Effects of infections in pregnancy Flashcards
Infections harmful to mother
Influenza
Infections harmful to foetus
Toxoplasmosis HSV Syphilis Parvovirus B19 CMV Rubella
Infections harmful to both mother and foetus
Hep A/E/B/C
VZV
HIV
Acronym for harmful to foetus
ToRCHeS Toxoplasmosis Other Rubella Cytomegalovirus (CMV) Herpes simplex virus (HIV , hep) Syphilis
Diagnosing infection in pregnancy
Serology
IgG signifies past infection
PCR- detection of viral or bacterial DNA or RNA
Cytomegalovirus (CMV)
Very common- 50% adults past exposure
Transmission can be via saliva, blood, sex, organ transplant or mother- anytime during pregnancy
Congenital CMV Cause
Primary infection more likely to cause it Most likely in 1st trimester Intrauterine- 1st, 2nd or 3rd trimester Intra-partum Post partum e.g. breast milk
Congenital CMV facts
7 per 1000 births
Congenital CMV diagnosis
Maternal serology- CMV IgG and IgM
Neonatal urine/saliva for CMV DNA PCR
Congenital CMV symptoms
Intra uterine growth retardation
Hepatosplenomegaly
Microcephaly
Sensorineural deafness
CMV + deafness
Commonest congenital cause of sensorineural hearing loss
Varicella Zoster Virus (VZV)
80-90% adults immune
V infectious- droplet/airborne
Mother- worse the later
Foetus- complicated
VZV CNS complications
VSV encephalitis/meningitis
Least contagious to most contagious R0
Hep C –> ebola –> HIV –> SARS –> Mumps –> measles
VZV diagnosis
Swab of vesicle fluid- viral PCR
Maternal serology
VZV Management
Varicella Zoster ImmunoGlobulin
Vaccination
TREATMENT- (val)acyclovir (safe during pregnancy)
VZV treatment
(val)acyclovir
Safe during pregnancy
VZV in children
Chicken pox
VZV in adults
Shingles
Congenital Varicella syndrome
Higher risk in 2nd trimester
Skin lesions (73%)- leading to limb hypoplasia
CNS (62%)- microcephaly, hydrocephaly, neurodevelopmental delay
Cataracts/other eye problems
GI, genitourinary + cardiac abnormalities
Miscarriage
Neonatal varicella
Mother has VZV around time delivery
–> most severe if 5-2 days before delivery
V severe/fatal
Neonate should receive VZIG and acyclovir
Herpes Simplex Virus
V common
>90% adults HSV 1 antibodies by 40
Neonatal HSV Infection
Most acquire infection perinatally
Nearly all infants manifest disease
Mortality 65% untreated
Mortality 25% if treated with acyclovir
Rubella
German measles >95% population have antibodies Uncommon Outside of pregnancy- self-limiting, rash, lymphadenopathy, arthralgia Diagnosis- serology/oral fluid PCR
Congenital rubella
Risk to pregnancy dependant on gestational age- highest when below 11/40 weeks- 90% 20% risk if below 20 weeks Microcephaly Heart disease Petechiae and purpura Eye anomalies
MMR
Measles Mumps Rubella
Parvovirus B19
Cellular target is RBCs Diagnosis- maternal serology/PCR, foetal ultrasound 0-20 weeks- 9% risk of foetal loss 9-20 weeks- 3% risk of hydrops fetalis >20 weeks- negligible
Hydrops fetalis
Caused by heart failure secondary to poor RBC production or aplasia
Due to parvovirus B19
Treated by intrauterine cord blood transfusion
Toxoplasmosis
Infection due to Toxoplasma gondii
Natural host is cat
Humans are intermediate host through ingestion of oocyst- cat faeces or infected meat
Infection is lifelong
Toxoplasmosis MOA
Evades immune detection as intracellular pathogen
Cysts in different tissues- favours muscle, brain etc.
Reactivation causes problems in immunocompromised e.g. HIV
Toxoplasmosis risk acquirement odds ratio
Cat ownership- 0.7
Gardening- 2
Eating raw meat- 2.6
Eating cured meat- 2.9
Congenital toxoplasmosis
Risk to foetus highest during first trimester
IUGR, hydrocephalus, cerebral calcification, microcephaly, hepatosplenomegaly
Diagnosis- maternal serology/amniotic fluid PCR
Congenital toxoplasmosis
Spyramicin
Pyrimethamine/sulfadiazine/folinic acid
Congenital toxoplasmosis
No vaccine
Avoid gardening, don’t handle cat litter, avoid uncooked or cured meats
Syphilis
Spirochete Treponema pallidum
STI
Diagnosis- clinical syndrome + serology- treponemal and non treponemal specific
Highest risk of transmission during 2st trimester or peripartum
Can be associated with miscarriage/still birth/prematurity
Syphilis treatment
Penicillin
Congenital syphilis- Early, 0-2 years
Rash Rhinorrhoea Osteochondritis Perioral fissures Lymphadenopathy GN
Congenital syphilis- Late, >2 years
Hutchinson's teeth Clutton's joints High arched palate Deafness Saddle nose deformity Frontal bossing Desquamations Snuffles- syphilitic rhinitis, mucus which is full of T.pallidum
Hutchinson’s Triad
Due to congenital syphilis
Deafness
Hutchinson’s teeth
Interstitial keratitis- inflamed cornea
Antenatal infection screening
At 12/40 weeks HBV HIV Syphilis CMV/toxoplasma/VZV
Rubella no longer part of antenatal screening from April 2016
Sepsis
Leads to premature labour or IUGR
UTI
Higher risk of outflow obstruction
Gestational diabetes
Peripartum sepsis
Infection of retained products of conception, chorioamnionitis
Group B strep
Risk of neonatal sepsis
Termination >24 weeks
Only if substantial risk that child born would be severely handicapped
Ethics around antenatal screening
Allows early detection of high risk pregnancies
Serology can be difficult to interpret
Retrospective testing for TORCH infections may lead to
–> future diagnostic procedures e.g. amniocentesis
–> decisions regarding continuation of pregnancy
–> often no treatment available
