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Manual of Perinatal Infections
Vandana Walvekar, MJ Jassawalla, Geetha Balsarkar
1:
Perinatal Infections
INTRODUCTION
CLASSIFICATION
BACTERIAL INFECTIONS
TORCH INFECTIONS
Rubella
Toxoplasmosis
Cytomegalovirus Infection
Herpes Simplex22
CONGENITAL SYPHILIS
HEPATITIS
Hepatitis B
Hepatitis C
HIV I AND II
VARICELLA
LISTERIOSIS
2:
Anaerobic Infections in Pregnancy
INTRODUCTION
ETIOLOGICAL AGENTS
PREDISPOSING FACTORS
PATHOGENESIS
CLINICAL SYMPTOMS
Bacterial Vaginosis in Pregnancy
DIAGNOSIS
TREATMENT
PROGNOSIS
PREVENTION
Neonatal Tetanus
3:
Nosocomial Infections
SYNONYM
INTRODUCTION
DEFINITION
INCIDENCE
CAUSATIVE ORGANISMS
SITES OF NOSOCOMIAL INFECTION
RISK FACTORS
PATHOGENESIS
DIAGNOSIS
PREVENTION
4:
Tropical Infections
INTRODUCTION
NATURAL HISTORY OF INFECTION
PATHOPHYSIOLOGY
Pathogenic Effects on the Mother
Congenital Malaria
Clinical Implications of Severe Malaria
CLINICAL MANIFESTATIONS
Uncomplicated Malaria
Severe Malaria
Prognostic Factors
DIAGNOSIS
Fluorescent Microscopy
Immunological Methods
Molecular Biological Detection Test
THERAPEUTIC MANAGEMENT
PROPHYLAXIS
Malarial Vaccines
Relapse/Recrudescence
INTRODUCTION
NATURAL HISTORY OF INFECTION
Various Routes of Transmission to the Fetus
Pathological Effects on the Mother
Occurrence of Congenital Tuberculosis
Pathological Effect on the Fetus
Congenital Tuberculosis
CLINICAL MANIFESTATIONS
DIAGNOSTIC METHODS
THERAPEUTIC MANAGEMENT OF THE INFECTION
Management of Pyelonephritis and Upper Urinary Tract Infections
Treatment of Nongenital Tuberculosis
5:
Vaginal Infections: Prophylaxis and Perinatal Outcome
INTRODUCTION
CHANGES IN MICROBIAL ECOSYSTEM DURING PREGNANCY
BACTERIAL VAGINOSIS, CANDIDIASIS, TRICHOMONIASIS
Bacterial Vaginosis
Candidiasis
Trichomoniasis
FUTURE DIRECTIONS
6:
Viral Infections
INTRODUCTION
CYTOMEGALOVIRUS
Microbiology
Infection
Symptomatic CMV in Newborn
Diagnosis
CMV Serology
Treatment
Prevention
HERPES SIMPLEX VIRUS
Epidemiology
Microbiology
Infection
Diagnosis
Treatment:
HUMAN IMMUNODEFICIENCY VIRUS
Epidemiology
Microbiology
Infection
Mechanisms of Mother to Infant Transmission
VARICELLA ZOSTER VIRUS
Epidemiology
Microbiology
Infection
Maternal-fetal Transmission
Diagnosis
Treatment
PARVOVIRUS B19
ENTEROVIRUSES
MUMPS
7:
HIV Infection in Pregnancy
INTRODUCTION
HISTORY
Magnitude of the Problem
Virology
ROUTES OF SPREAD
Sexual Route
Parenteral Route
Mother to Child Transmission (MTCT)
EPIDEMIOLOGY OF HIV IN PREGNANCY
IDENTIFICATION
Screening
EFFECTS ON THE IMMUNE SYSTEM
Effects of Pregnancy on the Immune System
Effects of HIV on the Immune System
The Immune System in Pregnant HIV Infected Women
PREGNANCY AND HIV INFECTION
Effects of Pregnancy on HIV Infection
Effect of HIV Infection on Pregnancy Outcome
MANAGEMENT GOALS
ANTENATAL INVESTIGATIONS
RATES OF TRANSMISSION
TIMING OF TRANSMISSION
Antepartum Transmission
Intrapartum Transmission
Postpartum Transmission
Factors Affecting Mother to Child Transmission
STRATEGIES TO PREVENT PERINATAL HIV TRANSMISSION
Antiretrovirals
Correction of Risk Factors
OPTIMIZING OBSTETRIC PRACTICE
Intrapartum Care and the Role of Elective LSCS
Breastfeeding Substitutes
POSTPARTUM CARE
Diagnosis of Pediatric HIV Infection
