Common use of available techniques detecting perinatal
infections needs to be accompanied with knowledge of proper interpretation of the tests and indications for treatment as well as communication with patients. The aim of this paper is to summarize current standards of diagnosis and treatment of
infections in pregnant women and neonates. The detection of specific
IgG antibodies in pre-conceptive period excludes the risk of transplacental Tg and PVB19
infection, while the risk of CMV
infection is diminished and probable symptoms alleviated. Confirmed diagnosis of primary
infection during pregnancy: 1.
Toxoplasmosis (seroconversion, presence of
IgA and
IgM, low avidity
IgG, PCR in amniotic fluid) is an indication for antimicrobial
therapy; 2. Symptomatic CMV
infection [seroconversion, virus detected in blood and urine (PCR, pp65
antigen)] for prophylactic
IgG administration in mother; 3. PVB19 (seroconversion,
IgM, PCR in blood and amniotic fluid) for frequent ultrasonographic evaluation of possible symptoms of
fetal hydrops, and fetal transfusin if
hydrops occurs. Diagnosis and treatment of the neonates should be managed in specialized c enters. Further monitoring of the
infection is handicapped by the presence of maternal
antibodies as well as the suppression of neonatal production of specific
IgA and
IgM.
Toxoplasmosis requires from 6 (in asymptomatic infestation) to 12 months (in symptomatic infestation) treatment with
pyrimethamine and
sulfadiazine with supplementation of
folinic acid. In symptomatic CMV
infection 6 weeks treatment with
ganciclovir is legitimate (decreases viruria and the risk of
hearing impairment); while in
asymptomatic infection with massive viral replication it can be considered as supposedly beneficial. The impact of prolonged treatment (over 6 weeks) as well as oral
antiviral (
valganciclovir) is currently under clinical investigation. The educational efforts should include: methods of preventing
infections (Tg, CMV), necessity of repeated testing and treatment in pregnancy (Tg, PVB19), treatment of the neonate (Tg, CMV) and breastfeeding (CMV).