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Роды с генитальным герпесом

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17 августа 2019

У тех, кто родил с генитальным герпесом, существует вероятность передать ребенку данное заболевание. Герпес – это широко распространенное вирусное заболевание. К сожалению, генитальный герпес перед родами – проблема, которая может застать многих будущих мам.

Сущность патологии

Генитальный герпес – это часто встречаемое инфекция, передающаяся половым путем, вызванная вирусами простого герпеса (ВПГ). Вирусы герпеса бывают двух видов:

  1. ВПГ 2-го типа. В 80-85% случаев поражает гениталии.
  2. ВПГ 1-го типа. В 15-20% случаев может стать возбудителем генитального герпеса. В остальных 80-85% случаев поражает ротовую полость (так называемая простуда на губах).

Более заразными являются те больные, у которых наблюдаются характерные для заболевания симптомы. Но не смотря на это, чаще заражаются от лиц, у которых герпес генитальный протекает бессимптомно. Маловероятно инфицирование при контакте с личными вещами зараженного (полотенце, посуда и т.д.) и во время пребывания в местах общего пользования (туалет, бани, бассейн). Вызвать генитальный герпес может вирус 1-го типа во время орального полового контакта, если у женщины острая фаза герпеса ротовой полости.

Если в организм человека проникает ВПГ, то в нем он остается на всю жизнь.

После острой фазы, проявляющейся, как правило, лихорадкой и сыпью, наступает фаза затишья (ремиссия). Во время ремиссии вирус находится в периферической нервной системе. Его активная стадия начинается при ослаблении иммунитета, стрессах, переохлаждении и т.д. Когда обострения герпеса генитального повторяются несколько раз в год, говорят о рецидивирующем генитальном герпесе. В ответ на вирус в крови человека вырабатываются защитные механизмы – иммуноглобулины (Ig), из которых в дальнейшем образуются антитела. Во время первичного проникновения вируса в организм в крови повышается количество IgM, после рецидивов в крови постоянно присутствуют IgG.

Симптомы ВПГ-2 у беременных

Первые симптомы заболевания появляются на 4-5 день. На гениталиях (коже и слизистых) возникают эритематозные пузырьки (папулы), диаметр которых будет меняться. Спустя пару дней папулы лопаются, трансформируясь в болезненные эрозии, подсыхающие к 7-8 дню. В первые 12 дней после инкубационного периода вирус можно обнаружить в крови человека методом ПЦР или ИФА. Сыпь может сопровождаться зудом, выделениями из влагалища, нарушением мочеиспускания (дизурией). В паховой области с обеих сторон пальпируются увеличенные лимфоузлы. У беременных с особенно ослабленным иммунитетом наблюдается общее недомогание из-за лихорадки: головная и мышечная боли, слабость, повышенная температура и т.д. Порядка 50% женщин, зараженных первично ВПГ 2-го типа, уже переносили инфицирование ВПГ 1-го типа. У таких женщин клиническая картина первичного генитального герпеса выражена слабее.

Через 8-10 дней после появления сыпи заболевание заканчивается, иногда рецидивируя. У беременных рецидивы ВПГ-2 повторяются чаще, чем вне беременности.

Рецидивирующий генитальный герпес и беременность

Более благоприятным прогнозом является рецидивирующий герпес и роды. В том случае, когда у беременной женщины наступает очередной рецидив генитального герпеса, обострения которого уже случались до беременности, в ее крови уже есть много IgG. Эти иммуноглобулины перейдут ребенку с током крови матери через плаценту во время беременности. Из этого следует, что роды с возможным инфицированием ребенка относительно безопасны, так как его организм уже будет иметь антитела (иммунитет) к ВПГ.Согласно статистическим данным, у тех, кто родил с генитальным герпесом рецидивирующей формы, только в 1% случаев новорожденные были заражены.Поэтому даже если активный генитальный герпес и роды совместились, прерывать беременность не нужно.

Другим важным вопросом для беременных женщин является способ рождения ребенка: с помощью кесарева сечения или естественным путем.

В настоящее время все ведущие акушеры-гинекологи сходятся во мнении, что при рецидивирующем генитальном герпесе необходимо выбирать естественный путь рождения ребенка.

Давно известно, что кесарево сечение рекомендуется только в ситуациях, когда естественные роды могут быть опасными для жизни ребенка или матери. Оптимальные роды в этом случае – естественные, через половые ходы матери. Кесарево же сопровождается шоком для ребенка, что может стать причиной снижения иммунитета и, соответственно, устойчивости к различным инфекциям.