CONCLUSIONS
8:
Sexually Transmitted Diseases in Pregnancy
INTRODUCTION
SYPHILIS
Natural History of Infection
Routes of Transmission from Mother to Fetus
Pathological Effect on Mother
Pathological Effect on Fetus (Larsen, 1996)
Changes in Syphilitic Placenta
Different Diagnostic Methods of Screening
Choice of Tests and Interpretation of Results
Clinical Features
Radiological Appearance
Signs of Early Congenital Syphilis
Prophylaxis
Treatment Guidelines for Acquired Syphilis during Pregnancy
GONORRHEA
Natural History of Infection
Routes of Transmission from Mother to Fetus
Pathological Effects on Mother
Pathological Effects on Fetus
Diagnostic Methods of Screening
Clinical Manifestations (Radcliffe, 1999)
Rectal Infection
Pharyngeal Infection
Gonococcal Disease of the Newborn
Complications of Gonorrhea
Systemic Complications
Prophylaxis
Therapeutic Management of Infections
Complicated Gonococcal Infections
Side Effects of Drugs on Fetus
Management of Recurrent Infections
LYMPHOGRANULOMA VENEREUM/CHLAMYDIAL INFECTIONS
Natural History
Routes of Transmission from Mother to Fetus
Pathological Effect on Mother
Effect of C. trachomatis on Reproduction and Pregnancy
Role of C.trachomatis in Maternal Puerperal Morbidity
Pathological Effect on Fetus
Diagnostic Methods of Screening
Cell Culture
Tests of Antigen Detection for Chlamydia Lipopolysaccharide (LPS) or Major Outer Membrane Protein (MOMP)
Recent Tests to Detect Amplified C. trachomatis DNA/RNA
Tests to Detect Antibodies: Microimmunofluorescence Antibody Tests
Clinical Manifestations
Primary Lesion
Secondary Stage
Prophylaxis
Therapeutic Management
Side Effects of Drugs on Fetus
Management of Recurrent Infection
GENITAL HERPES
Natural History of HSV Infection
Routes of Transmission from Mother to Fetus
Pathological Effect on Mother
Pathological Effects on Fetus
Intrauterine Infection
Intrapartum or Postnatal Infection
Skin, Eye and/or Mouth Infection
Encephalitis
Disseminated Infection
Diagnostic Methods of Screening (Moreland, 1996)
Clinical Features
Primary Genital Infection—First Episode
Non-primary Genital Herpes Infection—First Episode
Recurrent Genital Herpes
Prophylaxis
Therapeutic Management
Management of Herpes in Pregnancy (Radcliffe, 1999)
ANOGENITAL WARTS (VIRAL WARTS) (GENITAL HUMAN PAPILLOMA VIRUS INFECTION)
Natural History of Infection
Routes of Transmission from Mother to Fetus
Pathological Effects on Mother
Pathological Effects on Fetus
Diagnostic Methods of Screening
Clinical Manifestations
Cervical HPV Infections
Prophylaxis
Therapeutic Management
Management of Recurrence
9:
Hepatitis in Pregnancy
INTRODUCTION
VIRAL HEPATITIS
Pathogenesis
Clinical Picture
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Hepatitis G Virus
ACUTE FATTY LIVER
CHOLESTASIS IN PREGNANCY
DRUG-INDUCED ACUTE HEPATITIS
CHRONIC HEPATITIS AND PREGNANCY
10:
Toxoplasmosis
INTRODUCTION
NATURAL HISTORY OF INFECTION
VARIOUS ROUTES OF TRANSMISSION FROM MOTHER TO FETUS
Acquisition of Toxoplasma Infection
PATHOLOGICAL EFFECTS OF INFECTION ON THE MOTHER
PATHOLOGICAL EFFECTS OF THE INFECTION ON THE FETUS
DIFFERENT DIAGNOSTIC METHODS OF SCREENING
INTRAUTERINE DIAGNOSIS OF TOXOPLASMOSIS
CLINICAL MANIFESTATIONS
PREVENTION AND PROPHYLAXIS
