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Yr 4 - GOSH > Antenatal Care: Infections in Pregnancy > Flashcards

Antenatal Care: Infections in Pregnancy Flashcards

1
Q

What is congenital rubella syndrome?

A

Maternal infection with the rubella virus during first 20 weeks of pregnancy

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2
Q

When is the risk of congenital rubella syndrome highest?

A

Before 10 weeks gestation

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3
Q

Protective measure for congenital rubella syndrome?

A

MMR vaccine

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4
Q

If pregnant women are concerned about contracting cogenital rubella syndrome, what can be done?

A

When in doubt, they can be tested for rubella immunity.

If they do not have antibodies to rubella, they can be vaccinated with two doses of the MMR, three months apart.

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5
Q

When should non-immune women be offered the MMR vaccine?

A

AFTER giving birth –> pregnant women should not receive the MMR vaccination, as this is a live vaccine.

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6
Q

Features of congenital rubella syndrome?

A

1) Congenital deafness
2) Congenital cataracts
3) Congenital heart disease (PDA and pulmonary stenosis)
4) Learning disability

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7
Q

What virus is chickenpox caused by?

A

varicella zoster virus (VZV)

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8
Q

What can VZV infection in pregnancy lead to?

A

1) More severe cases in the mother, such as varicella pneumonitis, hepatitis or encephalitis

2) Fetal varicella syndrome

3) Severe neonatal varicella infection (if infected around delivery)

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9
Q

Who is immune to VZV in pregnacy?

A

Mothers that have previously had chickenpox are immune and safe.

When in doubt, IgG levels for VZV can be tested.

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10
Q

What does a positive IgG for VZV indicate?

A

Immunity

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11
Q

When can Wwmen that are not immune to varicella be offered the varicella vaccine?

A

before or after pregnancy.

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12
Q

If a non-immune woman is exposed to chickenpox in pregnancy, what can be done?

A

When they are not immune, they can be treated with IV varicella immunoglobulins as prophylaxis against developing chickenpox.

This should be given within ten days of exposure.

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13
Q

When should IV varicella immunoglobulins be given?

A

Within 10 days of exposure

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14
Q

When the chickenpox rash starts in pregnancy, what is given?

What is the criteria for this?

A

Oral aciclovir

a) must have presented with 24 hours
b) must be more than 20 weeks gestation

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15
Q

What is congenital varicella syndrome?

A

Congenital varicella syndrome occurs in around 1% of cases of chickenpox in pregnancy.

Occurs when infection occurs in the first 28 weeks of gestation.

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16
Q

Features of congenital varicella syndrome?

A
  • Fetal growth restriction
  • Microcephaly, hydrocephalus and learning disability
  • Scars and significant skin changes located in specific dermatomes
  • Limb hypoplasia (underdeveloped limbs)
  • Cataracts and inflammation in the eye (chorioretinitis)
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17
Q

What is listeria?

A

Listeria is an infectious gram-positive bacteria that causes listeriosis.

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18
Q

Listeriosis in pregnant vs non-pregnant women?

A

Listeriosis is many times more likely in pregnant women compared with non-pregnant individuals.

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19
Q

Symptoms of listeriosis in pregnancy for the mother?

A
  • Infection in the mother may be asymptomatic
  • May cause a flu-like illness
  • May cause pneumonia or meningoencephalitis (less common)
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20
Q

Impact of listeriosis on the pregnancy?

A
  • high rate of miscarriage or fetal death
  • can also cause severe neonatal infection.
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21
Q

How is listeria typically transmitted?

A

Unpasteurised dairy products, processed meats and contaminated foods.

Pregnant women are advised to avoid high-risk foods (e.g. blue cheese) and practice good food hygiene.

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22
Q

What is congenital cytomegalovirus (CMV) infection?

A

Cytomegalovirus (CMV) infection in the mother during pregnancy

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23
Q

How is CMV normally spread?

A

The virus is mostly spread via the infected saliva or urine of asymptomatic children.