Если учесть тот факт, что ВПГ находится в крови инфицированной мамы, а во время операции кровь контактирует с ребенком, то риск заражения для него не снижается. А может даже и наоборот, так как организм ребенка в состоянии стресса после кесарева и иммунитет может не сработать.

Широко известный акушер-гинеколог доктор Мишель Оден со своей командой для изучения процента риска инфицирования наблюдали за 34 беременными женщинами, в анамнезе которых имелся рецидивирующий генитальный герпес. Все эти женщины рожали естественным путем. По результатам исследования, ни один из 34 родившихся детей, подверженных контакту с вирусом при проходе через вагинальные пути, не был заражен ВПГ 2-го типа. Эта же группа ученных исследовала количество антител к ВПГ 2-го типа у этих новорожденных детей. Забор их крови проводили или из пуповины, или в течение первых двух недель жизни. Ранее ученые провели забор крови у инфицированных новорожденных ВПГ 2-го типа. Результаты исследования показали, что количество антител у незараженных новорожденных в несколько раз больше, чем у тех, кто заразился.

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Первичный генитальный герпес и беременность

Генитальный герпес во время беременности может быть как самостоятельной первичной инфекцией, так и первым клиническим эпизодом уже давно проникшей, но дремлющей инфекции. Во время беременности первичный эпизод будет клинически ярче и сложнее протекать. Это связано с тем, что для беременности характерна иммунодепрессия (угнетение иммунитета) и у женщины еще не выработаны IgG, а соответственно, и защитные от ВПГ-2 антитела. Активный вирус с кровью матери через пуповину проникнет в кровь плода. Наиболее опасно инфицирование для плода в 1-й и 3-й триместры беременности.

Если инфицирование происходит в 1-м триместре, то чаще всего происходит гибель плода и выкидыш.

Реже наблюдаются поражения развивающихся органов плода и врожденные уродства. Если первичный эпизод у беременной приходится на 3-й триместр, то у плода могут быть поражения нервной системы, кожи, печени, селезенки. У тех, кто рожал с генитальным герпесом, первичный рецидив которого был в 3-м триместре, в 80% случаев новорожденные умирают или становятся глубокими инвалидами. Лечение не эффективно в таких случаях. Не помогают даже и внутривенные вливания противовирусных препаратов. Радует тот факт, что первичное инфицирование генитальным вирусом и первичные обострения уже имеющейся инфекции в акушерстве встречаются крайне редко.

Рубрики

  • Отзывы о родах в Ницце (8)
  • Как родить в Ницце — подготовка (1)
  • Кто я и чем занимаюсь (9)
  • Родить с дулой в Ницце (6)
  • Клиники Франции — Ницца, Канны, Монако (7)
  • Госпитальный центр Принцессы Грейс Монако (3)
  • Клиника Сан Жорж — Ницца (2)
  • Госпитальный центр Канны (1)
  • Клиника Ленваль — Ницца (1)
  • Лазурный берег Франции — кому хорошо (6)
  • Беременность (19)
  • Беременность — финишная прямая (3)
  • Роды (3)
  • После родов (2)

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Статистика

Суббота, 15 Декабря 2012 г. 16:27 + в цитатник

Генитальный герпес — это вирусное заболевание, затрагивающее половые органы и соседние области тела. Заболевание является очень заразным,распространяется половым путем и является рецидивирующим. После первой стадии инфицирования, вирус "обустраивается" в организме и "засыпает". Он проявляет себя впоследствии в виде высыпаний.

Самым тяжелым случаем является передача вируса новорожденному от зараженной матери. Но, к счастью, это наблюдается редко — примерно 3 случая на 100 000.

Два вида вируса являются причиной герпеса :
Тип 1 (или HV1) вызывает герпетические высыпания на верхней половине тела, наиболее часто на верхней губе.
Тип 2 (или HV2) ответственен за появление герпетических высыпаний в нижней части тела, в особенности на половых органах.

Надо оговориться, что в последнее время все чаще наблюдаются генитального герпеса, вызванного вирусом 1 типа (от 10 до 30%).Это объясняется практикой орального секса.

Первый контакт с вирусом.
Первичное инфицирование происходит при первом же контакте вируса с организмом. Кроме случая передачи вируса от матери к ребенку, инфицирование происходит во время полового акта, при или без проникновения, что вызывает появление симптомов, более или менее выраженных.

Партнер, который передает инфекцию, или носит признаки инфекции на половом органе, ягодицах или бедрах или является носителем бессимптомной инфекции.В случае проявления лихорадки на губах, передача вируса происходит непосредственно на половые органы при оральном сексе.

