24 Obstetric and perinatal infections Flashcards
Placenta normally provides effective barrier to most circulating microbes.
Certain infections are more severe in pregnancy, as there is subtle immunosuppression, to prevent rejection of foetus.
Infection in first trimester associated more serious adverse outcome because heart/ brain/ eyes are still developing
What are examples?
Malaria
Viral hepatitis
Influenza
Polio
UTI/ pyelonephritis more common
Listeriosis
Coccidiomycoses
Foetus has very immature immune system. This is to prevent foetal immune response to mother
What are the defects?
IgM/ IgA not produced in significant amount until late in pregnancy
No IgG antibody synthesis - all from mother
Cell mediated response poorly developed, lack of production of cytokines
What are congenital defects if infected foetus?
CMV
Zika
CMV - sensorineural hearing loss, mental retardation, chorioretinitis, optic atrophy, hepatosplenomegaly. Most infections in mother asymptomatic, and most do not cause issue for baby
Zika - microcephaly, facial disproportionality
What are congenital defects if infected foetus?
VZV
HSV
VZV - skin lesions, limb deformities, CNS abnormalities
HSV - disseminated infection - including encephalitis
What are congenital defects if infected foetus?
Listeria
Wide variety of animals carry listeria. Contact with animals/ faeces/ unpasteurised milk/ cheese can spread infection
Listeria - pneumonia, meningitis
Infection also occurs during and immediately after birth
Causes mild influenza like illness in mother
What are congenital defects if infected foetus?
Rubella
Does not direct damage, but interferes with mitosis
LBW
Cataract
mental retardation
IDDM - virus replicates in pancreas
heart defects
How to diagnose congenital rubella?
Maternal IgG/ IgM and RNA PCR
Neonate IgM and RNA PCR in cord blood
Neonate PCR throat swab/ urine
Baby with hearing/ eye defects needs investigation for CMV.
How is it diagnoses?
Maternal IgG/ IgM and DNA PCR
Neonate IgM within 3 weeks of delivery
Neonate DNA PCR in blood/ urine/ saliva
Zika virus is a flavivirus. What are other flaviviruses?
Yellow fever
Dengue
West Nile virus
What is vector for zika?
80% of infections are asymptomatic
Aedes aegypti
What are congenital effects of zika?
Microcephaly
Eye defects
What are congenital defects if infected foetus?
Toxoplasmosis
Between 10% and 80% of adults have evidence of infection at some point with toxoplasmosis. Highest risk of primary infection in mother in pregnancy
Avoid infection by avoiding cysts in cat faeces, or undercooked meat
epilepsy
micocephaly
mental retardation
chorioretinitis
Mother suspected of toxoplasma infection in pregnancy.
What is treatment?
Spiramycin to prevent transmission to foetus
If toxoplasma PCR of amniotic fluid confirms fetal infection, treat mother with sulphadiazine plus pyrimethamine plus folinic acid instead of spiramycin
Chagas disease can be spread verticlaly, and via blood transfusion. Normally spread by reduvii bug.
What symptoms can it cause foetus?
prematurity
LBW
anaemia
hepatosplenomegaly
meningoencephalitis
If untreated can cause cardiac/ gastrointestinal complications in 20-30 years
Infections can also occur during/ after birth for neonate.
Risk increased if PROM. What is definition?
rupture of membranes for >18 hours before labour onset