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MIDW 305 > CBL 1 – Infections and TORCH > Flashcards

CBL 1 – Infections and TORCH Flashcards

1
Q

Who should be screened for TORCH?

A

Everyone when taking antenatal history

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2
Q

Defn TORCH?

A

a group of infections that can cause serious birth defects or other conditions in a fetus if the mother contracts the infection during pregnancy

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3
Q

What are the TORCH infections? (6)

A

Toxoplasmosis
Other agents (HIV, syph, parvo B19, varicella, zika)
Rubella
Cytomegalovirus (CMV)
Herpes Simplex Virus (HSV)

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4
Q

Risk factors for toxoplasmosis ? (4)

A
  • Food (raw/undercooked)
  • Outdoor cats
  • Gardening (the soil)
  • Vertical transmission
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5
Q

Is there routine screening for toxoplasmosis?

A

No, except for immunocompromised people

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6
Q

Rate of vertical transmission of toxoplasmosis?

A

20-50%

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7
Q

Symptoms of toxoplasmosis?

A

Flu like illness

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8
Q

How is toxoplasmosis confirmed?

A

Serology

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9
Q

What do you do if a client has toxoplasmosis?

A

CONSULT

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10
Q

How to screen for HSV?

A

Always ask about genital herpes for client AND partner

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11
Q

If someone has a Hx of HSV what should you order?

A

Type specific serologies

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12
Q

When is the greatest risk of HSV for vertical transmission/transmission through vaginal birth?

A

Primary infection in T3

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13
Q

What is the chance of HSV vertical transmission for primary T3 infection?

A

30-50%

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14
Q

What are the recommendations for T3 for people with Hx of HSV in pregnancy?

A

Vacyclovir or Acyclovir starting at 36 weeks

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15
Q

What are the recommendations for HSV outbreak in labour/ROM ?

A

CS <4 hours + CONSULT obvi

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16
Q

Risk factors for Parvovirus? ) (4)

A

Teachers
Household contact
Early Childhood Educators
Caregivers

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17
Q

Is routine screening recommended for 5ths disease/Parvo?

A

No

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18
Q

How many people are immune to parvo?

A

Most, 50-75% people

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19
Q

Symptoms of parvo?

A

Flu like symptoms

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20
Q

Confirming parvo infection?

A

Serology

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21
Q

What to do with confirmed parvo infection?

A

Consult

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22
Q

How many people are immune to varicella?

A

> 90 %

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23
Q

Are you at risk for vertical transmission of varicella if immune?

A

No

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24
Q

If non immune with varicella infection what should you do? (3)

A

Consult OB for VZVIG within 96 hours of exposure
Consider immunization in newborn if exposed near time of birth
If client becomes symptomatic consult ASAP

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25
Q

Can RMs Rx and admin Varicella vaccine pp?

A

Yes

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26
Q

How often should you screen for syphilis?

A

Twice in pregnancy (once at initial appointment and once in T3 (planning HB) or in labour)

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27
Q

What is the most common intrauterine infection?

A

CMV

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28
Q

Symptoms for CMV?

A

Flu like, but largely asymptomatic

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29
Q

Most common nb sequelae for CMV transmission?

A

Hearing Loss

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30
Q

Who should be screened for Rubella?

A

Everyone

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31
Q

When should rubella vaccine be offered if not immune?

A

PP

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32
Q

When would you not re-immunize with low levels for rubella?

A

Equivocal/Low dose after 2 MMR vaccines

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33
Q

What should you do if rubella infection in pregnancy?

A

Consult

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34
Q

What are the risks of COVID for pregnant people?

A

> risks of hospitalization in pregnancy

35
Q

Risks for fetus pregnant person with COVID 19?

A
  • Higher rates of PTB
  • Higher rates of NICU admission
36
Q

Management of COVID hospitalization in pregnancy?

A

3rd trimester growth ultrasound
EMF in labour
Send placenta to pathology

37
Q

What is Toxoplasmosis?

