Rastreamento das infecções perinatais na gravidez: realizar ou não? / Perinatal infections screening during pregnancy: perform it or not?

Devido à conhecida importância das infecções adquiridas intraútero, vários serviços médicos em todo o mundo preconizam o rastreio das doenças passíveis de transmissão vertical. Entretanto, há muitos questionamentos na literatura a respeito da real relevância, custo-benefício e aplicabilidade do rastreamento. Corrobora essa assertiva a terapêutica ineficiente, a baixa prevalência para algumas dessas afecções e a reduzida confiabilidade e elevado custo de certos testes laboratoriais usados para o rastreamento. Por outro lado, o rastreio e posterior tratamento de algumas infecções resultam na diminuição da morbimortalidade, o que é de extrema relevância, uma vez que reduz sequelas fetais e auxilia na manutenção da saúde das gestantes. Mais estudos são necessários para o estabelecimento de um panorama completo a respeito do rastreamento das infecções perinatais, pois, além dos impasses expostos, é importante considerar as características epidemiológicas de cada população, o que requer pesquisas mais aprofundadas. Esta revisão da literatura teve como objetivo reunir evidências quanto à recomendação ou não do rastreamento destas doenças durante o pré-natal nas diversas entidades de relevância nacional e internacional.

Due to the importance of intrauterine acquired infections, severalguidelines suggest the screening of diseases that can be vertically transmitted. However, there are questionsabout the real relevance, cost-benefit and applicability of this practice. The absence of an efficient treatmentand the small prevalence of some of these disorders combined with the reduced reliability and high costsof some laboratorial tests used for screening, confirm this statement. On the other hand, the possibility oftreatment associated with the screening and the subsequent reduction of morbimortality are a very relevantpoint, once it attenuates fetal sequelae and helps keeping pregnant women health. More studies are needed toestablish a complete picture of the screening of perinatal infections because beyond the impasses presentedabove, it is important to consider the epidemiological characteristics of each population, which requires moreextensive research. This literature review attempted to gather information about the importance of the prenatalscreening of perinatal infections in different and relevant national and international entities.

Serological studies on possible causes of intra-uterine infections in Thai infants.

Serological tests for toxoplasmosis, rubella, cytomegalovirus (CMV), Herpesvirus hominis (HVH) infections syphilis (TORCHES) were carried out in 49 infants with showed signs of possible intrauterine infections and in 212 mothers and their newborn infants. The tests employed were ELISA for rubella and CMV infections, indirect haemagglutination for HVH infection and toxoplasmosis and RPR Macro-vue card test for syphilis. The immunoglobulin class of the antibody was also determined, and only infants with IgM antibody was considered indicative of intrauterine infection. It was found that 36.7% and 10.2% of infants with signs of intrauterine infections were positive for rubella and CMV antibodies and 19% had mixed infections of rubella, CMV, toxoplasma, syphilis and HVH. In contrast, only 6.1% of normal newborn infants had rubella antibody, 6% had HVH antibody and less than 1% had toxoplasma antibody, and none of them had CMV and treponema antibodies. Higher rate of seropositivities were found in their mothers, the percentage seropositivities for rubella, HVH, CMV infections, syphilis and toxoplasmosis were 19%, 12%, 2% and 1% respectively.