SYPHILIS IN PREGNANCY

Syphilis in pregnancy is a serious disease as this may be transmitted to the foetus and affect it.

Effects of syphilis on pregnancy: The treponema pallidum affects the placenta and the foetus in pregnancy. The effects are usually observed after 20^th week of the pregnancy. In recent virulent infection, there is a possibility of abortion. Otherwise there are risks of intrauterine foetal death, stillborn and macerated foetus; baby may be borned alive with evidences of syphilis or the baby is borned with other health issues or healthy but develops syphilitic lesions later in the infancy or childhood. Placenta in the seriously infected cases may be relatively bulky in size with microscopical evidences of increased size of the villi due to increased cellularity, perivascular round cell infiltration and diminution in the vascularity of the villi. Spirochetes can be hardly found in placenta.

Effects of pregnancy on Syphilis: Pregnancy causes suppression or latency of syphilitic manifestations. Likewise serum reactions in pregnancy may be modified.

Treatment: Early diagnosis should be made and early institution of treatment should be started. Penicillin treatment at present is considered the therapy of choice for syphilitic pregnant women.

JAUNDICE IN PREGNANCY

Jaundice in pregnancy becomes detectable as visible yellow coloration of skin, sclerae and mucosa when plasma bilirubin rises above 2mg./100 ml(normal range 0.2-0.8 mg./100ml.).

The causes of jaundice in pregnancy can be grouped as follows:

Viral hepatitis:

(i) Infected hepatitis is caused by virus type A from infected person or carrier through contaminated food and water. This is the common cause of jaundice in pregnancy in many countries, and forms an important cause of maternal death due to ‘Associated Causes’. Maternal undernutrition predisposes the condition. There is centrilobular zonal necrosis of liver and intrahepatic cholestasis. Thus there are hepatocellular jaundice with intrahepatic obstructive jaundice. In majority cases complete regeneration of hepatic cells occur. Rarely acute hepatic necrosis and coma may develop. Pregnant woman is not more susceptible to this viral hepatitis.

(ii) Serum hepatitis type B is caused by transfusion of blood, pooled dried plasma or from needle prick of a syringe used on an infected person. Australia antigen is closely associated with serum hepatitis.

(iii) Gall stone: This is a rare cause of jaundice in pregnancy. This jaundice is obstructive type.

(iv) Hepatotoxic drugs: Chlorpromazine may cause jaundice by intrahepatic cholestasis in susceptible woman. Large doses of tetracycline can cause acute fatty liver during pregnancy.

(v) Haemolytic jaundice: Mismatched blood transfusion, cl. Welchii infection, congenital spherocytosis.

VIRUS INFECTION IN PREGNANCY

Measles in mother may be transmitted to the foetus. There is a suspicion that measles developing during early pregnancy can cause foetal abnormality in some cases. Non immunized pregnant woman coming in contact with a case of measles should have inj. human gamma globulin with in 3 days of exposure. Chicken pox can be transmitted from mother to the foetus and thus baby may be born with typical rash. Incidence of congenital malformation does not rise. Maternal mumps has no ill-effect on the foetus. Pregnant woman is not more susceptible to influenza. Present reports suggest that maternal influenza when virulent can cause abortion, premature labor but does not cause increased incidence of congenital malformation. Although a report shows higher incidence of foetal deformity especially in nervous system when influenza affects mother during early pregnancy.

Small pox: This can be transmitted from the mother to the foetus; thus abortion and premature labor are common. Congenital small pox can develop while mother contracts small pox in the late pregnancy. Chicken pox contracted in early pregnancy may rarely lead to congenital defects. The infection acquired within 10 days of delivery is transmitted to the newborn.

TOXOPLASMOSIS IN PREGNANCY

This is a protozoal disease (cause by toxoplasma gondii) considered to be widely distributed throughout the world. The mode of human infestations are unknown. Rawal and Jhala from Bombay found skin test positive in 3 percent population surveyed. Acquired toxoplasmosis in a pregnant woman most often remains asymptomatic, when the recent infection becomes mild or she gets infected before pregnancy. Rarely in a recent infection, fever and generalized lymphadenopathy may appear. Congenital toxoplasmosis: The maternal infection happens to develop placental foci which further damage the foetus. Maternal infections during second trimester of pregnancy have been associated with severe congenital toxoplasmosis at birth, stillbirth and prematurity; infection during first trimester can cause abortion although this does not involve the foetus. The infection during the third trimester causes variable affection of the newborn. It is considered that maternal toxoplasmosis can cause recurrent abortions, premature labor and stillbirths. Mild form of congenital toxoplasmosis which is common may develop a few retinal lesions. More severe infection shows encephalitis, chorioretinitis, fever, diffuse adenopathy, jaundice and maculopapular rash; later on epilepsy and mental retardation may become the sequelae.

OSTEOMALACIA IN PREGNANCY

Osteomalacia is caused by pregnancy and lactation when woman’s store of calcium are greatly reduced by inadequate diet, repeated pregnancies and prolonged lactation during previous pregnancies or sprue and steatorrhoea. This is a calcium deficiency disease either caused by inadequate intake of calcium or vitamin D (this is necessary for absorption of calcium from intestine) in diet or excess of calcium loss through milk in prolonged lactation or spure and steatorrhoea. The disease can be encountered in different parts of the world particularly in Indian subcontinent where women live in purdah (cloth that covers the body) effecting lack of vitamin D. There is decalcification of bones; as a result there is bowing spine forward and also that of legs; the pelvis assumes trifoliate due to collapse of side walls and sacrum. There are aching pains and tenderness in bones, waddling gait. Radiology shows in an advanced case radiotransparency of bones and skeletal deformity particularly that in pelvis. The disease gets worse with increasing number of pregnancies and lactation and also in advanced pregnancy. There may be increased foetal movements. First or even second baby is delivered normally but subsequently obstructed labor can develop due to osteomalacic pelvis. Baby is born usually healthy but in severe cases may be born with rickets.

Treatment: Adequate calcium and vitamin D are provided daily as mild 1-2 pints, tablet ostocalcium t.d.s. and vitamin D 600,00 i.u. (inj.ostelin forte) i.m. twice weekly. For osteomalaicic pelvis, close antenatal care is important and caesarean section is the method of delivery for severe pelvic contraction.