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Intrauterine infections are various infectious diseases of the embryo, fetus and newborn, the infection of which occurs in utero and during childbirth. Infections can be caused by viruses, bacteria, and (less commonly) parasites. The transmission route is vertical, from mother to fetus. The result of infection may be a miscarriage, congenital malformations or an acute infectious process in the newborn. infectious diseases viruses bacteria parasites The true frequency of congenital infections has not yet been established, but, according to a number of authors, the prevalence of this pathology in the human population can reach 10%. IUI has the same patterns as infectious diseases in general. They have a leading place in the structure of infant mortality. infant mortality

The share of IUI in the structure of perinatal mortality in our country is almost 25%, however, transplacental infection of the fetus is considered one of the most likely causes of 80% of congenital malformations, which, in turn, account for about 30% of all deaths in children under 1 year old. In 1971, WHO identified the concept of TORCH syndrome. This is an abbreviation for the most common intrauterine infections (T - Toxoplasmosis, O - others, which include mycoplasma, syphilis, hepatitis, streptococci, candida and other viral and bacterial infections, R - rubella, C - cytomegalovirus, H - herpes) and if not a clear etiological diagnosis, then they talk about TORCH syndrome TORCH syndrome Toxoplasmosis rubella cytomegalovirus herpes

The outcome of infection of the fetus 1) Infectious disease 2) Sanitation of the pathogen with the acquisition of immunity 3) Carriage of an infectious agent with the possibility of developing the disease in the future. Thus, the presence of infection in the mother, infection of the placenta and infection does not mean 100% development of IUI in the fetus and newborn. consequence of a persistent course. In addition, newborns have an age-related weakness of the immune system, which is why infections take a slow course. As a result of the action of the infection on the fetus, a complex of effects occurs, such as hyperthermia, the pathological effect of microorganisms and their toxins, as a result of which there is a violation of the process of placentation and metabolic disorders.

1. Manifestations of infection are determined by the period of infection of the fetus - in the first 2 weeks after conception blastopathy, more often ends in spontaneous abortion at a very early stage blastopathy - from 2 to 10 weeks of pregnancy true malformations due to lesions at the cellular level. malformations - from 10 to 28 weeks of pregnancy early fetopathy. The fetus can respond to the introduction of infection with a generalized inflammatory reaction (the 1st and 3rd phases of inflammation, alteration and proliferation and fibrosis are pronounced, and the 2nd phase of exudation is not expressed), as a result of which the child develops multiple malformations, such as fibroelastosis. - from 28 to 40 weeks of pregnancy late fetopathy. The fetus can already respond with a full-fledged inflammatory reaction, most often several organs of fetopathy are involved - infection during childbirth inflammation of more than one organ pneumonia, hepatitis. Pneumonia hepatitis 2. Teratogenic effect 3. Generalization of the process 4. Persistent, long-term course 5. High frequency of mixed, combined pathology 6. Low specificity of the clinic

The presence of intrauterine infection in a newborn may be suspected already during childbirth. The outflow of turbid amniotic fluid contaminated with meconium and having an unpleasant odor, the state of the placenta (plethora, microthrombosis, micronecrosis) may testify in favor of intrauterine infection. Children with intrauterine infection are often born in a state of asphyxia, with prenatal malnutrition, enlarged liver, malformations or stigmas of disembryogenesis, microcephaly, hydrocephalus. syndrome, respiratory and cardiovascular disorders. jaundice, pyoderma or fever, convulsive syndrome

Risk factors for the development of IUI Burdened obstetric and gynecological history. pathological course of pregnancy. Diseases of the genitourinary system in the mother. Infectious diseases of any other organs and systems in the mother that occur during pregnancy. Immunodeficiencies, including AIDS. ImmunodeficienciesAIDS Repeated blood transfusions, condition after transplantation

The early neonatal period with IUI is often aggravated by interstitial pneumonia, omphalitis, myocarditis or carditis, anemia, keratoconjunctivitis, chorioretinitis, hemorrhagic syndrome and other interstitial pneumonia, omphalitis manemia, keratoconjunctivitis, chorioretinitis. Instrumental examination of newborns may reveal congenital cataracts and calcifications of the brain, glaucoma, and congenital calcifications. cataract glaucoma congenital heart defects In the perinatal period, the child has frequent and profuse regurgitation, muscle hypotension, CNS depression syndrome, gray skin. In later periods, with a long incubation period of intrauterine infection, the development of late meningitis, encephalitis, osteomyelitis is possible. Encephalitis osteomyelitis

