Complication during Preganancy

1. Bacterial Vaginosis during Pregnancy

Approximately 10% – 30% of pregnant women will experience Bacterial Vaginosis (BV) during their pregnancy. Bacterial Vaginosis is caused by an imbalance in the normal bacteria that exists in a woman’s vagina. It is not transmitted sexually, but is associated with having vaginal intercourse. You may or may not experience symptoms.
How do I know if I have Bacterial Vaginosis?
One of the symptoms of BV is a gray or whitish discharge that has a foul fishy odor. However some women do not experience any symptoms. Diagnosis is made through a pelvic exam. Vaginal discharge is tested through a wet mount (microscopic slide test), pH test (BV often causes a pH level of 4.5 or higher), KOH slide (microscopic slide test) or a whiff test (a mixture that causes a strong fishy odor).

What causes Bacterial Vaginosis?
Bacterial Vaginosis is an imbalance of bacteria which leads to an over growth of bacterial species. The cause has not clearly been identified. It is not transmitted sexually but it is associated with having vaginal sex and therefore may be listed under sexually transmitted diseases when you look it up.
How can Bacterial Vaginosis affect my pregnancy?
There is significant evidence that links Bacterial Vaginosis with preterm labor. There have been many recent studies that have been conducted to verify this information and find a method of prevention. Other studies have also shown a possible link to miscarriages, low birth weight and premature rupture of membranes.If I am pregnant, will I be screened for Bacterial Vaginosis?
It is not necessary to screen non symptomatic pregnant women for BV. When obtaining your prenatal care, Bacterial Vaginosis is not routinely screened. It is important that you discuss any concerns you may have about BV with your health care provider.What treatments are available for pregnant women with Bacterial Vaginosis?
Treatment is highly recommended to avoid any chance of preterm labor.

2. Chicken Pox and Pregnancy

When you become pregnant you want to do everything you can to stay healthy. Unfortunately it is sometimes impossible to protect yourself from every illness out there. Chicken pox is a highly contagious viral infection that can be very serious. Fortunately there are ways to protect you and your baby if you are threatened by chicken pox.
What exactly is chicken pox?
Chicken pox is a viral infection also called varicella. It is accompanied by a rash, which appears as small reddish spots or pimples. A fever and body aches usually occur before the rash appears. Chicken pox is contracted during childhood in most cases although there are some instances when an adult is not immune and contracts chicken pox. About 95% of women in their childbearing years are immune to chicken pox.
Who is most at risk for getting chicken pox during pregnancy?

• If you have been infected with chicken pox once before, then you are most likely immune to getting chicken pox again.
• If you have NOT been infected with chicken pox and are pregnant, you may be at risk of contracting the virus. You will want to avoid contact with anyone who has chicken pox.
• If you are not sure if you have ever been infected with chicken pox, your doctor can give you a blood test to determine if you have the chicken pox antibodies. If the test shows that you have antibodies than you are immune to chicken pox.

How will my baby be affected if I have chicken pox?
How your baby will be affected depends on where you are at in your pregnancy. According to the Organization for Teratology Information Service (OTIS):

• If chicken pox occurs within the first trimester, the risk of birth defects is 0.5-1 percent
• If chicken pox occurs within the 13th and 20th week, the risk of birth defects is 2 percent
• If chicken pox occurs within 5 days or less of delivery or 1-2 days after delivery, there is a 20-25% chance that your baby will develop chicken pox, known as congenital varicella.
• If chicken pox occurs within 6-12 days before delivery, there is a chance that the baby can still get chicken pox. In this case your baby may receive some of your newly made chicken pox antibodies which will cause the congenital varicella to be mild.

Possible birth defects may be scars, eye problems, poor growth, small head size, delayed development, and/or mental retardation.
What can I do to protect my baby from chicken pox?

• If you have had chicken pox before, then there is nothing you need to do to protect your baby during pregnancy. Your body should have antibodies that protect you from contracting chicken pox and therefore your baby will be protected.
• If you have not had chicken pox before, you my receive the shot of zoster immune globulin (ZIG) if you are pregnant and come in contact with someone who has chicken pox. ZIG must be given with 4 days of first exposure. This is only given if you do not already have the antibodies against chicken pox.
• You can get a chicken pox vaccine if you do not have the chicken pox antibodies and you are not pregnant. You must wait 3 months before trying to conceive.

Can someone get chicken pox twice?
It is rare that a person will contract chicken pox twice, but those with immune problems are at an elevated risk of a second infection. There are also those cases when people think they had chicken pox when they were younger, when in fact it was just a rash or something else.
Cytomegalovirus (CMV) Infection
What is Cytomegalovirus (CMV)?
Cytomegalovirus (CMV) is a virus that can be transmitted to a developing child before birth. CMV infection is usually harmless and rarely causes illness. For most healthy persons who acquire CMV after birth there are few symptoms and no long-term health consequences. Once a person becomes infected, the virus remains alive, but usually dormant within that person’s body for life. There are two differnet types of infection: primary CMV and recurrent CMV infection. Primary infection can cause more serious problems in pregnancy than recurrent infection can.However, if a person’s immune system is seriously weakened in any way, the virus can become active and cause CMV disease. For the majority of people who have CMV infection, it is not a serious problem.
What are the symptoms of CMV ?
Most children and adults who are infected with CMV do not develop symptoms whereas others may experience the following symptoms three to twelve weeks after exposure:

