Cp Clinical Perspectives in Obstetrics and Gynecology OB/GYN Series Editor: Isaac Schiff, M.D. Clinical Perspectives in Obstetrics and Gynecology -CP OB/GYN Series Editor: Isaac Schiff, M.D. Published Volumes: Shoupe and Haseltine (eds.): Contraception (1993) Lorrain (ed.): Comprehensive Management of Menopause (1993) Gonik (ed.): Viral Diseases in Pregnancy (1994) Forthcoming Volumes: Framm and Quilligan (eds.): Cesarean Section: Guidelines for Appropriate Utilization Reindollar: Molecular Biology for the Obstetrician-Gynecologist Published Volumes (Series Editor: The Late Herbert J. Buchsbaum, M.D.): Buchsbaum (ed.): The Menopause (1983) Aiman (ed.): Infertility (1984) Futterweit: Polycystic Ovarian Disease (1984) Lavery and Sanfilippo (eds.): Pediatric and Adolescent Obstetrics and Gynecology (1985) Galask and Larson (eds.): Infectious Diseases in the Female Patient (1986) Buchsbaum and Walton (eds.): Strategies in Gynecologic Surgery (1986) Szulman and Buchsbaum (eds.): Gestational Trophoblastic Disease (1987) Cibils (ed.): Surgical Diseases in Pregnancy (1990) Collins (ed.): Ovulation Induction (1990) Sanfilippo and Levine (eds.): Operative Gynecologic Endoscopy (1990) Altchek and Deligdisch (eds.): The Uterus (1991) Viral Diseases in Pregnancy Bernard Gonik Editor With 31 Illustrations and 12 Color Plates Springer-Verlag New York Berlin Heidelberg London Paris Tokyo Hong Kong Barcelona Budapest Editor: Bernard Gonik, M.D. Professor and Vice Chairman Department of Obstetrics and Gynecology Wayne State University School of Medicine Chief of Obstetrics and Gynecology-Grace Hospital 6071 West Outer Drive Detroit, MI 48235, USA Library of Congress Cataloging· in· Publication Data Viral diseases in pregnancy / [edited by] Bernard Gonik. p. cm.-(Clinical perspectives in obstetrics·gynecology) Includes bibliographical references and index. ISBN-13: 978-1-4612-7620-3 1. Virus diseases in pregnancy. I. Gonik, Bernard. II. Series: Clinical perspectives in obstetrics and gynecology. [DNLM: 1. Virus Diseases-in pregnancy. WC 500 V81251994] RG580.V5V54 1994 618.3-dc20 DNLM/DLC for Library of Congress 93-38947 Printed on acid-free paper. © 1994 Springer·Verlag New York, Inc. Softcover reprint of the hardcover 1s t edition 1994 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Production coordinated by Chernow Editorial Services, Inc., and managed by Ellen Seham; manufacturing supervised by Jacqui Ashri. Typeset by Asco Trade Typesetting Ltd., Hong Kong. Color separated and printed by New England Book Components, Hingham, MA. Printed and bound by Edwards Brothers, Inc., Ann Arbor, MI. 9 8 7 6 5 4 3 2 1 ISBN-I 3:978-1-4612-7620-3 e-ISBN-13: 978-1-4612-2640-6 DOT: 10.1007/978-1-4612-2640-6 This textbook is dedicated to llana, Nathan, Daniel, and Cookie for their constant support and understanding. Also, to my many mentors and colleagues who, through their scientific and clinical endeavors, set the highest of standards for us to emulate. Lastly, to the women of the world; they bear our children, rear our young, and through their eyes we must all be judged. Preface The pregnant host is at risk for any of the viral diseases her nonpregnant counterpart acquires. Additionally, pregnancy heightens our concerns regarding specific viral diseases be cause of their potential for enhanced adverse effects on both maternal and fetal well-being. All too often the obstetrician relinquishes responsibility for the management of the gravida infected by a viral pathogen, and those expert in infectious diseases are confounded by the influence of pregnancy on these conditions. A major goal of this textbook is to narrow the gap between the two aforementioned management dichotomies in the virally infected pregnant woman. Weare at the infancy of our understanding of viral infections in pregnancy. The current and anticipated advancements are due in large part to a burgeoning oftechnological achievements in the areas of immunodiagnostics, molecular biology, and pharmacotherapeutics. Our in utero diagnostic capabilities, both invasive and noninvasive, have also allowed us new opportunities to study the effects of various maternal infectious disease processes on the developing fetus. New insights have been recognized pertaining to the maternal-fetal interface, the placenta, in that this structure is now acknowledged to function as both a mechanical and an immunological barrier to vertical transmission of infection. These observations suggest that there will be an outpouring of new data in the next several years that clinicians will need to master to maintain an