Congenital rubella occurs when a pregnant woman has rubella. At the same time, the probability and consequences of infection of the fetus depend on the gestational age: in the first 8 weeks, the risk reaches 80%; The consequences of intrauterine infection can be spontaneous abortion, embryo- and fetopathy. In the II trimester, the risk of intrauterine infection is 10-20%, in the III - 3-8%. Spontaneous abortion Children are born prematurely or with low body weight. The neonatal period is characterized by hemorrhagic rash, prolonged jaundice. The classic manifestations of congenital rubella are represented by Greg's triad: ocular involvement (microphthalmia, cataract, glaucoma, chorioretinitis), CHD (open ductus arteriosus, ASD, VSD, pulmonary artery stenosis), damage to the auditory nerve (sensoneural deafness).

If an intrauterine infection develops in the second half of pregnancy, the child usually has retinopathy and deafness. Retinopathy In addition to the main manifestations of congenital rubella, other anomalies may also be detected in the child: microcephaly, hydrocephalus, cleft palate, hepatitis, hepatosplenomegaly, malformations of the genitourinary system and skeleton. cleft palate In the future, intrauterine infection reminds of itself by the child's lag in physical development, STMR, or mental retardation.

Congenital cytomegaly Intrauterine infection with cytomegalovirus infection can lead to local or generalized damage to many organs, immunodeficiency, and purulent-septic complications. Congenital developmental defects usually include microcephaly, microgyria, microphthalmia, retinopathy, cataracts, congenital heart disease, etc. The neonatal period of congenital cytomegaly is complicated by jaundice, hemorrhagic syndrome, bilateral pneumonia, interstitial nephritis, and anemia. Long-term effects of intrauterine infection include blindness, sensorineural deafness, encephalopathy, liver cirrhosis, pneumosclerosis. liver cirrhosis pneumosclerosis

Congenital herpetic infection can occur in a generalized (50%), neurological (20%), mucocutaneous (20%) form. Generalized intrauterine herpes infection occurs with severe toxicosis, respiratory distress syndrome, hepatomegaly, jaundice, pneumonia, thrombocytopenia, hemorrhagic syndrome. Respiratory distress syndrome The neurological form of congenital herpes is clinically manifested by encephalitis and meningoencephalitis. Intrauterine herpes infection with the development of skin syndrome is accompanied by the appearance of a vesicular rash on the skin and mucous membranes, including internal organs. Limb hypoplasia (cortical dwarfism) may also be noted. Late complications include encephalopathy, deafness, blindness, psychomotor retardation. When a bacterial infection is layered, newborn sepsis develops. Newborn sepsis

Diagnosis of IUI includes two mandatory components: 1) clarification of the nature (etiology) of the infection and 2) proof of the prenatal genesis of the disease. Diagnosis of IUI is extremely difficult. The data of anamnesis and features of the course of pregnancy can only suggest the possibility of intrauterine infection. Accurate diagnosis involves the study of 1) the mother, 2) the placenta and 3) the fetus (newborn, child). The study of the afterbirth (placenta, membranes and umbilical cord) should be of high quality, which involves the study of at least 2 pieces of the umbilical cord, 2 rollers of the membranes (twisted from the rupture to the placenta attachment to the placenta) and 10 pieces of the placenta. It is necessary to conduct bacteriological and immunohistochemical (IHC) studies of the placenta and membranes. The introduction of IHC studies into the practice of a pathologist is absolutely necessary. This is the only way to overcome the existing overdiagnosis of chlamydia, mycoplasmosis, toxoplasmosis, "deenco" and other infections. The method of immunofluorescence in the study of the placenta gives a large number of false positive results.

