95 Infections in the pregnancy and neonates Flashcards
What are the viruses responsible for infections in pregnancy and in the neonate?
- Rubella
- Varicella Zoster Virus (VZV)
- Parvovorius
- Cytomegalovirus (CMV)
- Zika virus
- Human Immunodeficiency Virus (HIV)
- Hepatitis B Virus (HBV)
- Hepatitis C Virus (HCV)
- Herspes Simplex Virus (HSV)
- Human Papilloma Virus (HPV)
What are the bacterias responsible for infections in the pregnancy and neonate?
- Listeria monocytogenes
- Chlamydia trachomatis
- Neisseria gonorrhoea
- 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?
Commonences at 22 weeks (154 days) of gestation and ends 7 days after birth
What is the neonatal period?
First 28 days
What is the postnatal period?
First 6 weeks after birth
How does vertical transmission occur?
- Across the placenta (intrauterine)
- During birth
- Direct contact with maternal body fluids
- Prolonged rupture of membranes
- After birth (from mother or other contacts)
Manifestations in congenital infection?
- Growth retardation
- Congenital malformation
- Foetal loss
Name organisms that cause congenital infection?
- Rubella
- CMV
- HIV
- Toxoplasma
- Treponema pallidum
- Parvovirus
- VZV
Perinatal infection manifestations?
- Meningitis
- Septicaemia
- Penumonia
- Preterm labour
Name organisms that cause perinatal infection?
- Gonococus
- Chylamydia
- HSV
- VZV
- Group B strep
- E. coli
- Listeria
Postnatal infection manifestations?
- Meningitis
- Septicaemia
- Conjunctivitis
- Penumonitis
Name organisms and their method of transmission that cause postal infection?
- N. gonorrhoeae
- Chlamydia
- Breast milk:
• HIV
• CMV - Umbilicus:
• Staphylococci
• Tetanus - Person-to-person:
• Group B strep
• Listeria
• E.coli
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
Marker:
• IgM persists for 1st three months of life
What does MMR vaccine stand for?
Measles, mumps and rubella
History of MMR vaccine?
- 1988 - vaccine introduced
- 1998 - suggested link with autism
- 2003 - measles eliminated from UK
- 2006 - re-establisehd due to poor vaccine uptake
- 2013 - “catch-up” programme introduced
Why was pre-natal screening for Rubella susceptibility in pregnant women stopped in England in April 2016?
- Rubella infection in UK is at a level defines as ELIMINATED by WHO
- Screening for rubella susceptibility does not give any PROTECTION to the unborn baby in the current pregnancy
- Test may offer FALSE REASSURANCE to women that they are not susceptible to rubella infection
- Stopping antenatal screening is unlikely to result in increased rates of congenital rubella
What does Varicella Zoster Virus (VZV) cause?
Chicken pox (shingles)
Primary maternal VZV infection in 1st 20 weeks of gestation causes…
- Congenital varicella syndrome
* Eye defects, hypo plastic limb, microcephalus
VZV infection around delivery causes…
- Neonatal varicella syndrome
* Rash, pneumonitis
VZV prevention and treatment?
- Aciclovir (IV) - high dose
- VZV immunoglobulin:
• To mother or neonate
• Within 7-10 day of exposure
• May prevent foetal/ neonatal varicella syndrome - Live vaccine:
• Not part of routine childhood vaccination schedule
• Varivax
• Varilrix
Parvovirus B19: • When? • Result in... • Monitor for? • What is "fifth disease"?
- Maternal infection during 1st 20 weeks of gestation
- Foetal anaemia, hydros in <10%
- Monitor for foetal ascites
- Slapped cheek syndrome (“fifth disease”)
How to diagnose parvovirus?
- Amniocentesis
- Chorionic villus sampling
- (Cordocentesis - decreasing use)
CMV:
• VIrus family?
• When?
• Result in…
- Herpes family of viruses
- Maternal infection = either primary or reactivation
- May cause deafness, retardation in foetus
How to diagnose CMV?
NAAT on:
• Amniotic fluid
• Neonatal blood/ urine within 3 weeks of birth
Listeria monocytogenes causes?
Listeriosis
Listeriosis:
• Transmission?
• Consequences of infection in pregnancy?
- Transplacental transmission
- Infection in early pregnancy –> foetal death
- Infection in later pregnancy –> associated with premature birth
Complications of foetal infection of listeriosis?
• Bacteraemia • Hepatosplenomegaly • Meningoencephaly • Thrombocytopaenia • Prenumonits
What does intrapartum exposure to listeriosis cause?
Meningitis, bacteraemia
How to diagnose listeriosis?
Culture: blood, CSF, placental tissue, lochia
Treatment and management of listeriosis?
Take specialist advice re: antibiotics
What causes toxoplasmosis?
Taxoplasma gondii
How is toxoplasmosis transmitted?
- Definitive hosts: cats
- Faecal contamination
- Infected, under-cooked meat
- Infected fruit and vegetables
Infected toxoplasmosis pregnancy –> ___ chance of transplacental transmission
1:3
Infection in 1st and 2nd trimester leads to…
- Stillborn
- Death soon after birth
- Cerebral calcification
- Cerebral palsy
- Epilepsy
- Chorioretinitis
Maternal toxoplasmosis infection confirmed by presence of …
IgM antibodies
Treatment of toxoplasmosis?
Spiramycin
Ways to reduce HIV vertical transmission?
- HIV testing
- Counselling
- Antiretroviral medication
- Delivery by caesarean section prior to onset of labour
- Discouraging breastfeeding
Causative agent for syphilis?
Presentation?
Treatment
- Treponema pallidum
- Rare in neonates due to ore-natal screening
- Fever, rash, condylomata, mucosal fissures
- Treatment = benzylpenicillin
Staphyloccocus aureus:
• Causes what syndrome?
• Toxin?
- Scalded skin syndrome
* S. aureus toxin
Zika virus: • Spread? • Symptoms? • Risks of maternal infection? • Vaccine? • Prevention?
- Spread through bite of infected Aedes species mosquito
- Fever, rash, joint pain, conjunctivits
- May be transmitted from male to sexual partner(s)
- Infection during pregnancy - severe congenital brain effects e.g. microcephaly, Guillain-Barré syndrome
- No vaccine (yet) or treatment
- Prevention - barrier contraception, avoid mosquito bites
Influence of maternal microbiota on baby?
- Newborn’s gut microbiota can affects its own immune system
* Some evidence - mother’s microbiome shapes the immune system of her offspring
