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HD2 > Effects of Infections in Early Pregnacy > Flashcards

Effects of Infections in Early Pregnacy Flashcards

1
Q

What are the 2 ways to think of pregnancy in terms of infections?

A
  • relative immuno-suppression

- physiological changes in mother

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2
Q

Which infections are harmful to the mother?

A

Influenza

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3
Q

Which infections are harmful to the fetus?

A 
Toxoplasmosis
HSV
Syphilis
Parovirus B19
CMV
Rubella
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4
Q

Which infections are harmful to the mother and foetus?

A

Hepatitis (A, E, B, C)
VZV
HIV

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5
Q

How should you remember the main infections?

A 
TORCHES
Toxoplasmosis
Other (influenza, parovirus B19)
Rubella
Cytomegalovirus (CMV)
Herpes Simplex Virus, HIV, Hepatitis
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6
Q

How do you diagnose infection in pregnancy?

A
  • look for pathogen itself (PCR to detect viral DNA or RNA, very sensitive)
  • look for immune response to it (early IgM rise followed by IgG rise)
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7
Q

What is the footprint of infection?

A

IgG signifies part infection and is protective in many cases

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8
Q

What is cytomegalovirus?

A

CMV

  • very common (50% adults have past exposure)
  • primary infection subclinical
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9
Q

How is CMV transmitted?

A

Saliva
Blood/blood products
Sexual intercourse
Organ transplantation

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10
Q

When can CMV occur?

A

Any time during pregnancy

- primary infection more likely to cause congenital CM and will be most likely in 1st trimester of pregnancy

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11
Q

How to diagnose CMV?

A

Maternal serology - CM IgG and IgM

Neonatal urine/saliva - CMV DNA PCR

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12
Q

What are the wide range symptoms of CMV?

A

Severe - intra uterine growth retardation (non specific)
Hepatosplenomegaly
Microcephaly
Sensorineural deafness

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13
Q

What is the significance of deafness and CMV?

A
  • commonest congenital cause of sensorineural hearing loss
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14
Q

What is Varicella Zoster Virus?

A

Chicken Pox

  • Most adults immune
  • Lower % in tropical climates
  • extremely infectious via droplet/airborne
  • 1 person infects 10-12 susceptible individuals
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15
Q

What does the risk association of Varicella Zoster Virus depend on?

A
  • mother: worse the later

- foetus: more complicated

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16
Q

How is Varicella Zoster virus diagnosed?

A

Clinical syndrome
Swab of vesicle fluid
Maternal serology

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17
Q

How is Varicella Zoster virus prevented?

A

if known mother is IgG negative:

  • VZ immunoglobulin (post exposure)
  • Vaccination (pre-exposure)
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18
Q

How is Varicella Zoster virus treated?

A
  • valaciclovir

- safe during pregnancy

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19
Q

What is shingles?

A

Reactivation of chicken pox in a nerve root

- doesn’t cross midline

20
Q

When is there high risk of congenital varicella syndrome?

A
  • higher in second trimester
21
Q

What are the symptoms of congenital varicella syndrome?

A
  • skin lesions (limb hypoplasia)
  • CNS (microcephaly, hydrocephaly, neurodevelopmental delay)
  • cataracts/eye problems
  • GI, genitourinary and cardiac abnormalities
22
Q

What is the risk of neonatal varicella?

A
  • much higher than congenital

- during birth/just after deliver

23
Q

What is herpes simplex virus?

A
  • extremely common
  • HSV2 related to sexual activity
  • associated with wide spectrum of disease (genital/oral ulceration, CNS infection)
24
Q

How does neonatal HSV infection arise?

A
  • while passing through birth canal
  • if adults kiss child
  • if not treated = infection
25
Q

How is neonatal HSV infection diagnosed?

A
  • clinical
  • HSV DNA PCR neonate blood
  • vesicle swab
  • maternal vesicle swab
26
Q

How is neonatal HSV managed?

A

Aciclovir treatment

- reduces mortality

27
Q

What is rubella?

A
  • uncommon
  • most of population have antibodies to rubella
  • self limiting outside of pregnancy = rash, lymphadenopathy
  • in pregnancy dangerous
  • no treatment
28
Q

How is rubella diagnosed?

A
  • serology

- oral fluid PCR

29
Q

What are the risks of congenital rubella?

A 
- greater earlier there is contraction
RISK OF
- microcephaly
- heart disease
- petechiae and purpura
30
Q

What is Parovirus B19?

A
  • slapped cheek disease
  • erythrocytes are cellular target
  • most adults have past exposure
31
Q

How is parovirus diagnosed?

A
  • maternal serology/PCR

- fetal ultrasound

32
Q

At 0-20 weeks what is the risk of fetal loss?

A

9%

33
Q

At 9-20 weeks what is the risk to the fetus?

A

3% risk of hydrops fetalis (heart failure) as has to work harder to produce Hb

34
Q

At >20 weeks what is the risk to the fetus?

A

Negligible

35
Q

What is toxoplasmosis?

A
  • due to parasite toxoplasma gondii
  • natural host is cat
  • humans intermediate host through ingestion of oocyst (contact with cat feaces or eating infected meat)
36
Q

What is the risk of congenital toxoplasmosis?

A
  • lowest if maternal infection occurs in 1st trimester

- risk to foetus greatest during 1st trimester

37
Q

What are the clinical features of congenital toxoplasmosis?

A 
IUGR
Hydrocephalus
Cerebral calcification
Microcephaly
Hepatosplenomegaly
38
Q

How is congenital toxoplasmosis diagnosed?

A

Maternal serology
Amniotic fluid
PCR

39
Q

How is congenital toxoplasmosis prevented?

A
  • no vaccine

- avoidance behaviour only (no gardening, don’t handle cat little, avoid uncooked meats)

40
Q

What is syphilis?

A
  • STI
  • due to spirochete Treponema pallidum
  • common
  • highest risk during 1st trimester or peripartum
  • associated with miscarriage/still birth/prematurity
41
Q

How is syphilis diagnosed?

A

Clinical syndrome and serology

42
Q

How is syphilis treated?

A

Penicillin

43
Q

What are the clinical features of early congenital syphilis?

A

early 0 to 2 years:

  • rash
  • rhinorrhoea
  • osteochondritis
  • perioral fissures
  • lymphadenopathy
44
Q

What are the clinical features of late congenital syphilis?

A

Late >2 years

  • Hutchinson’s teeth
  • Clutton’s joints
  • high arched palate
  • deafness
  • saddle nose deformity
  • frontal bossing
45
Q

What is looked for during antenatal screening?

A

Week 12
HBV, HIV, Syphilis, CMV/toxoplasmosa, VZV
- regular US to monitor foetal development

46
Q

When can termination of pregnancy be offered?

A

Before 24 weeks

HD2 (22 decks)

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