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24
Q

Does CMV infection in pregnancy cause congenital CMV?

A

No commonly

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25
Q

Features of congenital CMV?

A

Fetal growth restriction
Microcephaly
Hearing loss
Vision loss
Learning disability
Seizures

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26
Q

What is congenital toxoplasmosis?

A

Infection with the Toxoplasma gondii parasite

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27
Q

How is Toxoplasma gondii typically spread?

A

It is primarily spread by contamination with faeces from a CAT that is a host of the parasite.

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28
Q

What is the host of Toxoplasma gondii?

A

Cats

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29
Q

When is the risk of congenital toxoplasmosis highest?

A

Later in pregnancy

30
Q

Triad of features in congenital toxoplasmosis?

A

1) Intracranial calcification

2) Hydrocephalus

3) Chorioretinitis (inflammation of the choroid and retina in the eye)

31
Q

Who does Parvovirus B19 infection typically affect?

A

Children

32
Q

What is Parvovirus B19 also known as?

A

1) fifth disease
2) slapped cheek syndrome
3) erythema infectiosum

33
Q

Presentation of parovirus B19 infection?

A

1) starts with non-specific viral symptoms

2) after 2 – 5 days, the rash appears quite rapidly as a diffuse bright red rash on both cheeks, as though they have “slapped cheeks”

3) a few days later a reticular (net-like) mildly erythematous rash affecting the trunk and limbs appears, which can be raised and itchy

34
Q

Is parvovirus B19 infection serious?

A

Healthy children and adults have a low risk of any complications, and management is supportive.

35
Q

When are children with parvovirus infection contagious?

A

They are infectious 7 – 10 days before the rash appears. They are not infectious once the rash has appeared.

36
Q

Complications of infections with parvovirus B19 in pregnancy?

A

1) Miscarriage or fetal death

2) Severe fetal anaemia

3) Hydrops fetalis (fetal heart failure)

4) Maternal pre-eclampsia-like syndrome

37
Q

When are complications of infections with parvovirus B19 in pregnancy most serious?

A

1st and 2nd trimester

38
Q

How can parvovirus infection in pregnancy lead to foetal anaemia?

A

1) parvovirus infection of the erythroid progenitor cells in the fetal bone marrow and liver

2) these cells produce RBCs –> the infection causes them to produce faulty red blood cells that have a shorter life span.

3) Less red blood cells results in anaemia.

4) This anaemia leads to heart failure, referred to as hydrops fetalis.

39
Q

Result of foetal anaemia in parvovirus B19 infection?

A

Hydrops fetalis

40
Q

What can be a rare complication of severe fetal heart failure (hydrops fetalis)?

A

Maternal pre-eclampsia-like syndrome (also known as mirror syndrome)

41
Q

What triad is seen in maternal pre-eclampsia-like syndrome?

A

1) hydrops fetalis
2) placental oedema
3) oedema in the mother

It also features hypertension and proteinuria.

42
Q

Women suspected of parvovirus infection need tests for…?

A

1) IgM to parvovirus, which tests for acute infection within the past four weeks

2) IgG to parvovirus, which tests for long term immunity to the virus after a previous infection

3) Rubella antibodies (as a differential diagnosis)

43
Q

Potential differential for parvovirus infection in pregnancy?

A

Rubella

44
Q

Management of parvovirus infection in pregnancy?

A

Supportive - referral to fetal medicine to monitor for complications and malformations.

45
Q

How is the Zika virus spread?

A

The zika virus is spread by host Aedes mosquitos in areas of the world where the virus is prevalent.

Can also be spread by sex with someone infected with the virus.

46
Q

Presentation of zika virus infection?

A

It can cause no symptoms, minimal symptoms, or a mild flu-like illness.

47
Q

What can zika virus infection in pregnancy lead to?

A

Congenital zika syndrome

48
Q

Features of congenital zika syndrome?

