe in pregnancy and lactation
• Valacyclovir and Famciclovir : Insufficient
data
Regimen for Suppressive Therapy
Acyclovir 400mg TDS or Valacyclovir 500mg BD
49. • HPV DNA detection during pregnancy : 5.2 – 65%
• On comparing with non-pregnant (age adjusted)
: Increased detection in pregnant females
• Clinical manifestation of HPV infection : Warts
• HPV infection manifesting as symptomatic warts :
More common during pregnancy
50. • Pregnant women showed decreased viral
clearance rates during first and second trimester
while there was a trend for increased clearance
during third trimester and post partum period
compared to non pregnant women
51. CONCERNS IN PREGNANCY
• Enlarge during
pregnancy
• Podophyllin –
contraindicated
• Perinatal exposure
The Internet Journal of Gynecology and Obstetrics. 2009 Volume 13
52. RISK OF PERINATAL TRANSMISSION
• Variable in different populations
• Range : 3.7 to 72%
53. • 19.7% of infants born to hpv positive mothers and
16.9% of those born to hpv negative mothers tested
HPV positive
• Strong and statistically significant association
between mother's and child's HPV status at the 6week
postpartum visit
54.
55. • No randomised clinical trials for effectiveness of
various treatment modalities in pregnancy
• Drugs contraindicated : Cytotoxics (
podophyllin/podophyllotoxin)
• Effective treatment : Cryotherapy, RFA, TCA
TREATMENT
56. Prevalence :
• Acute HBV infection :1–2 per 1000 pregnancies
• Chronic infection : 5–15 per 1000 pregnancies
HEPATITIS B VIRUS
Pregnancy has no effect on clinical presentation or course
of acute/ chronic Hepatitis B infection
57. • Elevated Transaminase levels : Acute HBV (over
1000 μm(ml)
• Confirmation : HBsAg and anti-HBc IgM antibody in
the serum
DIAGNOSIS
In chronic cases :
• HBsAg is positive
• Anti-HBc IgM is negative and IgG is positive
58. • Both passive and active immunization against
hepatitis B : Safe in pregnancy
• If a nonimmune pregnant woman has been exposed
to HBV : HBIG followed by vaccine
• Interferon : Not recommended
TREATMENT
Notas do Editor
several studies have found that during pregnancy, the number of bacterial species present in the vagina decreases,
A prospective study was conducted at MGM Maternity and Children Hospital, Kalamboli, Navi Mumbai from January 2012 - December 2012 on all newly registered Antenatal Care (ANC) patients. examined for Syphilis using the RPR test.
The cervical changes, such hyperaemia, eversion, and friability, which occur during pregnancy may facilitate the entry and lead to spirochaetaemia
The majority of pregnant women diagnosed with syphilis are asymptomatic, underscoring the need for routine serologic screening of all pregnant women as early as possible in pregnancy
A total of 19 067 sera were screened for biological false positive (BFP) reactivity by the VDRL test. Sera which were reactive in the VDRL test were confirmed by the fluorescent treponemal antibody absorption (FTA-ABS) test.
Dilute the antigens in saline either 100-fold for preliminary testing (if the patient has had a IgE-mediated reaction to penicillin) or 10-fold (if the patient has had another type of immediate, generalized reaction to penicillin within the preceding year).
In studies of HPV DNA detection during pregnancy, the prevalence has ranged from 5.2 to 65%, with most studies detecting HPV DNA in 30–40% of pregnant women. The
majority of studies,86,89,91,92,95 but not all,84,90 that have compared the detection of HPV DNA among pregnant to nonpregnant women have found increased detection during pregnancy, even when adjusting for age and sexual exposures
were multiple condylomatous masses on the bilateral labia majora extending towards the peri-anal area obstructing the introitus
The reported risk of transmission of HPV from mother to infant has varied considerably in different populations studied by various methods. Detection of HPV DNA from infant oral or genital specimens in the first few days of life has ranged from 3.7% to 72% among infants born to women testing positive for HPV DNA during pregnancy and 0.1–20% among infants born to women without HPV DNA detected during pregnancy