Methods of laboratory diagnostics of IUI can be divided into direct and indirect. The direct methods include: microscopy, the cultural method, virus replication on tissues, replication Detection of RIF, ELISA and IGCC antigens. blood. The presence of Ig G may indicate a transplacental introduction of maternal antibodies, so the blood of the newborn is examined again after 3-4 weeks. The detection of Ig M in the blood of a newborn indicates the presence of an active infection in the child. From additional studies in the general blood test, leukocytosis with a shift to the left, leukocytosis with neutropenia, toxic granularity of neutrophils, and anemia can be detected. In addition, children with suspected IUI should undergo abdominal ultrasound to detect hepatosplenomegaly, neurosonography.

Serological examination should be carried out before the introduction of blood products (plasma, immunoglobulins, etc.). - Serological examination of newborns and children of the first months of life should be carried out with simultaneous serological examination of mothers (to clarify the origin: "maternal" or "own"). - Serological examination should be carried out by the method of "paired sera" with an interval of 2-3 weeks. In this case, the study must be performed using the same technique in the same laboratory. It should be especially noted that in cases where, after the initial serological examination, blood products (immunoglobulin, plasma, etc.) were administered to the child, the study of “paired sera” is not carried out. The evaluation of the results of serological studies should be carried out taking into account the possible features of the nature and phase of the immune response. It should be emphasized that seroconversion (the appearance of specific antibodies in a previously seronegative patient or an increase in antibody titers in dynamics) appears later than the onset of clinical manifestations of infection.

Avidity (lat. - avidity) is a characteristic of the strength of the connection of specific antibodies with the corresponding antigens. During the body's immune response to the penetration of an infectious agent, the stimulated clone of lymphocytes begins to produce first specific IgM antibodies, and somewhat later specific IgG antibodies. IgG antibodies have initially low avidity, that is, they bind the antigen rather weakly. Then the development of the immune process gradually (it can be weeks or months) goes towards the synthesis of highly avid IgG antibodies by lymphocytes, which bind more strongly to the corresponding antigens. The high avidity of specific IgG antibodies makes it possible to exclude recent primary infection. Confirmation or exclusion of the fact of recent primary infection with Toxoplasma gondii, Cytomegalovirus and Herpes simplex virus is especially important when examining pregnant women, since the risk of fetal pathology is significantly increased with acute primary infection during pregnancy, compared with chronic infection and reactivation of a latent infection. Therefore, there is a constant search for new diagnostic approaches that allow the most reliable assessment of the stage and form of the infectious process.

The use of IgG antibody avidity as an indicator of the duration of primary infection, first proposed by Finnish researchers (Hedman K. M. et al., 1989), has now been introduced into the practice of serological testing for TORCH infection in a number of countries. So, in France, where, as in Ukraine, the problem of toxoplasmosis is still relevant, this test is included in the mandatory examination algorithm for suspected toxoplasmosis in pregnant women. The detection in the serum of the presence of both IgG and IgM antibodies to an infectious agent can be interpreted as evidence of a recent primary infection, since, as is known, the disappearance of IgM antibodies is usually about 3 months from the onset of the infectious process. But the period of circulation of IgM antibodies can vary significantly depending on the infectious agent and the individual characteristics of the body's immune response. When infected with Toxoplasma gondii, Сytomegalovirus and Herpes simplex virus, trace amounts of IgM antibodies to these infectious agents are in some cases detected for 1-2 years or more.

Thus, their presence in the blood of a pregnant woman is not always a confirmation of primary infection during pregnancy. In addition, the specificity of even the best commercial test systems for the detection of IgM antibodies is not absolute. In some situations, as a consequence of the very high sensitivity of the tests, non-specific false positive results are possible. The detection of highly avid IgG antibodies in the blood in this situation makes it possible to exclude recent primary infection. Low-avidity IgG antibodies, on average, are detected within 3-5 months from the onset of infection (this may to some extent depend on the method of determination), but sometimes they are produced for a longer period. By itself, the detection of low-avid IgG antibodies is not an unconditional confirmation of the fact of fresh infection, but serves as additional confirmatory evidence in a number of other serological tests. When the infection is reactivated, specific IgGs of high avidity are detected.

Indications for the purpose of the analysis: Avidity test is indicated in the complex of serological tests for the diagnosis of toxoplasmosis, cytomegalovirus and herpesvirus infection - with positive results of determining IgG and IgM antibodies (in order to exclude or confirm the likelihood of a recent primary infection). Preparation for the study: not required. Material for research: serum. Units: Results are reported as % (avidity index).

