The topic of intrauterine infection during pregnancy is an interesting one, because it really depends who you ask what the topic encompasses. If you ask an obstetrician/gynecologist, they would probably tell you an intrauterine infection is a bacterial infection of the uterus that could lead to chorioamnionitis, which could lead to premature birth and sepsis in the newborn. If you ask a neonatologist or a pediatrician, they would probably tell you about the TORCH infections and other congenital infections that could be passed from mother to baby (called vertical transmission) like HIV, Zika virus, and possibly even COVID-19.
Lauren is 32 weeks pregnant. This is her first pregnancy. She’s not entirely sure, but she thinks her water broke last week. She has just been admitted to the hospital with a fever and rapid heartbeat. A fetal heart monitor has also shown an increased fetal heartrate. Her doctors tell her that on speculum examination they observed purulent fluid (pus-like fluid) in her cervix. Finally, they tell her that her white blood cell count is elevated (an indicator her body is fighting an infection). The doctors suspect she has chorioamnionitis.
Chorioamnionitis is an infection and/or inflammation of the uterus, as well as the fetal amnion and chorion membranes (the inner and outer membranes on the fetal amniotic sac). This infection can be caused by the bacteria that exist in the lower genital tract as part of a woman’s natural bacterial flora. It is important to note that the female reproductive system consists of two parts: the lower genital tract, which contains the vulva, vagina, and cervix; and the upper reproductive system, which is made up of the uterus, fallopian tubes, and ovaries. The lower genital tract houses many harmless bacterial species. However, if those bacteria were to travel up to the upper reproductive system, they could cause trouble.
Normally in pregnancy, the upper and lower reproductive tracts are separated by a mucus plug and/or a membrane. As we saw in Lauren’s case above, she was at greater risk for developing an intrauterine infection because her water broke earlier than expected during her pregnancy. This allowed bacteria to gain access to the uterus.
At this point, Lauren will be treated with antibiotics. Definitive treatment for this intrauterine infection would be to deliver the baby. It is up to Lauren and her doctors to monitor her and her baby’s conditions and decide what the best course of action would be. After birth, the baby will be checked for sepsis and treated appropriately.
If you ask an obstetrician/gynecologist, they would probably tell you an intrauterine infection is a bacterial infection of the uterus that could lead to chorioamnionitis, which could lead to premature birth and sepsis in the newborn. If you ask a neonatologist or a pediatrician, they would probably tell you about the TORCH infections and other congenital infections that could be passed from mother to baby (called vertical transmission) like HIV, Zika virus, and possibly even COVID-19.
Intrauterine infections could refer to congenital infections (infections that are transmitted from mother to baby in utero or during childbirth). Historically, pediatricians have referred to these as the TORCH infections, though now we see that other infections like HIV, Zika virus, and possibly even COVID-19 can be passed to the baby in this manner.
TORCH is an acronym that stands for:
- Other (syphilis, varicella zoster, parvovirus B19, HIV, Zika virus, possibly COVID-19, etc.)
- CMV (cytomegalovirus)
- HSV (herpes simplex virus)
Toxoplasmosis is caused by a parasite called Toxoplasma gondii. This parasite can be found in contaminated drinking water and undercooked meats and shellfish. This is also the parasite whose eggs can be found in cat feces. That is why doctors advise against cleaning out the cat litter box when you are pregnant. The infection can cause brain or eye damage in a baby.
As you can see above, the Other category includes many infections. Originally, it referred to syphilis, an easily treatable sexually transmitted disease caused by bacteria called Treponema pallidum. Syphilis can cause many symptoms in a newborn including rash, the “snuffles,” anemia, and enlarged liver.
Rubella is caused by a virus called Togavirus. Rubella is one of those infections we are lucky to have a vaccine to prevent. Symptoms in a newborn include rash, eye damage, heart damage, lung damage, enlarged spleen, enlarged liver, and hearing loss.
Cytomegalovirus (CMV) is caused by Human herpesvirus 5. In the newborn, CMV can cause brain damage, eye damage, hearing loss, lethargy, enlarged spleen, and enlarged liver.
Finally, we have herpes simplex virus (HSV) which can be caused by Human herpesvirus 1 (HSV-1) or Human herpesvirus 2 (HSV-2). HSV-1 is the virus that causes common cold sores. It can also cause genital herpes. HSV-2 causes genital herpes. A newborn who is infected with HSV can suffer from a vesicular rash, conjunctivitis, fever, lethargy, seizures, and irritability. This infection can also cause many other symptoms throughout the body.
There are also many other infections that can be vertically transmitted from mother to baby. It is very important you keep your doctor informed of any exposures you may have had so steps can be taken to protect your newborn.