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MD1 Reproduction > Congenital and Perinatal Infections > Flashcards

Congenital and Perinatal Infections Flashcards

1
Q

What is a prenatal infection?

A

Infection acquired/carried by mother and transmitted to developing foetus

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2
Q

What is a perinatal infection?

A

Infection transmitted around time of delivery

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3
Q

What is a postnatal/postpartum infection?

A 
Infection acquired after delivery, withing 1st 2 days of life
From
- Family
- Healthcare workers
- Community
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4
Q

What is vertical transmission?

A

Mother > foetus; eg: transplacental

Mother > baby; eg: breast milk

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5
Q

What is horizontal transmission?

A

One person/baby > another

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6
Q

What is an ascending infection?

A

Vaginal organisms producing foetal infection

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7
Q

What are the non-specific effects of maternal infection?

A

Foetal death

Premature delivery

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8
Q

What are the specific effects of maternal infection?

A

Benign/self-limiting
End-organ damage
Chronic infection

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9
Q

What is the epidemiology of varicella zoster virus (VZV) infection?

A

Very efficient transmission via respiratory system

Maternal varicella

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10
Q

What is the clinical presentation of VZV in the mother?

A

Respiratory illness with productive cough and haemoptysis

Chicken pox

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11
Q

What are the factors influencing transmission to the foetus or neonate with VZV?

A

Congenital varicella
- Primary maternal varicella in 3rd trimester has greatest risk of transmission and mortality
- Chance of earlier transmission if maternal varicella very severe
Perinatal varicella
- Primary maternal varicella just before/after delivery

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12
Q

What is the route of transmission of VZV?

A

Congenital
- Transplacental
Perinatal
- Respiratory

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13
Q

What are the outcomes of a VZV infection?

A 
Maternal varicella
- 2% mortality
Congenital varicella
- Limb hypoplasia
- Dermatomal cicatricial scarring
- Microcephaly
- Cataracts
- Mental retardation
- GIT and genitourinary problems
Perinatal varicella
- Disseminated infection > disseminated intravascular coagulation
- 25-30% mortality
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14
Q

What is the treatment and prevention for VZV infection?

A 
Prophylactic varicella zoster Ig
- To prevent maternal, congenital, and perinatal varicella
- Given to mother/infant within 96 hours of exposure
- Can give to preterm babies
Acyclovir
- To treat acute varicella
- Oral/IV, depending on severity
Vaccination
- Very effective
- Given at 18 months
- Live attenuated
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15
Q

What is the epidemiology of cytomegalovirus (CMV)?

A 
Primary infection
Reinfection with different strain
Reactivation of latent infection
10% of CMV IgG positive people shedding at any time
More common in developing countries
Congenital CMV common
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16
Q

What is the clinical presentation of CMV in the mother?

A

Sepsis-like symptoms

  • Hepatomegaly
  • Respiratory distress
  • Atypical lymphocytosis
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17
Q

What are the factors influencing transmission to the foetus or neonate with CMV?

A

Timing of infection during pregnancy irrelevant
Type of infection matters
- Primary infection in mother has 25-50% foetal transmission rate
- Reactivation in 10-30% of mothers, but only 1-3% foetal transmission rate

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18
Q

What is the route of transmission in CMV?

A 
Congenital
- Transplacental
Perinatal
- Breast milk
- Cervical secretions
- Genital secretions
- Urine
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19
Q

What are the outcomes of a CMV infection?

A 
90% of neonates asymptomatic
- Still have risk of long-term complications
10% of neonates symptomatic
- Very high rates of long-term sequalae
- 20-30% mortality
- Chorioretinitis/optic atrophy
- Deafness
- Microcephaly and periventricular calcification
- Developmental delay
- Behavioural problems
- Pneumonitis (rare)
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20
Q

How is a CMV infection diagnosed?