Treatment of congenital CMVI consists of etiotropic and syndromic therapy. The indication for etiotropic therapy of congenital CMVI is the active period of the clinically manifest form of the disease. The criteria for the activity of the CMV infection process are laboratory markers of active virus replication (viremia, DNAemia, AGemia). Serological markers of CMVI activity (seroconversion, anti-CMV-IgM and/or increase in the dynamics of the concentration of low-avid anti-CMV-IgG) are less reliable. This is due to the fact that the results of a serological examination often turn out to be both false positive (for example, anti-CMV-IgG detected in a child can be maternal, transplacental, etc.) and false negative (for example, the absence of specific antibodies to CMV due to immunological tolerance or due to a low concentration of antibodies to CMV (beyond the sensitivity of test systems) in the initial period of the immune response, etc.).

General principles for the treatment of intrauterine infections involve immunotherapy, antiviral, antibacterial and post-syndromic therapy. Immunotherapy includes the use of polyvalent and specific immunoglobulins, immunomodulators (interferons). Antiviral therapy of directed action is carried out mainly with acyclovir. For antimicrobial therapy of bacterial intrauterine infections, broad-spectrum antibiotics (cephalosporins, aminoglycosides, carbapenems) are used, and macrolides are used for mycoplasmal and chlamydial infections. Posyndromic therapy of intrauterine infections is aimed at stopping individual manifestations of perinatal CNS damage, hemorrhagic syndrome, hepatitis, myocarditis, pneumonia, etc.

The drug of choice for the etiotropic treatment of congenital CMVI is cytotect-specific hyperimmune anticytomegalovirus immunoglobulin for intravenous administration. The therapeutic efficacy of the cytotect is due to the active neutralization of the cytomegalovirus by specific anti-CMV antibodies of the IgG class contained in the preparation, as well as the activation of antibody-dependent cytotoxicity processes. Cytotect is available as a 10% solution ready for use. For newborns, the cytotect is administered intravenously using a perfusion pump at a rate of no more than 5–7 ml/h. In case of manifest forms of CMVI, cytotect is prescribed: 2 ml/kg/day with administration every 1 day, for a course of 3-5 injections or 4 ml/kg/day administration every 3 days on the 1st day of therapy, on the 5th and 9th day of therapy. Subsequently, the daily dose is reduced to 2 ml/kg/day, and depending on the clinical symptoms and the activity of the infectious process, Cytotect is administered 1–3 more times at the same interval.

Due to the high toxicity of anti-CMV drugs (ganciclovir, foscarnet sodium), they are not used for the treatment of neonatal CMVI. The issue of the need for etiotropic treatment of newborns with asymptomatic congenital CMVI has not been finally resolved. The expediency of prescribing various immunomodulators is also not recognized by all. As antiviral and immunomodulatory therapy, recombinant interferon alfa-2b (Viferon, etc.) is used. Viferon is produced in the form of rectal suppositories containing IU interferon alfa-2b (Viferon-1) or IU interferon alfa-2b (Viferon-2): 1 suppository 2 times a day - daily, for 7-10 days, followed by administration of 1 suppository 2 times a day after 1 day for 2-3 weeks.

Forecast and prevention of intrauterine infections In generalized forms of IUI, mortality in the neonatal period reaches 80%. With local forms, serious lesions of internal organs occur (cardiomyopathy, COPD, interstitial nephritis, chronic hepatitis, cirrhosis, etc.). In almost all cases, intrauterine infections lead to damage to the central nervous system. COPD cardiomyopathy Prevention of IUI consists in preconception preparation (i.e., preparation for pregnancy), treatment before pregnancy, exclusion of contact between a pregnant woman and infectious patients, and correction of a pregnancy management program for women at risk. Women who have not previously had rubella and have not received rubella vaccinations should be vaccinated no later than 3 months before the expected pregnancy. In some cases, IUI may be the basis for artificial termination of pregnancy.

The constituent elements of preconception preparation Preparing for pregnancy begins with planning what and in what time frame the future parents will have to do. Preconception preparation must be read not a month or two before conception, but at least six months or better a year before the expected moment of conception. It includes: determining the health status of future parents; preparing the body of each parent for conception and the woman for pregnancy; determination of optimal days for conception.

