8.7 Infections in Pregnancy Flashcards
When in pregnancy do you get congenital rubella syndrome?
Maternal infection with rubella in first 20 weeks (highest risk in first 10).
When can women be vaccinated for rubella?
Test for antibodies. Give MMR before getting pregnant or after giving birth as it is a live vaccine.
What are the features of congenital rubella syndrome?
- congenital deafness
- congenital cataracts
- heart defects (PDA and pulmonary stenosis)
- learning disability
What can chicken pox infection in pregnancy lead to?
- severe cases in mother: varicella pneumonitis, hepatitis, encephalitis
- congenital/ fetal varicella syndrome
- neonatal varicella infection
What if a women in exposed to chickenpox in pregnancy?
- has it before? safe
- unsure? check VZC IgG present? safe
- not immune? give prophylactic IV varicella immunoglobulins within 10 days
- got a rash? more than 20weeks? treat with PO acyclovir
What does listeria cause in mother and foetus?
Mother: asymptomatic, flu-like, (rarely pneumonia or meningoencephalitis)
Fetus: high rate of miscarriage and death, severe neonatal infection
Where do you catch CMV?
From saliva r urine of asymptomatic children.
What does CMV in pregnancy cause?
Most cases do not causes congenital CMV.
Congenital CMV:
- FGR
- microcephaly
- hearing loss
- vision loss
- learning disability
- seizures
Where do you catch toxoplasma gondii from??
Cat faeces are host.
Usually asymptomatic
What can toxoplasmosis in pregnancy cause?
Later in pregnancy greater risk of congenital toxoplasmosis:
- intracranial calcification
- hydrocephalus
- chorioretinitis
(classic triad)
What are the other names for parvovirus B19 infection?
In children:
- fifth disease
- slapped cheek syndrome
- erythema infectiosum
(self limiting and fades over 1-2 weeks)
What is the prodrome and evolution of parvovirus B19 infection?
Non-specific viral Sx, then rapid rash at 2-5 days on cheeks, later red reticular rash on trunks and limbs can be raised and itchy.
(low risk of complications in adults and children, just supportive treatment)
What counts as exposure to parvovirus B19?
- people are infection 7-10 days before the rash
Explosure: - 15 mins in the same room
- close face to face contact
What should pregnant women who have parvovirus B19 exposure do?
Test:
- IgM for acute infection in past 4 weeks
- IgG for long term immunity from previous infection
- rubella antibodies (for you Ddx)
- if infected refer to fetal medicine
Complications of parvovirus B19 infection in pregnancy?
Particularly in the 1st and 2nd trimester:
- miscarriage or fetal death
- severe fetal anaemia
- hydrops fetalis (heart failure)
- maternal pre-eclampsia-like syndrome
How does parvovirus B19 cause fetal anaemia?
Infects the erythroid progenitor cells in bone marrow and liver –> produce faulty RBCs –> anaemia –> heart failure –> hydrops fetalis
What is another name for maternal pre-eclampsia-like syndrome?
Mirror syndrome
What happens in maternal pre-eclampsia-like syndrome / mirror syndrome?
(complication of parvovirus B19)
Rare complication of severe fetal heart failure (hydrops fetalis) triad of:
- hydrops fetalis
- placental oedema
- oedema in mother
Also hypertension and proteinuria.
Which mosquito spreads Zika?
Aedes mosquito
(also spread through sex with someone infected)
Test pregnant women with viral PCR and antibodies to Zika (supportive management by fetal medicine).
Symptoms of Zika?
No symptoms
Minimal symtoms to
Flu-like illness
What is seen in congenital Zika syndrome?
- microcephaly
- fetal growth restriction
- cranial stuff: ventriculomegaly or cerebellar atrophy