A 
Characteristic activated mononuclear white cells in peripheral blood
In mother
- IgG
- IgM
- IgG avidity
- Nucleic acid amplification test
Confirmation of foetal infection
- Amniotic fluid PCR
- Cord blood serology/PCR
- Guthrie blood spot
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21
Q

What is the treatment and prevention for a CMV infection?

A

Basic hygiene around toddlers/young children
Avoid pregnancy <6 months after primary infection
Monitor and assess regularly
Ganciclovir
- 6 week IV treatment for symptomatic neonates
Valganciclovir
- Oral follow up treatment for 12 months for symptomatic neonates

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22
Q

What is the epidemiology of rubella?

A

Peak in winter/spring

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23
Q

What is the clinical presentation of rubella in the mother?

A 
Low grade fever
Lymphadenopathy but unusual
- Occipital
- Post-auricular
- Posterior cervical nodes
Exanthem
- Macropapular rash
- Face > trunk > limbs
Polyarthralgia/polyarthritis
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24
Q

What are the factors influencing transmission to the foetus or neonate with CMV?

A

1st trimester key
- Risk greatest in early pregnancy within 1st month
- Declining over time
Very rare in 2nd trimester

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25
Q

What are the outcomes of a rubella infection?

A 
Ophthalmological
- Cataracts
- Glaucoma
- Retinopathy
Cardiac
- Patent ductus arteriosus
- Pulmonary artery stenosis
Auditory
- Sensorineural hearing loss
Others
- Meningoencephalitis
- Behavioural problems
- Increased rates of T1D and thyroid dysfunction
26
Q

How is a rubella infection diagnosed?

A 
Foetal diagnostic testing
- Amniotic fluid
- Cord blood
Neonatal serology
- IgG detection/rising titre
- IgM
27
Q

What is the treatment and prevention for a rubella infection?

A 
Vaccination
Don't give vaccination during pregnancy
- Vaccinate before if possible
- Post-natal
No treatment for infection
28
Q

What is the route of transmission in herpes simplex virus (HSV)?

A

Perinatal

29
Q

What are the outcomes of a HSV infection?

A 
Primary infection during pregnancy
- Abortion
- Intrauterine growth restriction
- Preterm labour
Primary infection near delivery: 3 disease patterns
- Skin-eye-mouth
- Encephalitis
- Disseminated disease
30
Q

What is the treatment and prevention for a HSV infection?

A

Primary infection during pregnancy
- Acyclovir until delivery
- Caesarian section to reduce risk of transmission
Recurrent disease during pregnancy
- Acyclovir to suppress
- Avoid instrumentation during delivery
- Examine neonate carefully for lesions
- Swab eyes/nasopharynx of neonate to detect colonisation
- Treat neonate with acyclovir if infection detected

31
Q

What is the clinical presentation of parvovirus B19 in the mother?

A 
Commonly asymptomatic
Commonly non-specific symptoms
- Fever
- Muscle pain
- Malaise
- Diarrhoea
- Headache
- Nausea
May have more specific symptoms
- Febrile illness with rash
- Arthropathy
- Temporary aplastic crisis
32
Q

What are the factors influencing transmission to the foetus or neonate with parvovirus B19?

A

Primary infection from weeks 18-20 of pregnancy puts foetus at risk of most serious effects

33
Q

What is the route of transmission in parvovirus B19?

A

Transplacental

34
Q

What are the outcomes of a parvovirus B19 infection?

A

10% risk of spontaneous abortion

Foetal anaemia and hydrops fatalis in 2nd/3rd trimester

35
Q

How is a parvovirus B19 infection diagnosed?

A

Maternal serology

- Classic IgG/IgM pattern for evidence of past infection with immunity vs current infection

36
Q

What is the treatment and prevention for a parvovirus B19 infection?

A

No prevention other than avoiding infection

Specialist treatment can reduce foetal death, including intrauterine transmission if anaemic

37
Q

What are the factors influencing transmission to the foetus or neonate with syphilis?