For a man and a woman, it all starts with taking a blood test, both from a finger and from a vein, passing urine and other biological materials. Analyzes, among other things, will determine the Rh factor of the blood. This is necessary in order to know whether an Rhesus conflict between a woman and a fetus is possible during pregnancy. Rh factor In general, the list of tests is rather big, but it allows you to clarify many questions regarding the hormonal status of a woman, the resistance of her body to viruses dangerous to the child, as well as the presence or absence of sexually transmitted diseases and infections in both future parents. Quite important is the collection and analysis by the doctor of information from the woman's outpatient card, where previous illnesses, injuries or operations are visible. The doctor also determines whether one of the parents is engaged in hazardous work, whether it is exposed to environmental risks. Determining the health status of future parents.

The expectant mother also needs to visit a number of narrow specialists, primarily a gynecologist. It may be necessary for a woman and/or a man to consult a geneticist. The reason for this may be genetic diseases of close relatives, as well as the age of future parents, which is not very favorable for conception. The age of future parents All of the above will take a lot of time, but will allow you to answer a number of important questions. For example: is it possible to conceive naturally? Is a woman capable of bearing a child and giving birth? Is it possible to contract embryonic infections in utero and during childbirth?

Preparing the body for conception and pregnancy With favorable results of the study of the state of health, future parents can prepare for conception, and a woman - for pregnancy. First of all, you need to give up bad habits, observe the daily routine, moderate physical activity, fully sleep and rest, and avoid negative emotions and stress. It's no secret that our bodies are what we eat. Therefore, future parents should eat a balanced and high-quality diet, especially during preconception preparation. A woman during this period needs to take vitamin B 9 (folic acid). The intake of vitamin E by both future parents contributes to conception. But, as is often the case, vitamins should also be taken in moderation. Therefore, they should be taken only after consulting a doctor and according to his appointment.

Determining the optimal days for conception When preparing for pregnancy, you need to establish the days that are optimal for conception. To do this, it is necessary to determine the moment of ovulation - the period when the egg is ready for fertilization by the sperm. To determine the moment of ovulation, both not very accurate (calendar method) and more reliable methods (measuring basal temperature, using a test to determine ovulation) can be used. Such methods are available to every woman and she can do them on her own. Measuring basal temperature One hundred percent determination of ovulation is possible only in a medical institution using ultrasound and under the supervision of doctors. After determining the moment of ovulation and if they want to conceive a boy or a girl, future parents can plan the day of conception, since, for example, some methods of planning the sex of a child are based on choosing a specific day of the menstrual cycle or season. Conceive a boy or girl on a specific day of the menstrual cycle, time of year a necessary, and, sometimes, an indispensable condition for successful conception, trouble-free pregnancy and childbirth without complications. A responsible approach and good preparation will allow a woman to enjoy pregnancy, and the fetus to grow and develop properly.

intrauterine infection testifies only to the fact of infectious infection of the fetus during fetal development or during childbirth.

Infectious process (infection) - a dynamic process that develops in a macroorganism as a result of the introduction into it

microorganism.

Thus the term "infection" is not equivalent to the term "infection". These terms are not synonymous! Term "infection" carries, basically, an epidemiological burden, while the term “inyavlyayufektsiya” has a broader interpretation - clinical and epidemiological.

Intrauterine infections - infectious diseases in which infection of the fetus occurred in the ante- or intranatal period.

Congenital infection -

an infectious disease in which infection and clinical manifestation of the disease have occurred

in utero.

That is why it is advisable to refer to congenital infectious and inflammatory diseases those that manifest themselves in the first three days of life.

The term "TORCH-syndrome" designate congenital infectious diseases, the etiology of which remains

undecrypted.

“TORCH syndrome” is a term coined from the first letters of the names of the most common intrauterine infections:

T (Toxoplasmosis), Q (0ther diseases), R (Rubella),

C (Cytomegalovirus),

H (Negres simplex virus)

Ways of transmission of infection from mother to fetus:

1. Transplacental - hematogenous. 2. Ascending.

3.Descending.