Health Education
Serological Screening during Pregnancy
THERAPEUTIC MANAGEMENT OF INFECTIONS
Efficacy of Treatment
Treatment
Alternative Therapies
Side Effects of the Drug on the Fetus
11:
Chlamydial, Listeriosis and Mycoplasma Infections in Pregnancy
CHLAMYDIAL INFECTIONS
Introduction
Epidemiology
Profile
Pathogenesis
Clinical Course
Sequelae
Risk Factors
Diagnosis
Screening
Treatment
LISTERIOSIS
Introduction
Pathogenesis
Mode of Transmission, Incubation, and Period of Communicability
Clinical Course
Diagnosis
Prevention
Treatment
MYCOPLASMA INFECTIONS
Introduction
Pathogenesis
Clinical Course
Diagnosis
Treatment
CONCLUSION
12:
Asymptomatic Bacteriuria in Pregnancy
INTRODUCTION
NATURAL HISTORY OF INFECTION
Transmission to the Fetus
Pathological Effects of the Infection
On the Mother
On the Fetus
Diagnosis
Clinical Manifestations
Prophylaxis
Therapeutic Management of Infection
Side Effects of Drugs Used on the Fetus
Management of Recurrent Infection
13:
Chorioamnionitis
INTRODUCTION
EPIDEMIOLOGY
PATHOGENESIS
PREDICTORS OF INTRA-AMNIOTIC INFECTION
CLINICAL FEATURES
DIAGNOSTIC TESTS
C-Reactive Protein (CRP)
Amniocentesis
Blood Culture
COMPLICATIONS AND SEQUELAE
MANAGEMENT
14:
Puerperal Sepsis
INTRODUCTION
HISTORICAL PERSPECTIVE
FEBRILE MORBIDITY IN PUERPERIUM
FACTORS PREDISPOSING TO PUERPERAL INFECTIONS
SPECTRUM OF POSTPARTUM INFECTIONS
Infection following Vaginal Delivery and Cesarean Section
Pelvic Cellulitis
Septic Pelvic Thrombophlebitis
Urinary Tract Infection and Pyelonephritis
Breast Infection
Toxic Shock Syndrome
PATHOLOGICAL PROGRESSION OF PUERPERAL SEPSIS
INVESTIGATIONS
MANAGEMENT OF PUERPERAL SEPSIS
Treatment of Septic Shock
Role of Vasoactive Drugs
Antibiotic Therapy
Role of Corticosteroids
Surgical Treatment
Role of Posterior Colpotomy
Extraperitoneal Abdominal Drainage
Exploratory Laparotomy for Hysterectomy
PROGNOSIS OF PUERPERAL SEPSIS
THERAPIES UNDERGOING RESEARCH IN PUERPERAL SEPSIS
PROPHYLAXIS
CONCLUSION
15:
Bacteremic Shock
INTRODUCTION
PREDISPOSING FACTORS
PREGNANCY AND BACTEREMIC SHOCK
PATHOPHYSIOLOGY
Activation of Clotting Cascade
Activation of Fibrinolytic System
Disseminated Intravascular Coagulation
Activation of Complement Cascade
Effects of Complement Activation
Release of Histamine
CLINICAL PRESENTATION
DIAGNOSIS AND INVESTIGATION
MANAGEMENT
Volume Expansion
Vasoactive Drug Therapy
Oxygenation
Treatment of Infection
Administration of Glucocorticoids
Surgical Management
Controversial Treatment Modalities
PREVENTIVE MEASURES
16:
Antibiotic Prophylaxis
INTRODUCTION
ANTIBIOTIC PROPHYLAXIS IN SPECIFIC SITUATIONS
Preoperative Antibiotic Prophylaxis
Types of Prophylaxis
Failure of Prophylaxis
HIV
Prophylaxis against Tuberculosis
MAC
Prophylactics against Pneumocystitis carinii Pneumonia
Heart Disease
Diabetes Mellitus
CONCLUSION
17:
Immunization during Pregnancy
INTRODUCTION
CHANGES IN IMMUNOLOGICAL SYSTEM DURING PREGNANCY
Transfer of Antibodies to the Fetus
IgG Transfer
IgM Transfer
Development of Immune System of the Fetus
IMMUNIZATION DURING PREGNANCY
Hepatitis A
Hepatitis B
Varicella
Influenza
Measles
Rubella
Poliomyelitis
Yellow Fever
Rabies
Tetanus
Cholera
Typhoid
Plague
Pneumococcus
INDEX
TOC
Index
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