5. Infections in Pregnancy & the Neonate Flashcards
- Describe the causative organisms of common intrauterine conditions
- Describe the transmission and clinical manifestations of each infection
- Describe the consequences of untreated intrauterine conditions and the presentation in the newborn
- Describe the common perinatal infections and the presentation in the newborn
- Describe the preventative measures taken to avoid intrauterine and perinatal infections
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What are the viruses responsible for infections in pregnancy and in the neonate?
- Rubella
- Varicella Zoster Virus (VZV)
- Parvovirus
- Cytomegalovirus (CMV)
- Zika virus
- Human Immunodeficiency Virus (HIV)
- Hepatitis B Virus (HBV)
- Hepatitis C Virus (HCV)
- Herpes Simplex Virus (HSV)
- Human Papilloma Virus (HPV)
What are the bacterias responsible for infections in the pregnancy and neonate?
- Listeria monocytogenes
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Staphylococcus aureus
- Treponema pallidum
Which protozoa cause infections in the pregnancy and neonate?
- Toxoplasma gondii
* Trichomonas vaginalis
Which yeasts can cause infections in pregnancy and neonate?
Candida albicans
What does congenital mean?
Condition present at birth (inherited or caused by the environment)
What is the perinatal period?
Commences at 22 weeks (154 days) of gestation and ends seven days after birth
When is the neonatal period?
First 28 days of life
When is the post natal period?
First 6 weeks after birth
How does vertical transmission occur?
Across the placenta (intrauterine) During brith Direct contact with maternal body fluids Prolonged rupture of membranes After birth (from mother or other contacts)
Manifestations in congenital infection?
Growth retardation
Malformation
Fetal loss
Postnatal infection manifestations
Meningitis
Septicaemia
Conjunctivitis
Pneumonitis
Perinatal infection manifestations?
Meningitis
Septicaemia
Pneumonia
Preterm labour
Rubella: Start? Initial signs? Symptoms/signs? Marker
- Primary maternal rubella infection in 1st trimester
- High risk of congenital rubella syndrome (60%)
• Initial signs hepatitis-associated jaundice, haemolysis, thrombocytopaenia
Symptoms and signs:
• Microcephalus, cataract, deafness, heart defects in foetus
• Low birth weight; failure to attain developmental milestones
• Termination of pregnancy in some cases
Marker:
• IgM persists for 1st three months of life
What is the history of the rubella vaccine?
- MMR vaccine (measles, mumps, rubella)
- 1988-> Vaccine introduced
- 1998–> Suggested link with autism
- 2003–> Measles eliminated from UK
- 2006–> Re-established due to poor vaccine uptake
- 2013–> “Catch-up” programme introduced
Why was screening for Rubella susceptibility in pregnant women stoped in England in April 2016?
- Rubella infection in the UK is at a level defined as ELIMINATED by the WHO
- Screening for rubella susceptibility does not give any PROTECTION to the unborn baby in the current pregnancy
- The test may offer FALSE REASSURANCE to women that they are not susceptible to rubella infection
- UNLIKEY to result in increased rates of congenital rubella
VZV?
Varicella Zoster virus
VZV causes…
Chicken pox/shingles
Primary maternal VZV infections leads to..
In 1st 20 weeks of gestation May cause congenital varicella syndrome -Eye defects -Hypoplastic limb -Microcephalus
VZV prevention and treatment?
- Aciclovir (IV) at high dose (presents virus replication)
- VZV immunoglobin
- To mother or neonate
- Within 7-10days of exposure
- May prevent foetal/neonatal varicellla syndrome - Live vaccine
- Not part of routine childhood vaccination schedule
- Varivax
- Varilrix
Paravirus B19: When? Result in... Diagnosis via? Monitor for? What is "fifth disease"?
When? Maternal infection during 1st 20 weeks of gestation
Results in: Foetal anaemia, hydrops in <10%
Diagnosis: amniocentesis, chorionic villus sampling, (cordocentesis – decreasing use)
Monitor for foetal ascites
• Slapped cheek syndrome (“fifth disease”)
Paravirus B19: When? Result in... Diagnosis via? Monitor for? What is "fifth disease"?
When? Maternal infection during 1st 20 weeks of gestation
Results in: Foetal anaemia, hydrops in <10%
Diagnosis: amniocentesis, chorionic villus sampling, (cordocentesis – decreasing use)
Monitor for foetal ascites
• Slapped cheek syndrome (“fifth disease”)
CMV: VIrus family? When? Result in... Diagnosis?
Herpes family of viruses
When? Maternal infection = either primary or reactivation
Results in… May cause deafness, retardation in foetus
Diagnosis - NAAT on:
• Amniotic fluid
• Neonatal blood / urine within 3 weeks of birth
Listeria monocytogenes causes…
Listeriosis