Вирус, который устраивается надолго. Однажды проникнув в организм, вирус больше его не покидает : он засыпает на период от нескольких недель до нескольких лет, иногда — окончательно. Но чаще всего, он все-таки периодически себя проявляет на областях тела, где он впервые проник в организм (рецидивирует).

Факторы, способствующие рецидивам вируса герпеса :
— стресс
— усталость
— другая инфекция
— уменьшение защитных сил организма
— гормональные изменения ( например, менструации)

Рецидивы являются наиболее частыми в первый год после момента первичного инфицирования

Особое внимание — матери и ребенку.
Генитальный герпес должен наблюдаться особенно тщательно у беременной женщины, поскольку вирус может передаваться от матери ребенку, а неонатальный герпес чреват тяжелыми последствиями.
Симптомы генитального герпеса являются одинаковыми для всех женщин, вне зависимости от наличия беременности. Тщательное обследование беременных женщин, особенно на последнем месяце беременности, позволяет выявить присутствие вируса в организме и выработать наилучшую стратегию для предупреждения заражения ребенка.

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В период родовой деятельности берутся анализы из герпетических высыпаний и шейки матки на подтверждения наличия вируса.

Первый дни жизни : период риска !

Новорожденный может быть заражен тремя путями :
Во время беременности, если мама первично инфицирована. В этом случае, вирус проходит через плаценту и заражает плод.
Во время родов : вирус, находящийся в выделениях влагалища, заражает ребенка при его прохождении по половым путям. Это наиболее часто встречающийся путь заражения.
В ранний постнатальный период : передача вируса происходит от матери или другого члена ближайшего окружения, у которых наблюдаются симптомы лабиального (губного) или генитального герпеса.
Клинические симптомы вирусного заражения у ребенка проявляются быстро, в течение первых дней жизни.Тяжесть заболевания может быть разной, но в тяжелых случаях и при отсутствии лечения может угрожать жизни ребенка.Он проявляется поражениями кожи и слизистых,нервной системы, глаз (конъюнктивит, кератит и т.п.) и других органов.

Риск передачи вируса за время беременности является низким : 1/10 000.

Лечение генитальной вирусной инфекции во время беременности (первичного инфицирования или рецидива) основывается на применении антивирусных препаратов. Оно значительно снижает риск передачи вируса новорожденному.

Роды проводятся со всеми мерами предосторожности. В редких случаях, возможно решение в пользу кесарева сечения, например, если герпетические высыпания видны во время родовой деятельности.

В первую очередь, предупреждается прямой контакт новорожденного с пораженными герпесом половыми органами матери. Цель — избежать или уменьшить риск передачи вируса путем соблюдения правил гигиены. Грудное вскармливание может быть противопоказано из-за присутствия герпетических высыпаний на сосках или грудных железах матери.

высыпания на остальных, более отдаленных участках тела, должны быть защищены.

В случае предшествующего проявления герпеса у матери,у новорожденного берутся анализы на возможное присутствие вируса (глаза, горло) в течение первых трех дней жизни, и при подтверждении заражения, лечение состоит в приеме антивирусных препаратов.

Меры предосторожности для уменьшения риска передачи вируса плоду и новорожденному ребенку.

Если у вас уже были случаи генитального герпеса : немедленно предупредите об этом своего лечащего врача.
Срочной консультации требуют новые болезненные высыпания или раздражения в области половых органов или оральный секс, во время которого произошел контакт рта с половыми органами партнера, имеющего лабиальный герпес.

Соблюдайте общие меры предосторожности :

В случае наличия герпетических высыпаний у вас или вашего партнера, избегайте половых сношений, даже защищенных презервативом.
Используйте презерватив в течение последних двух месяцев беременности, даже если высыпаний нет. На деле вы и/или ваш партнер можете быть носителями вируса без проявления симптомов.
На ваших губах или губах вашего партнера есть пузырьки лабиального герпеса? Избегайте орального секса, высокий риск передачи на половые органы партнера !

Защитить новорожденного от инфицирования :
— соблюдать самим строгим образом рекомендации, данные медицинским персоналом
— регулярно и тщательно мыть руки перед тем, как приступать к туалету ребенка или просто брать ребенка на руки
— проследить за тем, чтобы ваше окружение соблюдал все правила гигиены, которые соблюдаете вы и которые хотят взять ребенка на руки
— выделить ребенку отдельные полотенца и отдельные туалетные принадлежности.