4. Contact - through infected amniotic fluid.

The outcome of fetal infection depends on:

Type of pathogen; -its virulence; - the amount of infection;

The state of the immune system of the fetus and pregnant;

ways of penetration; - gestational age of the fetus.

depending on timing

infections

1. Tubal infertility (lethal infectious blastopathy)

2. Fetal death - early and late miscarriages, stillbirth (lethal infectious embryofetopathies)

3. Habitual miscarriage (infectious fetopathy)

4. IUI manifestations in live births can be observed in various ways

IUI manifestations in

live births:

a) by the time of birth, the inflammatory process is completed (residual form), the child is “practically healthy”, however, morphological changes in organs and systems indicate an infection (high level of stigmatization) - embryopathy. Infection at 8-12 weeks;

b) the inflammatory process passed in the early fetal period, but left behind sclerotic complications (cirrhosis of the liver or biliary atresia, cardiac fibroelastosis, non-hereditary forms of polycystic kidney disease, hydrocephalus, congenital secondary immunodeficiency, etc.). The latter is also reflected in the postnatal state of the child (early infectious fetopathy). Infection from 4 to 6 months of intrauterine development (16-26 weeks);

c) generalized and local forms of intrauterine infections - sepsis, pneumonia, meningoencephalitis, carditis, pyelonephritis, etc. - late infectious fetopathy. From 27 weeks;

d) bacteriological and virological carriage without clinical and morphological manifestations of the disease - intrauterine infection without clinical manifestations. However, pathogens can be fixed in body tissues for decades, causing a variety of reactions: polymorphic signs of immaturity, malnutrition, neurovegetative and mental disorders can also be caused by an infectious process.

e) transit of maternal antibodies in a newborn;

f) immunological tolerance - an organism infected with a pathogenic agent in utero loses the ability to actively produce antibodies when re-infected with the same pathogen. The inability to eliminate the microorganism is a consequence of immunological tolerance after contact of pathogen antigens with immature cells of the immune system during its embryogenesis.

g) intranatal infection - the incubation period.

Completed by: Shavenkova M 223 OMF Semey State Medical University

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Plan

Introduction 1. Intrauterine infections 1.1 Epidemiology and Etiology 1.2 Source and routes of infection 1.3 Symptoms 1.4 Risk factors for the development of IUI 1.5 Diagnosis and clinical presentation 2. Pathogenetic features of infection in young children Conclusion Literature

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Introduction

Intrauterine infections (IUI) - infectious diseases that are detected either prenatally or shortly after birth, but it occurs as a result of intrapartum or antenatal infection of the fetus. This is a group of diseases in which both infection and manifestation of the disease occurred in utero.

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1. Intrauterine infections

1.1 Epidemiology and Etiology The true frequency of congenital infections has not yet been established, but, according to some authors, the prevalence of this pathology in the human population can reach 10%. Intrauterine infections are characterized by the same patterns as infectious diseases in general. They have a leading place in the structure of infant mortality. The share of IUI in the structure of perinatal mortality in our country is almost 25%, however, transplacental infection of the fetus is considered one of the most likely causes of 80% of congenital malformations, which, in turn, account for about 30% of all deaths in children under 1 year old.

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Ways of penetration of infection to the fetus

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It is noteworthy that infection with these same infections in the postneonatal period proceeds in most cases asymptomatically or in the form of a mild infectious process. The causative agents of infectious diseases that the mother first encountered during pregnancy are especially dangerous for the fetus, since during this period the primary immune response is reduced, while the secondary one is normal. 1.2 Source and route of infection The mother is the source of infection. But there are also iatrogenic causes of infection during medical procedures. Routes of infection * Transplacental (hematogenous) route - from mother to fetus through the placenta. Viral IUI is more commonly transmitted, as the virus easily crosses the blood-placental barrier and toxoplasmosis. * Ascending - when an infection from the genital tract enters the uterine cavity and then can infect the fetus. More often these are bacterial infections, STDs, chlamydia, fungi, mycoplasmas, enterococci. * Descending path - from the fallopian tubes to the uterine cavity * Contact (intranatal) path - infection during passage through the birth canal.

