1.

Infection in Pregnancy
 Toxoplasma Gondii
• Epidemiology
15% fetus who are congenital infected having damaged of organ/structur post partum
like hydrocefalus, corioretinitis,while 85% asymptomatic
• Diagnosis
Diagnosis prenatal (14-27 weeks)
- Cordocentesis : take the fetal blood sample through the umbilical cord
- Amniocentesis : aspiration of amniotic fluid with USG
- Breeding of fetal blood/amniotic fluid to knowing there is a parasite
- P.C.R technique to identify D.N.A of T. gondii in fetal blood or amniotic fluid
- ELISA in fetal blood to detect specific fetal IgM dan IgA antibodies (anti
toksoplasma).
Diagnosis congenital toxoplasma
- There ase specific fetal IgM dan IgA antibodies (anti toksoplasma) from fetal blood
• Management
- Acute Infection : 1) Spiramin (antibiotics) → adults : 2-4 gr/day/oral divided into
4 dose for 3 weeks, repeated after
2 weeks until aterm pregnancy
2) Piremitamin (Fenilpirimidin antimalarial drugs) → dose :
1 mg/Kg/day for avoid accumulation, just give it 3-4
days
3) Sulfadiazin → dose : 50-100 mg/Kg/day
- Congenital Toxoplasma : 1) Sulfadiazin with dose 50-100 mg/Kg/day and
Pyremithamine 0,5-1 mg/Kg give it every 2-4 days
for 20 days
2) Intramuscular injection of Folinic Acid 5 mg every
2-4 days to overcome the toxic effects
of Pyremithamine
 Hepatitis Viral
• Hepatitis B Virus
1. Epidemiology : prevalence in pregnant women in Indonesia ranged between 1-5%,
depending on the prevalence of VHB in populated
2. Patofisiology : if acute infection happened → Hepatitis Fulminan → high mortality
in mother and fetal
in mother → abortion and post partum hemorrhage,
due to blood clotting due to liver dysfuction
predisposing factor to vertical transmission because high
DNA-VHB Titer in mother
3. Diagnosis : Acute HVB → Liver Serum Transaminase function test
(ALT increases),
serology HBsAg and IgM anti HBC in Serum
Chronic HVB → HBsAg (Hepatitis B surface Antigen) + > 6 months
, examination of ALT levels
(Alanin Amino Transferase), liver biopsy, HBV-DNA
3. Management : - in VHB acute infection and there’s Hepatitis Fulminan vaginal
delivery cultivated with a little traumatic and treated with an Interne
specialist
- in pregnant women with high Viral Load consideration may be given
HBIG/Lamivudin in 1-2 months before delivery
- labor shouldn’t be too long, especially on mom who have HBsAg +
• Hepatitis A Virus
1. Epidemiology : AS → down as much 95% since given the vaccine first time in 1995
in 2010 VHA case as much 1.670 case with
Incidence Rate 0,6/100.000
Indonesia → ranged 39,8-68,3%
2. Patofisiology : the transmission trough Fecal Oral
the problem that can arise in pregnancy → bleeding due to blood clots
3. Diagnosis : there’s IgM antibodies in sufferers serum
4. Management : no special treatments, keep balance of nutrition ,
bed rest, high calorie diet, discontinuance the treatments (drugs)
that have a high risk on pregnancy
• Hepatitis Delta Virus
1. Epidemilogy : rare, high prevalence in eastern countries like Arab Saudi, Mesir,
Kenya, Venezuela
2. Patofisiology : 2 type of infection → 1) Super Infection, where initially infection by
VHB, then infection by VHD
2) Co-Infection, where VHB and VHD
infect together
can be transmitted through sexual/syringe
3. Management : no vaccine but usually can be procted if already given immunized
Hepatitis B
• Hepatitis E Virus
1. Epidemiology : in Indonesia there was an outbreak in Jawa Barat in 1983 and
Kalimantan in 1989
outbreak in China → the prevalence 13,4%, 57% occurs in 3rd TM,
47,3% became Hepatitis Fulminan, 15,8% died
2. Patofisiology : the transmission through Fecal Oral, if it happens on big pregnancy
it can be Hepatitis Fulminan and high risk of death
3. Diagnosis : if IgM and IgG antiHEV + in sufferers
4. Management : there’s no antivirus, vaccination not yet available
 Tyfoid Fever
• Epidemiology
In Indonesia the prevalence reaches 358.810/100.000 population in 2007 with mortality
3,1-10,4% in hospitalized patients
• Etiology
Mjor aetiology in Indonesia are Salmonella enterika subspesies enterika serovar Typhi
(S. Typhi) and Salmonella enterika subspesies enterika serovar paratyphi A
(S. Typhi A)
• Patofisiology
The infection happened in GI Tract, the fever occurs die to endotoxin is excreated by
S.typhi
Influence on pregnancy with high heat and poor general circumstances → abortion,
premature birth and intrauterine fetal death especially in infeksi in 1st and 2nd TM
pregnancy
• Diagnosis
Laboratory Examination : - hematology → Hb levels can go turun can be normal ,
leukocytes are often low, LED increases,
normal or decreased platelets
- urinalysis → protein can be (-) can be (+) due to fever
- liver enzymes often increase with a inflammation
- Widal Test → there’re antibodies against S.typhi antigen
• Management
- Maintaining the temperature within normal limits
- Increasing fluid and nutrients requirements
- Prevent decrease in fluid volume
- Give enough fluids, calorie, vitamin, and protein, not much fiber
- Give a Antimicrobials → Cloramfenicol (adults dose : 4x500mg/day, oral or
I.V up to 7 days free of fever) not recommended in 3rd
trimester,it’s feared there could be premature birth
Recommended Ampisilin/amoxicilin
(a day 50-100 mg/Kg, divided into 4 dose, oral,IM,IV)
and ceftriakson (1-2 gr 2 x a day , IM,IV)