Intrauterine infection

Amniocentesis is performed by a physician for prenatal diagnosis of congenital disorders, to assess fetal maturity, or to look for Rh isoimmunization or intrauterine infection. Although ultrasound is not essential, amniocentesis is best performed with its assistance to aid locaHzation of the placenta and to determine the presentation of the fetus. The best sites for obtaining amniotic fluid are behind the neck of the fetus, below its head, or from other unoccupied areas of the amniotic cavity. 

Polyclonal increases in serum immunoglobulins are the normal response to infections. IgG response predominates in autoimmune responses IgA in skin, gut, respiratory, and renal infections and IgM in primary viral infections and bloodstream parasites, such as malaria. Chronic bacterial infections may cause an increase in serum levels of all immunoglobulins. In such cases, estimations of the individual immunoglobulins seldom provide more information than protein electrophoresis. They are of value, however, in the differential diagnosis of liver disease and of intrauterine infections. In primary biliary cirrhosis, the IgM level is greatly increased in chronic active hepatitis, IgG and sometimes IgM are increased and in portal cirrhosis, IgA and sometimes IgG are increased. In intrauterine infections, production of IgM by the fetus increases, and the IgM level in umbilical cord blood is increased. Estimations of IgE are used in the management of asthma and other allergic conditions, especially in children. 

Tocolytic therapy should not be used in cases of intrauterine infection, fetal distress, severe preeclampsia, vaginal bleeding, and maternal hemodynamic instability. The criteria for starting tocolysis are regular uterine contractions with cervical change. In women with cervical dilatation >3 cm, tocolytic therapy is less effective. ... 

Of all the likely prenatal factors in cerebral palsy, reduced blood flow to the fetal brain (cerebral ischemia) during gestation is the most important. The second most important is apparendy inflammation caused by intrauterine infection.12 Fetal inflammatory responses can evidendy contribute to brain injury by producing white matter lesions. In any case, inflammation resulting from infection of the chorio-amnion membrane system that surrounds the fetus (chorioamnionitis) is now a known causative factor for neurological disturbance and cerebral palsy. 

Foetal growth retardation (FGR) is defined as a predicted foetal weight at term that is under the 10 percentile or below 2.5 kg. It is linked to significantly elevated foetal morbidity and mortality (McCormick, 1985), with the most common causes cited as chronic hypertension, pre-eclampsia, smoking, alcohol, stress and intrauterine infections. It is believed that these conditions cause abnormalities in placental structure and function (Regnault et al., 2002) interfering with implantation, placentation, placental... 

Listeriosis can cause sepsis and meningitis, particularly in elderly and immunocompromised persons. Infection during pregnancy produces a mild, flu-like illness in the mother but serious intrauterine infection resulting in fetal death, neonatal sepsis, or meningitis. 

Pregnant women who have eaten L/sfena-contaminated foods shouid be treated empiricaiiy, even if oniy miidiy symptomatic, to prevent serious intrauterine infection. The antibiotic of choice is ampiciiiin, with gentamicin added for severe infection. 

Arvin AM, Alford CA (1990) Chronic intrauterine and perinatal infections. In Galasso GJ, Whitley RJ, Merigan TC (eds) Antiviral agents and viral diseases of man, 3rd edn. Raven,... 

Other less frequently used parenteral routes such as intra-articular or sub-conjuctival injections and intramammary or intrauterine infusions have limited application they aim at directly placing high drug concentrations close to the site of infection. These routes of administration differ from the major parenteral routes in that absorption into the systemic circulation is not a prerequisite for delivery of drug to the site of action. When the infection site is relatively inaccessible, such as in the case of mastitis, the combined use of systemic and local delivery of drug to the site of infection may represent the optimum approach to treatment. 

Further study has suggested that environmental factors must play a very important role. These factors and their impact are poorly understood at the present time, but they include the possibility of maternal intrauterine viral infections during the gestational period, obstetrical complications during delivery, and perinatal conditions during the early days or months of the patient s life. Essentially, it would appear that schizophrenic patients have a genetic vulnerability to develop the disorder, which is manifested later in life if and when certain environmental conditions occur. 

