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MD3002 Week 11 > 5. Infections in Pregnancy & the Neonate > Flashcards

5. Infections in Pregnancy & the Neonate Flashcards

1
Q
  • 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
A

-

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2
Q

What are the viruses responsible for infections in pregnancy and in the neonate?

A
  • 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)
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3
Q

What are the bacterias responsible for infections in the pregnancy and neonate?

A
  • Listeria monocytogenes
  • Chlamydia trachomatis
  • Neisseria gonorrhoeae
  • Staphylococcus aureus
  • Treponema pallidum
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4
Q

Which protozoa cause infections in the pregnancy and neonate?

A
  • Toxoplasma gondii

* Trichomonas vaginalis

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5
Q

Which yeasts can cause infections in pregnancy and neonate?

A

Candida albicans

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6
Q

What does congenital mean?

A

Condition present at birth (inherited or caused by the environment)

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7
Q

What is the perinatal period?

A

Commences at 22 weeks (154 days) of gestation and ends seven days after birth

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8
Q

When is the neonatal period?

A

First 28 days of life

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9
Q

When is the post natal period?

A

First 6 weeks after birth

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10
Q

How does vertical transmission occur?

A 
Across the placenta (intrauterine)
During brith
Direct contact with maternal body fluids
Prolonged rupture of membranes
After birth (from mother or other contacts)
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11
Q

Manifestations in congenital infection?

A

Growth retardation
Malformation
Fetal loss

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12
Q

Postnatal infection manifestations

A

Meningitis
Septicaemia
Conjunctivitis
Pneumonitis

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13
Q

Perinatal infection manifestations?

A

Meningitis
Septicaemia
Pneumonia
Preterm labour

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14
Q 
Rubella:
Start?
Initial signs?
Symptoms/signs?
Marker
A
  • 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

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15
Q

What is the history of the rubella vaccine?

A
  • 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
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16
Q

Why was screening for Rubella susceptibility in pregnant women stoped in England in April 2016?

A
  1. Rubella infection in the UK is at a level defined as ELIMINATED by the WHO
  2. Screening for rubella susceptibility does not give any PROTECTION to the unborn baby in the current pregnancy
  3. The test may offer FALSE REASSURANCE to women that they are not susceptible to rubella infection
  4. UNLIKEY to result in increased rates of congenital rubella
17
Q

VZV?

A

Varicella Zoster virus

18
Q

VZV causes…

A

Chicken pox/shingles

19
Q

Primary maternal VZV infections leads to..

A 
In 1st 20 weeks of gestation
May cause congenital varicella syndrome
-Eye defects
-Hypoplastic limb
-Microcephalus
20
Q

VZV prevention and treatment?

A
  1. Aciclovir (IV) at high dose (presents virus replication)
  2. VZV immunoglobin
    - To mother or neonate
    - Within 7-10days of exposure
    - May prevent foetal/neonatal varicellla syndrome
  3. Live vaccine
    - Not part of routine childhood vaccination schedule
    - Varivax
    - Varilrix
21
Q 
Paravirus B19:
When?
Result in...
Diagnosis via?
Monitor for?
What is "fifth disease"?
A

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”)

22
Q 
Paravirus B19:
When?
Result in...
Diagnosis via?
Monitor for?
What is "fifth disease"?
A

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”)

23
Q 
CMV:
VIrus family?
When?
Result in...
Diagnosis?
A

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

24
Q

Listeria monocytogenes causes…

A

Listeriosis

25
Q

Listeriosis:
Transmission?
Consequences of infection in pregnancy?

A
  • Often unapparent in maternal infection
  • Transplacental transmission
  • Infection in early pregnancy foetal death
  • Infection in later pregnancy  associated with premature birth
26
Q

Complications of feotal infection of listeriosis?

A

Bacteraemia, hepatosplenomegaly, meningoencephaly, thrombocytopaenia, pneumonitis

27
Q

Listeriosis diagnosis via cultures from…

A

Blood, CSF, placental tissue, lochia

28
Q

Listeriosis diagnosis via cultures from…

A

Blood, CSF, placental tissue, lochia

29
Q

Infection of toxoplasmosis in 1st and 2nd trimester leads to..

A
  • Stillborn
  • Death soon after birth
  • Cerebral calcification
  • Cerebral palsy
  • Epilepsy
  • Chorioretinitis
30
Q

Ways to reduce HIV vertical transmission?

A
  • HIV testing
  • Counselling
  • Antiretroviral medication
  • Delivery by ceasarean section prior to onset of labour
  • Discouraging breastfeeding,
31
Q

Causative agent for syphilis?
Presentation?
Treatment

A

Causative agent: Treponema pallidum

Presentation: Fever, rash, condylomata, mucosal fissures

Treatment: Benzylpenicillin

32
Q

Causative agent for syphilis?
Presentation?
Treatment

A

Causative agent: Treponema pallidum

Presentation: Fever, rash, condylomata, mucosal fissures

Treatment: Benzylpenicillin

33
Q 
Zika virus:
Spread?
Symptoms?
Risks of maternal infection?
Vaccine?
Prevention?
A

Spread through bite of infected Aedes species mosquito.
May be transmitted from male to sexual partner(s)

Symptoms: Fever, rash, joint pain, conjunctivitis

• Infection during pregnancy – severe congenital brain effects e.g. microcephaly, Guillain-Barré syndrome

No vaccine (yet) or treatment. No aspirin or NSAIDS. Prevent bleeding. Fluids good.

Prevention – barrier contraception, avoid mosquito bites

34
Q 
Zika virus:
Spread?
Symptoms?
Risks of maternal infection?
Vaccine?
Prevention?
A

Spread through bite of infected Aedes species mosquito.
May be transmitted from male to sexual partner(s)

Symptoms: Fever, rash, joint pain, conjunctivitis

• Infection during pregnancy – severe congenital brain effects e.g. microcephaly, Guillain-Barré syndrome

No vaccine (yet) or treatment. No aspirin or NSAIDS. Prevent bleeding. Fluids good.

Prevention – barrier contraception, avoid mosquito bites

35
Q

Influence of maternal microbiota on bay?

A

Mothers microbiome shapes the immune system of her offspring

MD3002 Week 11 (6 decks)

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