Срочно обратитесь к врачу, в следующих случаях
— возникновение мелких прозрачных пузырьков на коже ребенка
— покраснение глаза, постоянное слезотечение
— изменение поведения ребенка ( отказ от груди или бутылочки, засыпание во время туалета или кормления, повышенная возбудимость. )
— постоянная лихорадка, конвульсии.

Приводит ли герпес к стерильности ?
Нет,герпес не приводит к бесплодию.

Может ли произойти заражение герпесом через слюну ?
Да, если у мамы, папы или другого лица, находящегося в контакте с ребенком, есть герпетические высыпания на губах. Запомните,что любое лицо, которое хотя бы раз в жизни встретившееся с вирусом, может быть источником заражения ребенка, так как является бессимптомным носителем.

Может ли произойти заражение ребенка через соску бутылки ?
нет, заражение ребенка происходит исключительно в результате прямого контакта ( например, через поцелуй). В любом случае, после приготовление стерильной бутылочки избегайте проверку температуры приготовленной смеси ртом, лучше использовать тыльную стороны кисти.

Все о вашей беременности — чем хорош ( и не очень) этот период.

Девушки, добрый день! Скажите, кто как перенес беременность и родил с половым герпесом, начиталась страшилок, пишут что только кесарево..Я мечтаю вообще о 2х детях (пока ни одного). И как ваши мужья отреагировали на ваше заболевание , вы их тоже заразили? или они не поняли, у некоторых ведь не проявляется..

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Автор, это герпес типа В, он с трудом передается и почти не влияет на беременность. Герпес типа А, который встречается на губах тяжелее и требует определенной подготовки иммунитета от женщины

Рожать с половым герпесом опасно только если есть рецидивы на момент родов. Поэтому делают кесарево, что бы не заразить ребенка. Если высыпаний нет и имунка хорошая, то рожайте.

Только кесарево. На беременность он не влияет, но есть большая вероятность заражения младенца в родах. Организму ребенка этот вирус опасен. Знакомые потеряли таким образом младенца. Мать заразила его герпесом в родах. А врачам не сказала, что у нее герпес.

Моя подруга 2-их родила. Сперва одного. потом второго. Расслабтесь такие ли рожают. Только враче предупредите заранее, который у вас роды будет принимать.

Да ладно Вам не пугайте. У меня лет 20 герпес генитальный. Родила сама двоих и нормально

Я рожала, нормально ребенок здоров, но на момент родов высыпаний не было, высыпало во время беременности на месяце 2-м, вот тут и узнала, что у меня эта бяка, откуда взялся? муж заразил при куни, откуда же еще.

Похожие темы

6- точно. нельзя делать куни если у мч герпес на губах. заразитесь!

7 Ну с болячками на губах он мне никогда и не делал, я же не псих,может в тот момент полез, когда только у него прошел на губах или только начались первые признаки, мужики же не скажут, подлые, ты знаешь кажется у меня герпес скоро вылезит, а ты мучайся потом, уххх ненавижу

Просвятите глупую. У меня на губах иногда (пару раз в год) гнойники такие бывают, я из них гной выдавливаю, потом проходят. Это генитальный герпес?

Это обычный! А зачем давить-то. Генитальный на половых органах.

Я рожала с герпесом, все нормально

Радовалась бы, что так легко кесарево получишь.

Я двоих с герпесом родили, совершенно здоровые дети, а кесарево только в период обострения т.е. во время родов на половой губе блямба, а ещё мне в род. доме сказали, что он опасен только если впервые появился во время беременности. Муж относится спокойно, и не заразился.

у меня было две замершие беременности на сроке 8-9 недель, врачи говорят что причиной этому именно генитальный герпес. печально. не знаю как теперь, смогу ли я стать когда-нибудь мамой.(

14. Глупости!! Врачи просто не знают причину Вашей ЗБ, вот и на герпес все валят. У меня герпес второго типа уже много лет, двое детей и никаких ЗБ никогда не было.

Тоже был. Родила двоих детей,оба гиперактивные,но здоровые,ттт,слава Богу,узнала,когда была первым беременна,благо,на последнем месяце. Врачу,прин роды так и не сказала,не смогла,второй раз была беременна,очень нервничала всю бер,поначиталась в инете,врачу тоже не смогла сказать,высыпаний на момент родов не было,рожала сама,хоть и была в депрессняке и накрученная,казалось ,что выяснится о последствиях через месяц,*****. Все ок. Врачу лучше скажите,ну и пропейте на 36нед вольтрекс,ацикловир,что выпишут.чтобы не было во время родов.и не нервничайте. Главное,чтобы на мрмент родов все было ок.

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