Toivonen J, Luukkainen T, Allonen H. Protective effect of intrauterine release of levonorgestrel on pelvic infection three years comparative experience of levonorgestrel- and copper-releasing intrauterine devices. Obstet Gynecol 1991 77(2) 261. ... 

Teratogenic effects of tetracyclines have been demonstrated (158-160), as evidenced by increased rates of intrauterine death, congenital anomalies in general (161), and congenital cataracts (162) in fetuses exposed to tetracyclines. However, it is often impossible to distinguish between the drug and an underlying unidentified viral infection as a cause of the observed abnormalities. 

Table 11.1 Recommended doses for intrauterine antimicrobiai agents in uterine bacterial infections in mares...

Table 11.2 Recommended doses for intrauterine administration of antimycotic agents for the therapy of uterine fungal Infections In mares...

Secondary amenorrhea also is caused by uterine failure. The patient with a uterine problem is normal hormonally, but does not menstruate. Ashermans syndrome, or intrauterine adhesions, is the most common outflow-tract abnormality that causes amenorrhea. Endometrial damage may occur in response to a dilatation and curettage and to infections of the endometrium. Pituitary dysfunction can cause secondary amenorrhea. This is most often caused by intrinsic pituitary tumors. However, Sheehan s syndrome and pituitary apoplexy can also restilt in hormone deficiency. 

Intrauterine devices, as well as sometimes causing discomfort and heavier periods, can also cause infection. 

For many months we have now routinely kept all cord sera so that they can be screened (a) for elevations indicating intrauterine stimulation and (b) as a baseline for any subsequent elevation which might establish that postnatal infection has occurred. 

Grimes DA. Intrauterine device and upper-genital-tract infection. Lancet 2000 356 1013-1019. 

Because medical conditions, emotional/behavioral symptoms, and physiologic indices change during the premenstrual and per-imenopause phases, it is important to rule out other disorders that may contribute to mood fluctuations or pain syndromes (Table 78-2). For example, dysmenorrhea may be primary, which occurs during ovulatory cycles, or secondary, which relates to pelvic pathology (e.g., infection caused by the placement of intrauterine devices, endometriosis, pelvic inflammatory disease, ovarian cyst, endometrial cancer, adhesions, and benign uterine tumors). 

Wright C, Hinchliffe SA, Taylor G. Fetal pathology in intrauterine death due to parvovirus B19 infection. Br J Obstet Gynaecol. 1996 103 133-136. 

The exposure of children during fetal development and early postnatal life to air pollutants is associated with low birth weight, preterm birth, intrauterine growth restriction, congenital defects, preterm and infant mortality, decreased lung growth, increased rates of respiratory tract infections, childhood asthma,... 

Sulfonamides are administered to food-producing species as additives to feed and drinking water, controlled-release oral boluses, and intrauterine infusions. These drugs are applied to the brood chambers of honeybee hives mixed with confectioners sugar or in syrup. The insoluble nature of sulfonamides is an important consideration. Highly insoluble sulfonamides such as phthalylsulfathiazole are absorbed from the gastrointestinal tract very slowly and are used to treat enteric infections. With triple sulfas for oral administration, the concentration of individual sulfonamides is limited by the drug s solubility, while efficacy reflects the additive activity of all three components. Sodium salts of sulfonamides, which are readily soluble in water, are available for intravenous administration. 

Rickinson AB, Kiefif E (1996) Epstein-Barr Virus. In Fields BN, Knipe DM, Howley PM (eds) Fields Virology. Lippincott-Raven, Philadelphia, pp 2397 2445 Robb JA, Benirschke K, Barmeyer R (1986) Intrauterine latent herpes simplex virus infection I. Spontaneous abortion. Hum Pathol 17 1196-1209... 

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