A

Part of TORCH, parasite

38
Q

What should you order for suspected toxoplasmosis infection?

A

IgG and IgM, repeat 2 weeks later

39
Q

What should you order for confirmed Toxoplasmosis infection?

A

Amnio after 18 weeks GA and within 4 wks of exposure
U/S if amnio unclear (IUGR, microcephaly, etc)

40
Q

What is the Tx to reduce chance of toxoplasmosis vertical transmission?

A

Spiramycin

41
Q

What should you do if confirmed case of vertically transmitted Toxoplasmosis infection?

A

Refer to MFM

42
Q

What are the types of HSV?

A

Type 1 – usually lip
Type 2 – usually genitals
Both can be found in genitals, and both cause viral shedding

43
Q

Why are we concerned with HSV in pregnancy? (3)

A
  • Part of TORCH – vertical transmission (rare)
  • Intrapartum (through contact with vaginal secretions in birth)
  • Postpartum (through direct skin contact)
44
Q

What is the most risky HSV situation in pregnancy?

A

Primary exposure in 3rd trimester (30-50% chance of transmission to babe)

45
Q

What are the possible clinical scenarios with HSV in pregnancy ? (3)

A

Primary (HSV 1 or HSV 2 IgM with no IgG and breakout)
Non-primary – first recognized episode but has antibodies (IgG)
Recurrent – clinical episode with someone with antibodies (IgG)

46
Q

Management of HSV? (4)

A
  • Offer type specific HSV testing to client in early pregnancy and repeat at 32-34 wks
  • Offer acyclovir/valacyclovir to partner or client at 36 wks
  • C/S if active lesions (consult not transfer)
    AND C/S if primary outbreak in T3 (transfer?)
  • Reduce FSE, ARM, instrumental delivery
47
Q

What is fifth’s disease AKA parvovirus?

A

Part of TORCH, spread by resp secretions

48
Q

Risks of parvo?

A

Most have no adverse outcomes >20 wks
Risks of miscarriage <20 wks 13 %

49
Q

Symptoms of parvo?

A

Flu, rash, joint pain, most asymptomatic

50
Q

Is routine screening for parvo rec?

A

No, most people are immune

51
Q

Who is more likely to get parvo?

A

Parents, people working with kids

52
Q

What to do if parvo infection diagnosed?

A

Refer to MFM or OB for regular US/Dopplers to rule out anemia and hydrops

53
Q

What to do if someone is exposed to varicella and not immune in preg?

A

Serum testing
Immunoglobulin administered in 96 hrs of exposure

Cannot be Rx by midwives for some reason

54
Q

What to do if someone is symptomatic of varicella and not immune? (3)

A

Oral acyclovir
Detailed US
Hospital admission

55
Q

What should you consider if varicella outbreak close to birth?

A

Newborn immunization

56
Q

Recommendation for CMV exposure with no previous immunity?

A

Amnio at least 7 weeks after onset after 21 wks GA
Serial US (IUGR, microcephaly, liver calcifications)

57
Q

Incidence of fetal transmission with primary infection of CMV?

A

Primary infection 30-40 % vertical transmission, 25 % sequelae to fetus if infected

58
Q

CMV fetal sequalae? (3)

A
  • Hearing loss
  • visual impairment
  • delay of motor development
59
Q

Fetal risks of Rubella?

A

Severe <16 wks
Miscarriage, congenital rubella syndrome

60
Q

Tx of rubella in pregnancy?

A
  • Post exposure prophylaxis immunoglobulin
  • Risk of VT – offer termination >16 wks
61
Q

What level of IgG non immune rubella?

A

<10 iu/ml

62
Q

Reading serologies?

A

IGG - good (there forever) – immune?
IGM - Mal (iMmediate) – active infection

62
Q

Who is recommended to have CS with HSV?

A

Primary outbreak in T3
Legions at time of delivery (controversial)

63
Q

Vaccines to be avoided in pregnancy?

A

MMR and Varicella

64
Q

What are the T1 lab reqs?

