Birth Injury Infections
Infections can have serious consequences for developing and newborn babies, including brain and other major organ damage. An infection can be transmitted to an unborn baby via the placenta, the umbilical cord, the amniotic fluid, or the vaginal canal. Of course, it is the doctor’s responsibility to detect and treat infections, and to take measures to protect the baby from the harm these infections can cause. Some of the more common infections associated with preventable birth injury cases are:
This is an inflammation of the membranes surrounding the baby in her mother’s uterus due to a bacterial infection. It typically results from bacteria ascending into the uterus from the vagina and is most often associated with prolonged labor. The risk of developing chorioamnionitis increases with each vaginal examination that is performed in the final month of pregnancy, including during labor. Failure of the doctor to recognize the onset of chorioamnionitis and timely deliver the baby can result in permanent and serious injury or even death.
GROUP B STREP (GBS)
GBS is a bacteria commonly found in the lower part of the digestive system (colon) and, in women, the vagina. In healthy adults, GBS is not harmful and does not cause medical problems. But in pregnant women and newborn infants, being infected with GBS can cause serious illness.
Approximately one in three pregnant women in the US carries GBS in their intestinal tract and/or in their vagina. Carrying GBS is not the same as being infected. Carriers are not sick and do not need treatment during pregnancy. There is no treatment that can stop you from carrying GBS.
Pregnant women who are carriers of GBS can become infected. GBS can cause urinary tract infections (typically involving only the bladder), infection of the amniotic fluid (“bag of water” surrounding the fetus), and infection of the uterus after delivery. GBS infections during pregnancy may lead to preterm labor or stillbirth.
Pregnant women who carry GBS can pass on the bacteria to their newborns, and some of those babies become infected with GBS. Newborns who are infected with GBS can develop pneumonia (lung infection), septicemia (blood infection), and/or meningitis (infection of the lining of the brain and spinal cord).
These complications can be prevented by giving intravenous antibiotics during labor to any woman who is at risk of GBS infection.
You are at risk of GBS infection if:
- You have a urine culture during your current pregnancy showing GBS
- You have a vaginal and rectal swab culture during your current pregnancy showing GBS
- You had an infant infected with GBS in the past
If you go into labor and have not had a culture for GBS in your current pregnancy or a previously affected infant, you are at risk for GBS if:
- You go into labor prematurely (more than three weeks before your due date)
- You have a fever ≥100.4 degrees Fahrenheit during labor
- You have ruptured membranes for ≥48 hours
The biggest concern with genital herpes during pregnancy is that you might transmit it to your baby during labor and delivery. Newborn herpes is relatively rare (about 1,500 newborns are affected each year), but the disease can be devastating, so it’s important to learn how to reduce your baby’s risk of becoming infected. You can transmit herpes to your baby during labor and delivery if you’re contagious, or “shedding virus,” at that time. The risk of transmission is high if you get herpes for the first time (a primary infection) late in your pregnancy.
Much less commonly, you can transmit the virus if you’re having a recurrent infection. If you’ve ever had a herpes outbreak, the virus remains in your body and can become reactivated. In rare cases, a pregnant woman may transmit the infection to her baby through the placenta if she gets herpes for the first time in her first trimester. If a baby is infected this way, the virus can cause a miscarriage or serious birth defects.
If you’re having an outbreak or symptoms of an impending outbreak when your water breaks or when you go into labor, you’ll need an immediate cesarean delivery. This would be the case if you have any visible sores on your cervix, vagina, or external genitals, or any symptoms, like tingling, burning, or pain, that sometimes signal an imminent outbreak. (Currently, there’s no quick and reliable way to test whether you’re actually shedding virus.)
To improve your chances of being able to deliver vaginally, most experts — including the American College of Obstetricians and Gynecologists — recommend that pregnant women with recurrent genital herpes be offered oral antiviral medication from 36 weeks or so until delivery. Recent studies show that this reduces the risk of an outbreak at the time of labor.
If you first get genital herpes late in pregnancy and blood tests confirm you’ve never had it before, some experts recommend having a cesarean section even if you don’t have symptoms when you go into labor. About a third of the time, newborn herpes affects a baby’s skin, eyes, or mouth, but not his other organs. If that’s the case, he may have sores at delivery or develop them up to four weeks later. They typically turn up between 1 and 2 weeks of age.
Herpes lesions usually look like blisters and can appear anywhere on a baby’s body. They often appear where there has been a small break in the skin or any trauma — like where the hospital wristband was or where an electrode was placed on his head to monitor his heart rate during labor.
If your baby has herpes that’s limited to the skin, eyes, and mouth and gets prompt treatment with intravenous acyclovir, he’ll most likely do well. One study showed that more than 90 percent of babies with this form of herpes were developing normally when they were tested as 1-year-olds, although an infected baby can have serious recurrent outbreaks or long-term problems.
If not treated promptly, a baby who starts out with herpes limited to the skin, eyes, and mouth can go on to develop an even more serious form of herpes.
In another third of newborns who get herpes, the central nervous system is affected. This most often shows up at about 2 to 3 weeks of age with symptoms such as irritability, fever, lethargy, poor feeding, or seizures.
The remaining third of newborns get what’s called “disseminated herpes”. This involves multiple organs, often the lungs and liver. It typically shows up during the first week after birth. Babies with disseminated herpes may or may not have skin lesions. (If they don’t, diagnosing herpes as the source of the baby’s illness is tricky.)
These latter forms of herpes are very serious. Unfortunately, even with prompt treatment, a number of these babies will die, and many of the survivors will end up with serious long-term health and developmental problems.
Trichomoniasis is a fairly common sexually transmitted infection that is caused by a microscopic parasite. A “trich” infection during pregnancy is associated with a higher risk of preterm birth, preterm premature rupture of the membranes (PPROM), and having a low-birth-weight baby (a baby weighing less than 5.5 pounds at birth). Trichomoniasis can also make you more susceptible to HIV if you’re exposed to it.
It’s possible for your baby to become infected with the trich parasite during delivery, but that happens very rarely, and the infection can be treated with antibiotics.
You might not have any symptoms. If you do, you may have a yellowish or greenish vaginal discharge, often with a frothy appearance and an unpleasant odor, and your vagina and vulva might get red, irritated, or itchy. You might experience some discomfort while urinating or during intercourse, and possibly some spotting after intercourse. You may notice lower abdominal discomfort, but that symptom is less common. Symptoms could start soon after you become infected or show up much later. So, if you’ve just been diagnosed with trich, it doesn’t necessarily mean that you recently contracted it.
If you do have symptoms, let your practitioner know so you can be tested for trich and other possible culprits. To test for trichomoniasis, your practitioner will take a swab of vaginal fluid and examine it under a microscope. She may also send a sample to the lab for a more sensitive test.
Unless you have symptoms, you won’t be tested for trich. There’s no evidence that treating trich lowers your risk of complications, and some research suggests that it may even increase the risk of preterm birth. For this reason, only women with bothersome symptoms are tested and treated for trich during pregnancy.
If you have bothersome symptoms and are diagnosed with trich, you’ll be given a course of oral metronidazole, which is generally considered safe for the baby during pregnancy. Your partner should be treated at the same time, whether or not he has symptoms (most men don’t).
You’ll need to abstain from sexual intercourse until you’ve both finished the treatment and are symptom-free – otherwise, you risk being reinfected.
Have sex only with a partner who has sex only with you. If this isn’t the case, using condoms reduces the risk of transmission of trichomoniasis and most other STIs.