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1.3 Symptoms All IUDs have a number of common symptoms. The similarity of symptoms is associated with several points: the characteristics of pathogens are often intracellular infections, the body cannot eliminate infections on its own - as a result, a persistent course. In addition, newborns have age-related weakness of immunity, which is why infections take a slow course. As a result of the action of the infection on the fetus, a complex of effects occurs, such as hyperthermia, the pathological effect of microorganisms and their toxins, as a result of which there is a violation of the process of placentation and metabolic disorders. 1. Manifestations of infection are determined by the period of infection of the fetus in the first 2 weeks after conception - blastopathy, more often ends in spontaneous abortion at a very early stage from 2 to 10 weeks of pregnancy - true malformations due to lesions at the cellular level.

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from 10 to 28 weeks of pregnancy - early fetopathy. The fetus can respond to the introduction of an infection with a generalized inflammatory reaction (the 1st and 3rd phases of inflammation, alteration and proliferation and fibrosis are pronounced, and the 2nd phase - exudation is not expressed), as a result of which the child develops multiple malformations, for example, fibroelastosis. from 28 to 40 weeks of pregnancy - late fetopathy. The fetus can already respond with a full-fledged inflammatory reaction, most often several organs are involved. Infection during childbirth - inflammation of more than one organ - pneumonia, hepatitis. 2. Teratogenic effect 3. Generalization of the process 4. Persistent, long-term course 5. High frequency of mixed, combined pathology 6. Low clinical specificity

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General signs: * intrauterine growth retardation * hepatosplenomegaly * minor developmental anomalies (dysembryogenesis stigmas) early or prolonged or intense jaundice * various rashes * respiratory distress syndrome * cardiovascular failure * severe neurological disorders * febrile conditions in the first day of life

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1.4 Risk factors for the development of IUI * Aggravated obstetric and gynecological history * Pathological course of pregnancy * Diseases of the genitourinary system in the mother * Infectious diseases of any other organs and systems in the mother that occur during pregnancy * Immunodeficiencies, including AIDS * Repeated blood transfusions * Condition after transplantation 1.5 Diagnosis and clinical presentation Diagnosis of IUI is extremely difficult. First of all, they rely on the data of the anamnesis, especially the course of pregnancy. Methods of laboratory diagnostics of IUI can be divided into direct and indirect. The direct ones include: * microscopy * cultural method, virus replication on tissues * Detection of antigens RIF or ELISA * PCR

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The clinical picture of intrauterine infections significantly depends on the time and route of infection. In the first 8-10 weeks of intrauterine development, only an alternative phase of inflammation is possible, the process ends either with the death of the embryo or the formation of congenital malformations. Later, the proliferative component of inflammation also begins to appear. Infection at a later date (11-28 weeks) causes proliferation of connective tissue (for example, myocardial fibroelastosis), dysplasia and hypoplasia of internal organs, intrauterine growth retardation, and generalized infectious processes. When the fetus is infected after 28 weeks, three components of inflammation are involved - alterative, proliferative and vascular. With localized forms of intrauterine infections, internal organs are affected (fetal hepatitis, hepatolienal syndrome, cardiomyopathy, interstitial nephritis, intrauterine pneumonia, enterocolitis, etc.) and the central nervous system (encephalitis or meningoencephalitis).

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The process of formation of the fetal brain continues throughout pregnancy, so congenital malformations and lesions of the central nervous system are recorded much more often than the pathology of other organs. Since the clinical manifestations of intrauterine infections are mostly non-specific, in most cases the diagnosis is "perinatal encephalopathy" or "impaired cerebral circulation". The clinical picture with a generalized intrauterine infection resembles sepsis (damage to internal organs, hemolytic anemia, thrombocytopenia, hemorrhagic syndrome, adrenal insufficiency, infectious toxicosis). An asymptomatic onset is possible, followed by the development of a clinical picture (delayed pathology): hypertension-hydrocephalic syndrome, progressive cataract, diabetes mellitus, hepatitis, pathology of the urinary system, etc.

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It should be noted that vulvovaginitis in girls, girls and postmenopausal women is predominantly of bacterial origin and is often accompanied by an allergic component. It is important to note that these age > periods are characterized, as a rule, by hypoestrogenism, which is the background for the occurrence of bacterial vulvovaginitis with the addition of an allergic component, which, unfortunately, is not always taken into account by doctors in the treatment of patients. The need to include desensitizing therapy in the treatment of inflammatory diseases, including the lower genital tract, in this group of patients is pathogenetically justified.

