Fetal Abnormalities II: Teratogens and Infections Flashcards
What are the adverse effects of UTI during pregnancy? Why is it especially important to screen for them?
- Can cause premature birth/low birth weight
- Can often be asymptomatic, so always screen for bacteiuria/nitrates etc
What is chorioamnionitis? How does it commonly occur in pregnancy?
- Infection involving amniotic fluid and placenta
- Mostly causes by ascending cervicovaginal organisms
Chorioamnionitis clinical signs? How do we treat?
- Signs are non-specific of infection; purulent amniotic fluid, fever, signs of sepsis (hypo/tachy)
- This is a medical emergency; treat w/ broad spectrum antibiotics
Heuristic for pregnancy infection timing vs severity
Earlier infection, more severe consequences
Name three routes of infection for intrauterine/early life infections
- Ascending cervicovaginal organisms
- Birth canal
- Breast milk
A mother has an infection. Will this always affect the fetus? What is the outcome dependent on?
- It won’t necessarily affect the fetus
- Just because mum is affected, doesn’t mean the baby will get the infection
- And even if the baby gets the infection, this doesn’t necessarily mean they will have symptoms
What is the acronym/expansion of problematic infections that can occur at birth?
SCORTCH
S: Syphilis
C: Cytomegalovirus
O: Other (incl Zika virus)
R: Rubella
T: Toxoplasmosis
C: Chickenpox
H: HSV, Hep B
How do we test if infection has spread from mother to child?
- PCR/Culture of amniotic fluid
- Fetal blood specimen (uncommon)
- Imaging
What is biological avidity? How does it relate to infection timeframes?
- Avid = avidity = an antigens keenness to bond w/ antibody
- High avidity result indicates infection longer ago
- In early validation, plasma cells ship rougher, less refined Ig. Only later do they start to refine product and become more durable
Typical symptoms of CMV
- Typically, none
- In immunocompromised, can have fever, malaise, sore throat, splenomegaly
Outcomes of CMV in pregnancy on fetus
- Vision/hearing loss
- Mental retardation
- Microcephaly
- Seizures/motor disabilities
What is the most typical presentation of CMV in newborn babies? How do we diagnose it?
- Typically, no symptoms
- We diagnose with urine or saliva PCR
What are the stages of syphillis? During what stages is transmission from mother to child most likely?
- Syphilis stages are early (chancre), secondary (rash, neurosyphilis, patches in mouth), intermediate (asymptomatic), and late (neuroinflammation, cardiac/end organ damage)
- Transmisison is most vulnerable in primary, and least so in late
Effects of syphilis on fetus/newbron/>2yo
Fetus: stillbirth/preterm birth
Newborn: hepatosplenomegaly, meningitis, rash
>2yo: Developmental delay, sensorineural hearing loss
What is the most dangerous time for HSV infection during pregnancy?
Late pregnancy, before the mother has had time to produce and transfer antibodies.
What everyday infection is screened for in early pregnancy (asymptomatic here)? When is prophylaxis indicated?
- Screen for UTI
- If people have recurrent UTIs, we use prophylactic antibiotics also
Is congenital CMV transmission more likely in primary or secondary infection?
More likely in primary (meaning first time the mother has been infected)
