Managing Infection During Delivery: Protecting Maternal and Neonatal Well-Being

Mother holding her newborn after labor in a hospital.

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Mother and child are in a delicate balance with each other during pregnancy. As the full 9-month term progresses to an end, labor and delivery become important moments that influence neonatal outcomes. While acquiring infection during pregnancy can be detrimental to both mother and baby, the baby may also develop infection during delivery.

The process of birth presents potential risks, especially concerning the transmission of infections from mother to baby with organisms by exposure of genital secretions or lesions at the time of delivery from the mother.¹

One of the most common infections babies may acquire during delivery is herpes simplex virus (HSV). Often, HSV infections may appear asymptomatic in adults or present with minimal symptoms, primarily due to adults’ immunity. HSV can be transmitted via contact with herpes lesions, infected mucosal secretions, and infected oral and genital secretions. If a mother is actively infected with HSV, she can vertically transmit it during delivery to the baby.

During delivery, the baby would be exposed to the infected mother’s viral lesions through direct contact in the genital tract. This may pose a risk of detrimental effects of HSV in neonates, such as encephalitis, chorioretinitis, and intracranial calcifications. If the newborn babies who are exposed to the infected mother’s lesions are not treated appropriately, their mortality is increased by 50% to 80%.^2,3

Treatment: Intravenous antiviral medication to newborns (commonly, acyclovir).

Prevention: The American College of Obstetricians and Gynecologists recommends cesarean delivery for mothers identified with active lesions or infections with HSV during labor and delivery.⁴

Suppose the virus is contracted in the first or second trimester of pregnancy. In that case, mothers are commonly treated with antiviral therapy (oral acyclovir) to reduce the length and intensity of symptoms and the length of the viral shedding phase.

Routine physician visits for a health check and maintenance of HSV and the possibility of sexually transmitted infections (STIs) are recommended.

Group B Streptococcus (GBS) transmission can also occur during delivery when the bacteria, which may naturally colonize the mother’s vagina or rectum, are passed on to the baby as it passes through the birth canal. GBS colonization in the genital and gastrointestinal tracts is common in healthy adults and may not cause symptoms or illness. However, this transmission can lead to severe infections in newborns, including pneumonia, sepsis, and meningitis.

Treatment: Antibiotics, specifically penicillin, ampicillin, cefotaxime, or gentamicin.

Prevention:

• Screening during pregnancy: Pregnant women are routinely screened for GBS colonization around the 35th to 37th weeks of pregnancy. This involves taking swabs from the vagina and rectum to detect the presence of GBS bacteria.
• Intrapartum antibiotic prophylaxis: Women who test positive for GBS colonization during pregnancy are offered intravenous antibiotics during labor. This prophylactic antibiotic treatment helps to reduce the risk of transmitting GBS to the baby during delivery.
• Identifying risk factors: Women who have previously given birth to a baby with GBS disease, those who have tested positive for GBS bacteria during pregnancy, and those who develop signs of chorioamnionitis during labor may be considered at higher risk and receive antibiotics even if GBS status is unknown.
• Monitoring for signs of infection in newborns: Health care providers closely monitor newborns for signs and symptoms of GBS infection after birth, such as fever, difficulty feeding, lethargy, or respiratory distress. Prompt diagnosis and treatment of GBS infection in newborns are essential to prevent serious complications.
• Educating pregnant women: Educating pregnant women about the importance of GBS screening, the signs of GBS infection in newborns, and the benefits of intrapartum antibiotic prophylaxis can help empower them to make informed decisions about their health care during pregnancy and childbirth.

Chlamydia trachomatis transmission can occur during delivery and can occur when a pregnant woman is infected. Unlike GBS, C trachomatis is not a normal part of the vaginal flora but rather a sexually transmitted infection that can lead to various complications if untreated. Infants born to mothers with untreated chlamydia infection can develop neonatal chlamydial conjunctivitis (eye infection) or chlamydial pneumonia. Neonatal conjunctivitis presents as eye discharge, redness, and swelling within the first few weeks of life, while chlamydial pneumonia may manifest as respiratory symptoms such as coughing, wheezing, and difficulty breathing.

Treatment: Therapy with antibiotics such as azithromycin and erythromycin.

Prevention:

• Screening during pregnancy: Pregnant women should be routinely screened for C trachomatis infection, especially if they are at increased risk, such as those under 25 years of age, those with a history of STIs, or those with new or multiple sexual partners during pregnancy.
• Partner screening and treatment: Treating sexual partners of pregnant women diagnosed with chlamydia infection helps prevent reinfection and reduces the risk of transmission during pregnancy and childbirth.
• Safe sexual practices: Encouraging pregnant women and their partners to practice safe sex, including consistent and correct use of condoms, can help prevent the transmission of C trachomatis and other sexually transmitted infections.

Other pathogens or infections that may be transmitted during delivery include HIV, human papillomavirus, syphilis, gonorrhea, toxoplasmosis, and cytomegalovirus.

Knowledge about infections during pregnancy and delivery is crucial for adopting preventive measures. By being aware of potential risks and implementing strategies such as maintaining good hygiene, getting vaccinated, and seeking regular prenatal care, both mother and newborn can lower the likelihood of encountering harmful effects from common pathogens such as HSV, GBS, and chlamydia. This proactive approach protects maternal health and promotes a safer and healthier pregnancy and childbirth experience.

REFERENCES

1. Newborn infection. ScienceDirect. Accessed April 25, 2024. https://www.sciencedirect.com/topics/medicine-and-dentistry/newborn-infection
2. Kumar M, Saadaoui M, Al Khodor S. Infections and pregnancy: effects on maternal and child health. Front Cell Infect Microbiol. 2022;12:873253. doi:10.3389/fcimb.2022.873253
3. De Rose DU, Bompard S, Maddaloni C, et al. Neonatal herpes simplex virus infection: from the maternal infection to the child outcome. J Med Virol. 2023;95(8):e29024. doi:10.1002/jmv.29024
4. Practice bulletin 220: management of genital herpes in pregnancy. American College of Obstetricians and Gynecologists. May 2020. Accessed April 25, 2024. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/05/management-of-genital-herpes-in-pregnancy