Infections in pregnancy

Question 1

Why are infections in pregnancy important?

Answer 1

Maternal illness may be worse; maternal complications may be more common; preterm labour; vertical transmission; neurological damage is more common in bacterial infection

Question 2

What is cytomegalovirus?

Answer 2

A herpes virus that is transmitted by personal contact.

Question 3

Can all women get CMV?

Answer 3

No, 35% of women in the UK are immune.

Question 4

What are the fetal/neonatal effects of CMV?

Answer 4

Approx 10% are symptomatic at birth, with FGR, pneumonia and thrombocytopaenia. Most of these will develop severe neuro symptoms such as hearing, visual and mental impairment or will die.

Question 5

How do you diagnose fetal CMV?

Answer 5

US abnormalities are evident in 20%, the others are diagnosed when a specific CMV test is required. Amniocentesis at least 6 wks after maternal infection will confirm or refute vertical transmission

Question 6

How do you manage fetal CMV?

Answer 6

Close surveillance and fetal blood sampling at 32 weeks for fetal platelet levels will help determine those at most risk for severe sequelae.

Question 7

What is herpes simplex?

Answer 7

The type 2 DNA virus that is responsible for most genital herpes.

Question 8

Does a mother have to have herpes symptoms to carry the virus?

Answer 8

No, less than 5% of pregnant women have a history of prior infection, but many more have antibodies.

Question 9

How common is neonatal herpes infection?

Answer 9

Neonatal infection is rare, but has a high mortality.

Question 10

When would vertical transmission of herpes occur?

Answer 10

Vertical transmission occurs at vaginal delivery particularly if vesicles are present

Question 11

Would the timing of the maternal herpes infection affect vertical transmission?

Answer 11

Vertical transmission is more likely to follow recent maternal infection because the fetus will not have passive immunity from maternal antibodies

Question 12

How do you diagnose fetal herpes simplex?

Answer 12

It is usually clear clinically and swabs are of little use in pregnancy

Question 13

How would you manage fetal herpes simplex?

Answer 13

Refer to GU clinic, elective section recommended for mothers within 6 weeks of a primary attack. In women with recurrent herpes, even if vesicles are present at time of delivery, C section is not recommended, just daily aciclovir. Exposed neonates are also given aciclovir.

Question 14

What is rubella?

Answer 14

A virus that usually affects children and causes a mild febrile illness with a macular rash.

Question 15

Is congenital rubella common?

Answer 15

No, it is very rare in UK women because of widespread immunisations.

Question 16

What are the fetal/neonatal effects of rubella?

Answer 16

Maternal infection in early pregnancy can cause deafness, cardiac disease, eye problems and mental retardation. The probability and severity of malformation decreases with advancing gestation

Question 17

What is the management of rubella during pregnancy?

Answer 17

If a non-immune woman develops rubella before 16 weeks gestation, termination is offered.

Question 18

What are some teratogenic infections?

Answer 18

CMV, rubella, syphilis

Question 19

Syphilis in pregnancy at a glance:

Answer 19

Rare. Screening routine because treatment prevents congenital syphilis.

Question 20

Group B strep at a glance:

Answer 20

High maternal carrier rate; major cause of severe neonatal illness

Question 21

Group B strep treatment?

Answer 21

Intrapartum penicillin of high risk groups and positive third trimester screen greatly reduced neonatal infection

Question 22

Group A strep at a glance:

Answer 22

Common cause of sore throat; occasionally causes chorioamnioitis or puerperal sepsis.

Question 23

Group A strep treatment?

Answer 23

Antibiotics and supportive therapy

Question 24

Hep B at a glance:

Answer 24

Carraige common in high-risk women. High transmission rate, high chronic disease rate and mortality in neonate. Universal screening allows neonatal administration of Ig

Question 25

Hep C at a glance:

Answer 25

Mostly in high risk (HIV) women: 6% vertical transmission

Question 26

Chlamydia at a glance:

Answer 26

5% in pregnancy. Neonatal conjunctivitis and preterm labour. Antibiotics may prevent preterm labour

Question 27

Bacterial vaginosis at a glance:

Answer 27

Common. Associated with preterm labour. Screening and treatment is previous preterm labour