Antenatal Care: Infections in Pregnancy Flashcards by Grace Poole

What is group B streptococcus

Commensal of the vagina in 25% women

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What can group B streptococcus colonisation cause

Group B streptococcus infection of the newborn

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What are the 6P’s of risk factors for GBS disease of new-born

Previous GBS 
Prematurity 
PROM
Pyrexia
Positive GBS UTI 
Positive mother

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What group B streptococcus leads to disease

Streptococcus agalctiae

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How can GBS present

Asymptomatic
UTI
Chorioamnionitis
Endometritis

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What are symptoms of UTI

Urgency
Frequency
Dysuria

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What are symptoms of chorioamnionitis

Fever
Lower abdominal pain
Foul-smelling discharge
Tachycardia

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What are symptoms of endometritis

Fever
Lower abdominal pain
Foul-smelling discharge
Bleeding

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How will neonatal GBS present

Floppy
Cyanosis
Tachypnoea
Pyrexia

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What type of organism is Group B streptococcus

Gram +ve diplococcus

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What is first line investigation for GBS

vaginal and rectal swab

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What does RCOG recommend about GBS screening

Do not screen all women for GBS. Screen if - UTI symptoms, STI symptoms, Chorioamnionitis, previous GBS infection

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What is first-line management for GBS

IV penicillin

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Who is IV penicillin offered to

PUG-PUP:

Pre-term (Less than 37W)

UTI GBS

GBS culture positive

PROM >18h

Unduly high T

Past GBS

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What type of organism is rubella

SSRNA

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How does congenital rubella present clinically (7)

Blueberry muffin rash
Chorioretinitis
Congenital cataracts
PDA
Hepatosplenomegaly
Cerebral palsy
Microencephaly
SNHL

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What is first-line investigation for rubella

ELISA for IgM and IgG

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How is maternal rubella managed

No treatment - support symptoms

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What does risk of vertical transmission depend on

Gestation

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When is risk of transmitting rubella to foetus highest

<12W

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If rubella <12W what should be done

Advise TOP

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If rubella 12-20W gestation what should be done

RT- PCR on amniotic fluid sample

- If positive, offer TOP or frequent growth scans

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If rubella >20W gestation what should be done

No management

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What is CMV also known as

HHV5

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What is the most common virus transmitted via pregnancy

CMV

What proportion of CMV is transmitted to the foetus

1/3

What proportion of CMV will cause foetal damage

When is CMV risk of foetal damage highest

First trimester

What are 6 features of congenital CMV

1. Blueberry muffin rash = pinpoint petechial rash 2. Growth retardation 3. SNHL 4. Encephalitis 5. Hepatosplenomegaly 6. Microcephaly

How will maternal CMV present

CMV mononucleosis

How is mum investigated for CMV

IgM and IgG

How is foetus investigated for CMV

Amniocentesis and PCR at 21W

At what age do foetuses receive amniocentesis for CMV if mother is positive

21W

How is a mother's CMV treated if pregnant

No treatment. Anti-virals are teratogenic and cannot be given.

How is a foetus with CMV managed

TOP

How does herpes simplex present in neonates

5-21d post-delivery with vesicular rash

If mother has herpes in last trimester what is done

Oral acyclovir

If mother has a primary attack of genital herpes more than 28W what should be done

C-Section

If maternal VZV infection occurs in last 4W of pregnancy, what is the risk of transmitting it to the new-born

50%

How can VZV be transmitted to the new-born

Trans-placental | Trans-vaginal

How is VZV in last four-weeks pregnancy managed

IVIg and oral acyclovir

What is foetal varicella syndrome

If mother is infected with VZV (re-activation) before 20W it can pass in-utero

When does foetal varicella syndrome occur

Before 20W

How will foetal varicella syndrome present

Eyes: micropthalmia, chorioretinitis, cataracts Limb hypoplasia Neurological: microcephaly, spinal atrophy

If pregnant mother comes into contact with someone with chickenpox and has not had chickenpox before what should be done

Test for IgG to assess immunisation status. If not immunised give VZIg in 10d

When should acyclovir be given for maternal chickenpox

Presents within 24h with a rash and >20W gestation

What follow-up should happen if mother has had chickenpox

US scan 5W post-infection to look for anomalies

Explain VZV vaccine in pregnancy

Do not give during pregnancy. If mother is not immunised offer 1m afterwards

How can hepatitis B be transmitted to neonate

Trans-placental.

How is hepatitis B not transmitted

Breast-Feeding

What are mothers screened for antenatally

HbsAg

How should babies born to hepatitis B positive mothers be managed

Ig at birth and vaccination

How is HIV in pregnancy transmitted to neonates most commonly

Delivery

What are 5 risk factors that increase risk transmitting HIV

1. Breast Feeding 2. PROM >4h 3. Pre-term 4. Hep C 5. High viral load >400 6. Seroconversion

What are 3 factors that decrease risk transmitting to neonate

Bottle Feeding ART C-Section

When are women tested for HIV

Booking visit. If declined, re-test at 28W

What immunisations should patients with HIV be offered

Pneumococcal Influenza Hep B

Explain HARRT during pregnant if women is on it

Continue HAART

If HIV positive women is not on HAART when should it be started during pregnancy

24W until delivery

When is a vaginal delivery allowed in HIV +ve pregnancies

<50 viral copies

If on zidovudine monotherapy when is a C-section offered

38W

If on other HAART when is a C-section offered

>39W

If neonates are born to HIV +ve mother and viral load is less than 50, how are they managed

Give zidovudine within 4h and continue for 4W

If neonates are born to HIV +ve mother and viral load is more than 50, how are they managed

ART

Explain breast feeding in HIV

Do not breast feed. May give cabergoline to suppress breast milk.

What will in-utero infection with parvovirus B19 cause

Foetal hydrops

What will neonatal infection with parvovirus B19 present

Malaise URTI Headaches Low-grade fever Erythema infectiosum = maculopapular rash sparing nose, eyes and mouth

How is a mother with parvovirus B19 managed

Self-resolving

How is a foetus with parvovirus b19 managed

Serial scans every 1-2W from 16 to 30W to assess growth. If evidence of foetal hydrops give erythrocyte transfusion

How will congenital chlamydia infection present

Conjunctivitis 5-14d post-birth

How is congenital chlamydia infection managed

Azithromycin

What are in-utero complications of chlamydia

Low birth-weight | PROM

What are neonatal complications of chalmydia

Conjunctivitis Pneumonitis Otitis media

How will congenital chlamydia infection present

Conjunctivitis 5-14d post-birth

How is congenital chlamydia infection managed

Azithromycin or Erythromycin

What are in-utero complications of chlamydia

Low birth-weight | PROM

What are neonatal complications of chalmydia

Conjunctivitis Pneumonitis Otitis media