appropriate level of expertise in the care of their patients. This infectious disease textbook is the first in many years to address specifically the topic of viral disease in pregnancy. Topics were selected on the basis of their importance to obstetrics and the fact that new information was available for dissemination to the clinical community. The contributing authors were chosen for their recognized expertise, and have provided the readership with scientifically complete yet clini cally relevant chapters. A color section, highlighting specific derma to logic or diagnostic features of certain viral diseases, VB VIll Preface is included because many of these conditions first come to the attention of the caring physician as a result of clinical manifes tations of the disease. Although not all of these examples were obtained from pregnant women, they were the most representa tive illustrations available. An attempt was made, when possi ble, to follow a designated format for the chapters to maintain a sense of uniformity. Authors were asked to include sufficient information so that patient counseling and management deci sions could be extrapolated from appropriate chapters. At times, authors differed in their approach to specific viral dis eases in pregnancy. Some chapters, therefore, present dispa rate opinions, reflecting the dynamics of this field of study. It is hoped that our efforts in the writing, editing, and production of this work have culminated in a useful reference text for a wide variety of health care providers. Omissions or inaccuracies are in part the responsibility of the editor, and I therefore look forward to comments from interested individ uals in the event these are identified. This will allow for improvements in the quality ofthis and other texts in the future. I acknowledge Margaret Butler for her assistance in the preparation of these materials and the staff at Springer-Verlag for their commitment to quality work. Bernard Gonik Contents Preface ........................................ Vll Contributors ............... .................. ... Xl 1 Immune Responses to Viral Infection 1 EYAL Y. ANTEBY AND SIMCHA YAGEL 2 Viral Teratology 12 JAN E. DICKINSON 3 In Utero Diagnosis of Congenital Infection 24 NELSON B. ISADA AND STANLEY M. BERRY 4 Genital Herpes Simplex Virus ................... 50 PAUL A. HENSLEIGH AND LILY K. NGUYEN 5 Cytomegalovirus 69 GAIL J. DEMMLER 6 Varicella-Zoster Virus 92 LAURA E. RILEY 7 Epstein-Barr Virus ............................ 106 KENNETH F. TROFATTER, JR. 8 Human Immunodeficiency Virus 128 PAMELA STRATTON 9 Hepatitis Viruses 156 NEIL S. SILVERMAN 10 Human Papillomavirus ........................ 185 BRUCE PATSNER, DAVID A. BAKER, AND EARL JACKMAN 11 Parvovirus ............ "...................... 196 JOHN F. Roms AND ANTHONY M. VINTZILEOS IX x Contents 12 Influenza Virus ............................... 215 SHAMSA Z. SHAHAB AND W. PAUL GLEZEN 13 Enterovirus .................................. 224 PAUL R. SUMMERS AND HOWARD T. SHARP 14 Mumps, Measles, Rubella, and Roseola ........... 236 BRYAN T. OSHIRO, MANJU MONGA, AND JACK M. GRAHAM 15 Molluscum Contagiosum ....................... 248 RAN GOSHEN AND BERNARD GONIK 16 Immunization During Pregnancy ................ 253 BERNARD GONIK Index .......................................... 263 Contributors EYAL Y. ANTEBY, M.D. Department of Obstetrics and Gynecology, Hebrew University Hadassah Hospital, Mt. Scopus, Jerusalem, 91240 Israel DAVID A. BAKER, M.D. Department of Obstetrics and Gynecology, Division of Infec tious Disease, State University of New York at Stony Brook, Stony Brook, NY 11794-8091, USA STANLEY M. BERRY, M.D. Department of Obstetrics and Gynecology, Division of Mater nal and Fetal Medicine, Wayne State University, Hutzel Hospi tal, Detroit, MI 48201, USA GAIL J. DEMMLER, M.D. Department of Pediatrics, Infectious Diseases Section, Texas Children's Hospital, Clinical Care Center, Houston, TX 77030- 2399, USA JAN E. DICKINSON, F.R.A.C.O.G. Department of Obstetrics, King Edward Memorial Hospital for Women, Subiaco, Western Australia 6008, Australia W. PAUL GLEZEN, M.D. Department of Microbiology and Immunology, Preventive Med icine Section, Baylor College of Medicine, Houston, TX 77030, USA BERNARD GONIK, M.D. Department of Obstetrics and Gynecology, Wayne State Uni versity School of Medicine, Detroit, MI 48235, USA RAN GOSHEN, M.D. Department of Obstetrics and Gynecology, Hebrew University Hadassah Hospital, Mt. Scopus, Jerusalem, 91240 Israel JACK M. GRAHAM, M.D. Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, TX 75246, USA Xl