VIRAL INFECTIONS IN PREGNANCY

RUBELLA: Rubella or German measles (RNA virus) is transmitted by respiratory droplet exposure. Maternal Rubella Infection is manifested by rash, malaise, fever, lymphadenopathy and polyarthritis. Fetal infection is by trans placental route throughout pregnancy. Risk of major anomalies when this infection occurs in first, second and third month is approximately 60%, 25% and 10%, respectively. Multisystem abnormalities are seen following congenital rubella infection. - Congenital rubella syndrome (CRS) predominantly include cochlear (sensorineural deafness), cardiac (septal defects, PDA), hematologic (anemia, thrombocytopenia), liver and spleen (enlargement, jaundice), ophthalmic (cataracts, retinopathy, cloudy cornea), bone (osteopathy) and chromosomal abnormalities. The virus predominantly affects the fetus and is extremely teratogenic if contracted within the first trimester. There is increased chance of abortion, stillbirth and congenitally malformed baby. Infants born with congenital rubella shed the virus for many months and is a source of infection to others. Test for rubella specific antibody (IgM) should be done within 10 days of the exposure to know whether the patient is immune or not. Rubella specific IgG antibodies are present for life after natural infection or vaccination.

-Detection of viral RNA by PCR is possible. Prenatal diagnosis of rubella virus infection using PCR can be done from chorionic villi, fetal blood and amniotic fluid samples.

-Active immunity can be conferred in non-immune subjects by giving live attenuated rubella virus vaccine (MMR) preferably during 11–13 years. It is not recommended in pregnant women. When given during the child-bearing period, pregnancy should be prevented within three months by contraceptive measure. However, if pregnancy occurs during the period, termination of pregnancy is not recommended.

MEASLES: The virus (RNA) is not teratogenic. However, high fever may lead to miscarriage, FGR, microcephaly and oligohydramnios, stillbirth or premature delivery. Non-immunized women coming in contact with measles may be protected by intramuscular injection of immune serum globulin (5 ml) within 6 days of exposure. Mortality is high when complications like pneumonia, encephalitis develop. Diagnosis is made by assay of IgM and detection of viral RNA (RT-PCR). Management is supportive care. Antibiotics are given to prevent secondary bacterial infections.

Ribavirin may be given for viral pneumonia. Active vaccination (live attenuated) should not be given in pregnancy.

INFLUENZA: Influenza virus (RNA) are enveloped. Hemagglutinin (H) and neuraminidase are present on the surface. Influenza strains are named according to their genus, species and H and N subtypes. The course of pregnancy remains unaffected unless the infection is severe. Effects on pregnancy due to H1-N1 infection: miscarriage, preterm labor, PROM, pneumonia, ARDS, renal failure, DIC and death. Severity of illness are high in pregnancy.

There is no evidence of its teratogenic effect even if it is contracted in the first trimester. However, outbreak of Asian influenza showed increased incidence of congenital malformation (anencephaly) when the infection occurred in

the first trimester. Influenza (inactivated) vaccine is safe in pregnancy and also with breastfeeding. Diagnosis:

Rapid influenza diagnostic tests (RIDTs) are immunoassay used for detection of viral RNA by RT-PCR. Management: Treatment is supportive care. During influenza season, all pregnant women should be given the inactivated vaccine (IM).

CHICKENPOX (Varicella): Varicella zoster virus (DNA) does cross the placenta and may cause congenital or neonatal chickenpox. Maternal mortality is high due to varicella pneumonia.

Other maternal complications are: Encephalitis and bacterial superinfection. Congenital varicella syndrome (CVS) is characterized by: -Hypoplasia of limb, psychomotor retardation, IUGR, chorioretinal scarring, cataracts, microcephaly and cutaneous scarring.

The risk of congenital malformation is nearly absent when maternal infection occurs after 20 weeks. Varicella (live attenuated virus) vaccine is not recommended in pregnancy. Varicella PCR can identify VZV specific DNA from vesicular fluid. ELISA can detect VZV specific IgG and IgM. Varicella zoster immunoglobulin (VZIG) should be given to exposed non-immune patients as it reduces the morbidity. VZIG should also be given to newborn exposed within 5 days of delivery. Oral acyclovir, valacyclovir is safe in pregnancy and reduce the duration of illness when given within 24 hours of the rash. However, it cannot prevent congenital infection.

HOMOEOPATHIC MEDICINES FOR CONTROLLING VIRAL INFECTIONS IN PREGNANCY: -

Homoeopathy has a very good scope in treating all types of Viral fevers. Homoeopathy takes into account overall picture of fever totality and disease picture. It takes into account the physical and mental makeup of person individually.

Remedies like Arsenicum, Influenzinum, Belladonna, Bryonia, Rhus tox, Eupatorium, etc can help in curing viral fevers as well as post viral cough completely without any distress to the patients.