A 32-year-old G5 delivers a stillborn fetus at 34 weeks. The placenta is noted to be much larger than normal. The fetus appeared hydropic and had petechiae over much of the skin.
For the clinical scenario presented, select the most likely causative agent.
Transplacental infection can occur with any stage of syphilis, but the highest incidence of congenital infection occurs in women with primary or secondary disease. The fetal and neonatal effects include hepatosplenomegaly, edema, ascites, hydrops, petechiae or purpuric skin lesions, osteochondritis, lymphadenopathy, rhinitis, pneumonia, myocarditis, and nephrosis. The placenta is enlarged, sometimes weighing as much as the fetus.
A 38-year-woman at 39 weeks delivers a 7-lb infant (female) without complications. At 2 weeks of life, the newborn develops fulminant liver failure and dies.
Transplacental transfer of hepatitis B from the mother to fetus occurs with acute hepatitis, not chronic seropositivity. Acute infection in first trimester infects 10% of fetuses, and in third trimester 80% to 90% are affected. Perinatal transmission occurs by ingestion of infected material during delivery or exposure subsequent to birth in mothers who are chronic carriers. Some infected infants may be asymptomatic, and others develop fulminant hepatic disease. Administration of hepatitis B immune globulin after birth, followed by the vaccine, can prevent disease in infants born to mothers who are chronic carriers.
A 20-year-old woman who works as a kindergarten teacher presents for her routine visit at 32 weeks. Her fundal height measures 40 cm. An ultrasound reveals polyhydramnios, an appropriately grown fetus with ascites and scalp edema. The patient denies any recent illnesses, but some of the children at her school have been sick recently.
Parvovirus can cause fetal anemia. Maternal infection can lead to fetal hydrops, abortion, or stillbirth. In susceptible adults, 20% to 30% will acquire disease during school outbreaks. If a pregnant woman has this diagnosis confirmed with IgM antibodies, ultrasound is done for fetal surveillance. If hydrops is diagnosed, fetal transfusion can be offered. One-third of fetuses will have spontaneous resolution of hydrops, and 85% of fetuses who receive transfusion will survive.
A 25-year-old woman in her first pregnancy delivers a 6-lb male neonate at 38 weeks. The newborn develops fever, vesicular rash, poor feeding, and listlessness at 1 week of age.
Neonatal herpes infection has three forms— disseminated with involvement of major organs; localized, with involvement confined to the central nervous system; and asymptomatic. A 50% risk of neonatal infection occurs with primary maternal infection, but only 4% to 5% risk with recurrent outbreaks. Postnatal infection can occur through contact with oral and skin lesions. Neonatal infection presentation is nonspecific, with signs and symptoms such as irritability, lethargy, fever, and poor feeding. Less than 50% of infants do not have skin lesions.
A 22-year-old woman delivers a 7-lb male infant at 40 weeks without any complications. On day 3 of life, the neonate develops respiratory distress, hypotension, tachycardia, listlessness, and oliguria.
Early onset group B Streptococcus disease occurs within 1 week of birth. Signs of the disease include respiratory distress, apnea, and shock. Late-onset disease usually occurs after 7 days and manifests as meningitis.
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