• Fever
• Swollen glands
• Exhausted or run down

What are characteristics of CMV?
CMV is a member of the herpes virus group that is characterized by the ability to remain dormant within the body over a long period. Infectious CMV may be shed in bodily fluids (urine, saliva, blood, tears, semen, and breast milk) intermittently, without any detectable signs and without symptoms.
How common is CMV?
Cytomegalovirus (CMV):

• Infects between 50% and 85% of adults in the United States by 40 years of age
• Is more widespread in developing countries and in areas of lower socioeconomic conditions
• Is higher among the following risk groups:
  • babies in utero
  • people who work with children
  • immunocompromised persons, such as organ transplant recipients and persons infected with human immunodeficiency virus (HIV)

How is CMV spread?
Transmission of CMV occurs from person to person and is not associated with food, water, or animals. CMV is not highly contagious but has been shown to spread in households and among young children in day care centers. The infection is spread through close intimate contact with a person excreting the virus in their saliva, urine, breast milk or other bodily fluids.
How is CMV diagnosed?
Most CMV infections are rarely diagnosed because the virus usually produces few, if any, symptoms. However, people who have had CMV develop antibodies to the virus which remain in their body for the rest of their life. A blood sample can test for the CMV antibody followed by another blood sample within two weeks. The virus can also be cultured from specimens obtained from urine, throat swabs, and tissues samples. Laboratory tests to culture the virus is expensive and not widely available.
What is the treatment for CMV?
Maternal CMV infections may be treated with one of only two drugs that are used in in severe situations of CMV infection. There are no treatmens for prenatal or postnatal therapy of the infection. Vaccines for treatment are still in the research and developmental stages.
How can CMV be prevented?
Transmission of Cytomegalovirus is often preventable because it is most often transmitted through infected bodily fluids that come in contact with hands and then are absorbed through the nose or mouth of a susceptible person. People who interact with children should use safe hygiene practices including good hand washing and wearing gloves when changing diapers. Hand washing with soap and water is effective in preventing the spread of CMV.
How does CMV affect pregnancy?
The following potential problems can occur for infants who are infected from their mothers before (during pregnancy) birth:

• Moderate enlargement of the liver and spleen
• 80-90% suffers from complications within the first few years of life including hearing loss, vision impairment, and varying degrees of mental retardation.
• 5-10% will present with no symptoms at birth but will develop varying degrees of hearing and mental or coordination problems.

When CMV is transmitted at the time of delivery from contact with genital secretions or later in infancy through breast milk, these infections usually result in few, if any, symptoms or complications.
What are some recommendations for pregnant women regarding CMV infection?

• Throughout your pregnancy practice good personal hygiene, including hand washing with soap and water
• If you develop a mononucleosis like illness, you should be checked for CMV infection
• Refrain from sharing food, eating utensils and drinking utensils with anyone.
• Your doctor can test the CMV antibodies to determine if you have already had CMV infection.
• Breastfeeding benefits outweigh the minimal risk of transmitting CMV

What are some recommendations for individuals who care for infants and children regarding CMV infection?
Most healthy people working with infants and children are not at risk from CMV infection. However, women of child-bearing age who previously have not been infected with CMV still have a potential risk for passing CMV to their babies in utero. CMV is commonly transmitted among young children. Since CMV is transmitted through contact with infected body fluids, including urine and saliva; child care providers (including day care workers, special education teachers, and therapists) should be educated about CMV infection and practice preventive measures. Susceptible non-pregnant women working with infants and children should not routinely be transferred to other work situations. Routine laboratory testing for the CMV antibody in female workers is not recommended, but can be performed to determine their immune status.
Incompetent Cervix : Weakened Cervix
During pregnancy, as the baby grows and gets heavier, it presses on the cervix. This pressure may cause the cervix to start to open before the baby is ready to be born. This condition is called incompetent cervix or weakened cervix and it may lead to a miscarriage or premature delivery. However, an incompetent cervix happens in only about 1 out of 100 pregnancies.
What causes an incompetent or weakened cervix?
A weakened cervix can be caused by one or more of the following conditions:

• Previous surgery on the cervix
• Damage during a difficult birth
• Malformed cervix or uterus from a birth defect
• Previous trauma to the cervix, such as a D&C (dilation and curettage) from a termination or a miscarriage
• DES (Diethylstilbestrol) exposure

How will I know if I have an incompetent cervix?
Incompetent cervix is not routinely checked for during pregnancy and therefore is not usually diagnosed until after a second or third trimester miscarriage has occurred.
Women can be evaluated before pregnancy or in early pregnancy by ultrasound, if they have any of the factors that are potential causes of incompetent cervix. Diagnosis can be made by your physician though a pelvic exam or by an ultrasound. The ultrasound would be used to measure the cervical opening or the length of the cervix.
How often does an incompetent cervix happen?
An Incompetent or weakened cervix happens in about 1-2% of pregnancies. Almost 25% of babies miscarried in the second trimester are due to incompetent cervix.
What is the treatment for a weakened cervix?
The treatment for an incompetent or weakened cervix is a procedure that sews the cervix closed to reinforce the weak cervix. This procedure is called a cerclage and is usually performed between week 14-16 of pregnancy. These sutures will be removed between 36-38 weeks, to prevent any problems for when you go into labor. Removal of the cerclage does not result in spontaneous delivery of the baby. A woman would not be eligible for a cerclage if:

• There is increased irritation of the cervix
• The cervix has dilated 4cm
• Membranes have ruptured

Possible complications of cervical cerclage include uterine rupture, maternal hemorrhage, bladder rupture, cervical laceration, preterm labor and premature rupture of the membranes. The likelihood of these risks are very minimal and most health care providers feel that a cerclage is a life saving procedure that is worth the possible risks involved.

3. Toxoplasmosis