مقاله انگلیسی رایگان در مورد عفونت های بارداری – الزویر 2018

In pregnancy, potential effects of infections on both mother and fetus must be considered. Pregnant women are at increased risk of some infections due to physiologic changes of pregnancy. Infections may cause complications with the pregnancy, and some maternal infections are transmissible to the fetus. When determining treatment, potential effects on the fetus and the pregnancy must be taken into consideration including different effects by trimester. In this article, the authors discuss common infections that require special considerations in pregnancy, infections that can be vertically transmitted, and infections that can cause in utero and perinatal infection leading to birth defects (including the classic TORCH infections).

PREGNANCY CONSIDERATIONS WITH COMMON INFECTIONS

Urinary Tract Infections

Recurrent bacteriuria and pyelonephritis are more common in pregnancy. Smooth muscle relaxation and dilation of ureters with pregnancy increases the propensity for ascending infection. Screening and treatment of urinary tract infections (UTIs) are more intensive in pregnancy than in the general population. Infectious Disease Society of America guidelines recommend universal screening of pregnant women for asymptomatic bacteriuria with urine culture in early pregnancy and periodic rescreening in women with positive culture during pregnancy.1 Diagnosis is made if greater than or equal to 105 colony-forming units of uropathogen or greater than or equal to 104 of Group B Streptococcus (GBS) is present in urine culture.2,3 Pyelonephritis in pregnancy typically requires inpatient empirical intravenous antibiotics, with the patient switched to an oral regimen once improving and afebrile for 24 to 48 hours.4 Appropriate antibiotics are given for 10 to 14 days followed by suppressive therapy for the remainder of pregnancy to prevent recurrence.4 GBS growing in any amount in urine culture during pregnancy indicates significant anogenital colonization and therefore qualifies the woman for intrapartum antibiotics to prevent neonatal GBS disease.5 The pregnancy and trimester need to be considered when prescribing antibiotics. Penicillins, cephalosporins, and aztreonam are considered safe in pregnancy. Antibiotics with high protein binding, such as ceftriaxone, may cause hyperbilirubinemia in newborns if used within a day of delivery. Nitrofurantoin is associated with birth defects6,7 and hemolytic anemia8 and, therefore, is avoided in the first trimester and at term. Trimethoprim-sulfamethoxazole should be avoided in the first trimester and at term because trimethoprim is a folic acid antagonist and sulfonamides can displace plasma binding of bilirubin in newborns. Tetracyclines are avoided in pregnancy due to fetal bone and teeth developmental defects9,10 and fluoroquinolones are avoided due to developmental defects of cartilage in animal experiments.