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Congenital cytomegalovirus infection

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2. Pathogenetic features of infection in young children

An important distinguishing feature of an infectious disease is the cyclical course with changing periods: incubation, prodromal (initial), height (development) and convalescence (recovery). The incubation period is from the introduction of the pathogen into the body until the first clinical symptoms of the disease appear. During this period, the pathogen multiplies, immunological changes and other processes are observed that disrupt the normal activity of tissues, organs and systems of the macroorganism. The duration of the incubation period is different - from several hours (flu, food poisoning) to several months (viral hepatitis B, infectious mononucleosis) and even years (leprosy, leishmaniasis).

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The prodromal period is manifested by a number of symptoms, usually non-specific for this infection (fever, malaise, loss of appetite). Changes develop at the site of the entrance gate, i.e., a primary focus is formed (tonsillitis, catarrhal phenomena in the upper respiratory tract, etc.), followed by the spread of pathogens to various organs and tissues. In some diseases, pathognomonic, characteristic only of this nosological form, symptoms are observed (with measles - a symptom of Velsky-Filatov-Koplik). The duration of the prodromal period is different - from several hours to several days; sometimes it is missing. The peak period - along with the clinical manifestations common to many infections, symptoms and syndromes characteristic of this disease appear

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Expressed changes in the place of the primary focus; with a number of infections, skin rashes appear (scarlet fever, measles, chicken pox, rubella); with whooping cough - paroxysmal convulsive cough; hematological, biochemical and morphological changes acquire a typical character. The period of convalescence occurs due to the development of specific immunity and is characterized by a gradual normalization of functional and morphological parameters. In some infections, the recovery of impaired functions is slow. At this time, specific sensitization remains, the risk of developing allergic complications and superinfection

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Conclusion

Intrauterine infection - a disease of the fetus or newborn, which has arisen as a result of its antenatal or intranatal infection with the causative agent of any infectious disease. Previously, the term TORCH syndrome was widely used. Currently, it is rarely used, as it includes only five diseases: toxoplasmosis, syphilis, rubella, cytomegalovirus infection and herpes.

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Infectious diseases are a large group of human diseases resulting from exposure to the body of viruses, bacteria and protozoa. They develop during the interaction of two independent biosystems - a macroorganism and a microorganism under the influence of the external environment, and each of them has its own specific biological activity. Infection is the interaction of a macroorganism with a microorganism under certain conditions of the external and social environment, as a result of which pathological, protective, adaptive, compensatory reactions develop, which are combined into an infectious process. The infectious process is the essence of an infectious disease and can manifest itself at all levels of biosystem organization - submolecular, subcellular, cellular, tissue, organ, organism.

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Bibliography

Degtyarev D. N., Degtyareva M. V., Kovtun I. Yu., Shalamova L. V. Principles of diagnosing intrauterine infections in newborns and tactics of managing children at risk. - M.: Perinatology today, 1997. - T. 3. - S. 18-24. Volodina N. N., Degtyareva D. N. Diagnosis and treatment of intrauterine infections. - M.: Method. rec. for neonatologists, 1999. Cheburkin A.V., Cheburkin A.A. Perinatal infection. . A. Ya. Senchuk, Z. M. Dubossarskaya Perinatal infections: practical. allowance. - M.: MIA, 2004. - 448 p.

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Completed by: Shavenkova M 223 OMF Semey State Medical University

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Plan

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Introduction

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1. Intrauterine infections

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Ways of penetration of infection to the fetus

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Congenital cytomegalovirus infection

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2. Pathogenetic features of infection in young children

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Conclusion

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Bibliography

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Download lecture presentation on VUI. Presentation on the topic "intrauterine infections"

Congenital infection -

The term "TORCH-syndrome" designate congenital infectious diseases, the etiology of which remains

Ways of transmission of infection from mother to fetus:

depending on timing

IUI manifestations in

e) transit of maternal antibodies in a newborn;

Plan

Introduction

1. Intrauterine infections

Ways of penetration of infection to the fetus

Congenital cytomegalovirus infection

2. Pathogenetic features of infection in young children

Conclusion

Bibliography

Plan

Introduction

1. Intrauterine infections

Ways of penetration of infection to the fetus

Congenital cytomegalovirus infection

2. Pathogenetic features of infection in young children

Conclusion

Bibliography

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