A

● Blood group and antibody screen
● CBC
● HIV serology
● STS serology (Syph, chlamyd, Hep B)
● HBsAg
● anti-HCV (for clients with risk factors)
● Rubella antibody titre
● CT/GC
● Urine C&S (1)

65
Q

How is toxo diagnosed?

A

Can be identified with serologic testing or amniocentesis, or by the presence of abnormal ultrasound findings. Amnio is more diagnostic.

66
Q

What could fetal effects of syphilis be?

A

○ skeletal deformities
○ severe anemia
○ Hepatomegaly
○ Spleenomegaly
○ Jaundice
○ CNS issues including blindness and loss of hearing
○ skin rashes
○ Meningitis
○ Prematurity
○ Low birth weight
○ Miscarriage, stillbirth, neonatal death - fetal / neonatal demise occurs in 40% of affected pregnancies

67
Q

What is the OTHER in TORCH (5)?

A

syphilis,
varicella,
parvovirus,
HIV,
hep B

68
Q

Which parts of TORCH do we routinely test for?

A

Syphillis
Rubella
Varicella (if not immune)
HIV
Hep B

69
Q

What is the transmission rate from parvo B19 infection to fetus?

A

17-33%

70
Q

What could childhood effects of syphilis be?

A

○ <2 years from birth
■ asymptomatic
■ Preterm birth
■ Low birthweight
■ Stillbirth
■ Disseminated infection
■ Skin or mucous membrane lesions
■ Bone deformities
■ Anemia
■ Hepatosplenomegaly
■ Neurologic complications as above, deafness
○ >2 years from birth
■ Scarring of cornea
■ Lymphadenopathy
■ Dental abnormalities

71
Q

What does parvo look like in children?

A

Red cheeks, flu

72
Q

Does Varicella testing need to happen routinely?

A

No, screening first if they have had it (prior to 2004) or had routine vaccines

73
Q

What can happen if parvo crosses placenta?

A

Miscarriage
Hydrops
Fetal anemia
Hypoxia
Impaired hepatic function

74
Q

What is the chance of nb transmission with active recurrent HSV lesions at time of birth for vag birth?

A

2-5 %

75
Q

What are the potential abn findings on US for toxo? (6)

A

○ Hydrocephalus
○ Intracranial calcifications
○ Microcephaly
○ Fetal growth restriction
○ Ascites
○ Hepatosplenomegaly

76
Q

Risks of toxo for the fetus?

A

Vertical transmission can lead to blindness, cerebral/cardiac anomalies

77
Q

Serology for toxo?

A

IgG/IgM both negative = absence of infection or extremely recent acute infection
Positive IgG + negative IgM = old infection (infection greater than 1 year ago)
Both IgG/IgM both positive = recent infection OR false-positive test result

78
Q

Serology for 5ths disease/parvo

A

+ IgG, - IgM = immune
- IgG, + IgM = recent infection/false positive
+ IgG, + IgM = recent infection, repeat bloodwork should show increasing parvovirus B19 IgG titre. If IgG titre does not increase, then it indicates an older infection
- IgG, - IgM = non-immune susceptible to infection

79
Q

What is OTHER in Torch ? (5)

A

syphilis
varicella
parvovirus
HIV
hep B

80
Q

Tx for syph?

A

Benzathine Pen G (different than Pen G we give in labour)

2.4 million units IM weely 1-2 x

81
Q

Tx for chalmydia?

A

Amox 500 mg PO TID 7 days

82
Q

Potential U/S findings that can relate to TORCH congenital infections ? (9)

A

-Big heart
-Big spleen/lover
-Big plaenta
-Big brain
-Hydrops
IUGR
-Oligo/Poly
-Brain calcifications
-Abdominal calcifications

  • Cerebral ventriculomegaly
    -Intracranial calcifications
    -Cardiomegaly
  • Hepatosplenomegaly
    -Intra-abdominal calcifications
    -Hyrdops Fetalis
    -Placentomegaly
    -Hydroamnio/Oligo
    -IUGR

MIDW 305 (13 decks)

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