Antenatal Infection 2 Flashcards
How are babies born to mothers infected with or carriers of Hepatitis B managed?
Give immunoglobulin and vaccinate babies of carriers and infected mothers at birth
Give further Hep B vaccination at 1-2 months and at 6 months
How do you follow up baby vaccinated for Hepatitis B?
Do serology of vaccinated baby at 12-15months
If HBsAg -ve and Anti-HBs is present - child is protected
Hepatitis B serology?
HBsAg - acute, ongoing disease (if >6m chronic)
Anti-HBs - immunity (from exposure or immunisation)
Anti-HBc - previous or current infection (IgM at start then IgG) (Caught)
HBeAg - breakdown of core antigen from infected liver cells - marker of infectivity
Carrier will be HBsAg positive and antiHBc positive
What does neonatal HSV infection cause?
Blindness Low IQ Epilepsy Jaundice Respiratory distress DIC Death
Usually presents as grouped vesicles on a red base
How is HSV managed in pregnancy?
If primary infection in pregnancy:
Oral aciclovir ± Caesarean section within 6 weeks of due date
If active primary infection at time of delivery, LSCS even if membranes have ruptured
Give mother and newborn high dose acyclovir at birth
Try to avoid fetal blood sampling and instrumental delivery
What is varicella zoster?
DNA virus
How is varicella managed if maternal suspected varicella contact?
IF motor has previous primary VZ infection - assume immunity, no action required as maternal antibodies
IF no previous infection - VZ IgG tenting to confirm immunity status
If not immune, give woman VZ IG within 10 days of contact and before rash appears
Manage as potentially infectious from 8-28 days
How is maternal varicella infection managed?
Aciclovir within 24h of rash onset if >20weeks gestation
Serial US to identify fetal abnormality
What are complications of varicella infection of newborn/fetus?
Varicella of newborn - can be asymptomatic
Managed with VZIG ± acyclovir
Fetal varicella syndorme:
Reactivation of virus in utero only occurs when fetus infected by maternal varicella before 20 weeks gestation
Skin scarring Eye defects - microphthalmia, cataracts Hypoplasia of limbs Microcephaly Seizures
What is ophthalmia neonatorum? How is it managed?
Purulent discharge from the eye of neonate <21 days old
Chlamydia, Herpes virus, staph, strep, pneumococci, E.coli
Swab for bacterial and viral culture
Local cleansing of eye
Erythromycin for 3 weeks
Give parents erythromycin single dose
For gonocooccal infection - benzylpenicllin IM and chloramphenicol drops for 7 days
Isolate
What are group B streptococcus? Examples?
Commensal bowel bacteria found in vainga or rectum in 20% of women
Streptococus agalacticae
What are risk factors for GBS infection in neonate?
GBS infection in previous baby
Prematurity < 37 weeks
Rupture of membranes >24h before delivery
Pyrexia during labour
Positive test for GBS in motehr
Mother diagnosed with UTI found to be GBS in pregnancy
It is the rupture of membranes that expose baby to GBS
How is GBS infection of neonate prevented?
Presence of GBS is deleted using swabs or urine cultures if UTI
High dose IV benzylpenicillin throughout labour
What is indication for abx for GBS in labour?
GBS positive swabs UTI caused by GBS Previous baby with GBS infection Pyrexia during labour Gestation < 37 weeks Rupture of membranes > 18 hours
If ROM in woman > 37 weeks gestation - induce immediately to reduce dental exposure
Not indicated in C-section as it is ROM that exposes baby to GBS
What is action if inadequate intrapartum abx for GBS?
24 hours regular observations
One red flag or 2+ red flag risk factor warrant empirical abx therapy with benzylpenicillin and gentamicin and full septic screen