A

Stage of infection matters, rather than stage of pregnancy

  • 90% transmission if primary syphilis
  • 60-90% if secondary syphilis
  • 40% early latent
  • Low risk if late latent/tertiary
38
Q

What is the route of transmission in syphilis?

A

Transplacental

39
Q

What are the outcomes of a syphilis infection?

A 
Stillbirth in 40%
Premature delivery
Snuffles
- Secretions from nose
- Lots of treponemes
Hutchinson's teeth
Osteochondritis syphilitica
Deafness
Intellectual disability
40
Q

How is a syphilis infection diagnosed?

A

Antenatal serology at 1st visit

Follow-up serology if high risk of infection

41
Q

What is the treatment and prevention for a syphilis infection?

A

3 dose intramuscular benzathine penicillin to mother and baby if infected at birth

42
Q

What is the route of transmission in chlamydia?

A

From genital tract at delivery

43
Q

What are the outcomes of a chlamydia infection?

A

50% transmission if present in mother’s genital tract
25% conjunctivitis
10% pneumonia
May have persistent colonisation

44
Q

How is a chlamydia infection diagnosed?

A

Need to look carefully for haemorrhagic conjunctivitis and specifically test for chlamydia

45
Q

What is the clinical presentation of toxoplasma gondii in the mother?

A

Usually asymptomatic

May have flu-like symptoms and lymphadenopathy

46
Q

What are the factors influencing transmission to the foetus or neonate with toxoplasma gondii?

A

Primary infection during pregnancy dangerous

Highest risk of foetal abnormalities if infected in 1st trimester

47
Q

What are the outcomes of a toxoplasma gondii infection?

A 
70-90% asymptomatic at birth
Can get
- Rash
- Lymphadenopathy
- Chorioretinitis
- Hydrocephalus
- Mental retardation
48
Q

How is a toxoplasma gondii infection diagnosed?

A

Screening usually not recommended

Can check IgG

49
Q

What are the factors influencing transmission to the foetus or neonate with hepatitis B virus (HBV)?

A

Stage of infection important

  • 90% transmission if eAg positive or PCR positive
  • 5% transmission if markers for active infection negative
50
Q

What is the route of transmission in HBV?

A

Transmission at birth

51
Q

How is a HBV infection diagnosed?

A

Routine antenatal screening for all

52
Q

What is the treatment and prevention for a HBV infection?

A

Vaccination

HBV IV Ig for neonate within 12 hours of delivery

53
Q

What are the factors influencing transmission to the foetus or neonate with hepatitis C virus (HCV)?

A

Risk of infection depends on mother’s viral load

54
Q

What is the route of transmission in HCV?

A

Transmission at birth

55
Q

What is the treatment and prevention for a HCV infection?

A

Caesarian section reduces risk of transmission by 30%

Duration of exposure to ruptured membranes during birth affects risk

56
Q

What is the epidemiology of group B Streptococcus?

A

In bowel/vagina of 20-30% of women

40-70% babies born to colonised mothers will also be colonised

57
Q

What are the factors influencing transmission to the foetus or neonate with group B Streptococcus?

A 
Preterm delivery
Prolonged exposure to ruptured membranes
Intrapartum fever
Chorioamnionitis
Having previous baby with infection
58
Q

What is the route of transmission in group B Streptococcus?

A

Ascending infection

Colonisation at delivery

59
Q

What are the outcomes of a group B Streptococcus infection?

A

1% of colonised babies will have invasive disease
- Sepsis
- Pneumonia
- Meningitis
Sepsis and pneumonia more common with early post-natal infection
Colonisation later after birth more likely to cause meningitis
Increases risk of preterm delivery

60
Q

How is a group B Streptococcus infection diagnosed?

A

Self-collected vaginal and anal swabs

61
Q

What is the treatment and prevention for a group B Streptococcus infection?

A

Penicillin + gentamicin

Can give intrapartum chemoprophylaxis if mother screens positive for carriage

MD1 Reproduction (11 decks)

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