A

1) microcephaly

2) foetal growth restriction

3) other intracranial abnormalities e.g. ventriculomegaly and cerebellar atrophy

49
Q

What tests should pregnant women that may have contracted the Zika virus have?

A

Should be tested with viral PCR and antibodies to the Zika virus.

Positive result –> referred to fetal medicine for close monitoring of the pregnancy.

50
Q

Treatment of zika virus?

A

None

51
Q

Are pregnant women at higher risk of developing lower urinary tract infections and pyelonephritis?

A

Yes

52
Q

Risk of UTIs in pregnancy?

A
  • Increases risk of preterm delivery
  • May increse risks of other adverse outcomes e.g. low birth weight, pre-eclampsia
53
Q

Define asymptomatic bacteriuria

A

Asymptomatic bacteriuria refers to bacteria present in the urine, without symptoms of infection.

Testing for bacteria in the urine of asymptomatic patients is not recommended as it may lead to unnecessary antibiotics. Pregnant women are an exception to this rule, due to the adverse outcomes associated with infection.

54
Q

Risks of asymptomatic bacteriuria?

A
  • Higher risk of developing lower urinary tract infections
  • Pyelonephritis
  • Subsequently at risk of preterm birth.
55
Q

When are pregnant women tested for asymptomatic bacteriuria?

A

At booking appt AND routinely throughout pregnancy –> this involves sending a urine sample to the lab for microscopy, culture and sensitivities (MC&S).

56
Q

Presentation of lower UTIs?

A
  • Dysuria (pain, stinging or burning when passing urine)
  • Suprapubic pain or discomfort
  • Increased frequency of urination
  • Urgency
  • Incontinence
  • Haematuria
57
Q

Presentation of pyelonephritis?

A
  • Fever
  • Loin, suprapubic or back pain (this may be bilateral or unilateral)
  • Looking and feeling generally unwell
  • Vomiting
  • Loss of appetite
  • Haematuria
  • Renal angle tenderness on examination
58
Q

What are nitrites produced by?

A

Nitrites are produced by gram-negative bacteria (such as E. coli)

59
Q

How are nitrites formed?

A

Gram-negative bacteria break down nitrates (a normal waste product in urine) into nitrites.

60
Q

What does the presence of nitrites in the urine suggest?

A

Suggests the presence of bacteria.

61
Q

What can the presence of leukocytes in the urine suggest?

A

There are normally a small number of leukocytes in the urine, but a significant rise can be the result of an infection, or alternative cause of inflammation.

62
Q

How do urine dispticks assess for leukocytes in the urine?

A

Urine dipstick tests examine for leukocyte esterase, a product of leukocytes, which gives an indication to the number of leukocytes in the urine.

63
Q

Are nitrites or leukocytes are more accurate indication of UTI?

A

Nitrites

64
Q

Most common cause of UTI?

A

E. coli

65
Q

Organisms causing UTIs?

A
  • E. coli
  • Klebsiella pneumoniae (gram-negative anaerobic rod)
  • Enterococcus
  • Pseudomonas aeruginosa
  • Staphylococcus saprophyticus
  • Candida albicans (fungal)
66
Q

Management of UTIs in pregnancy?

A

Requires 7 days (extended) course of Abx.

Abx options:
1) nitrofurantoin (avoid in 3rd trimester)
2) Amoxicillin (only after sensitivities are known)
3) Cefalexin

67
Q

What 3 Abx are safe in pregnancy?

A

1) nitrofurantoin
2) amoxicillin
3) cefalexin

68
Q

When should nitrofurantoin be avoided?

Why?

A

3rd trimester –> risk of neonatal haemolysis (destruction of the neonatal red blood cells).

69
Q

Can trimethoprim be used for UTIs in pregnancy?

A

Avoid in 1st trimester –> folate antagonist (can cause congenital malformations such as neurabl tube defects e.g. spina bifida)

It is NOT known to be harmful later in pregnancy, but is generally avoided unless necessary.

70
Q
A

Yr 4 - GOSH (45 decks)

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