Infcetions in Pregnancy Flashcards
How is chicken pox spread?
Respiratory droplets
What are the symptoms of chicken pox?
Fever
Malaise
Itchy vesicular rash
When is chicken pox infective?
48hrs before rash develops to once the chicken pox lesions have crusted over (usually 5-7 days after the rash starts)
In children, what is the treatment for chickenpox?
Nothing as usually harmless and self-limiting
In adults, chickenpox is associated with a greater morbidity and can increase risks of the development of what?
Hepatitis
Pneumonitis
Encephalitis
->risk especially pronounced in immunocompromised and in pregnancy so important to ask women about chicken pox history in their appointment
If a women is pregnant and has no history of chickenpox, what advice should be given?
Avoid exposure to anyone with chickenpox or shingles during pregnancy and seek urgent medical help if they do
What syndrome may occur in the foetus if there was maternal primary chickenpox?
Foetal varicella syndrome
What can foetal varicella syndrome cause to happen?
Skin scarring
Congenital eye abnormalities
Hypoplasia of ipsilateral limbs
Neurological abnormalities
What happens if chickenpox infection occurs in the last four weeks of pregnancy?
Risk of infection in the newborn
If a pregnant women has had significant exposure to chickenpox but is unsure if she is immune, what can be done?
Take serum IgG:
If immune (IgG positive), reassure
If non-immune (IgG negative) , offer Varicella Zoster immunoglobulin asap
What shoulder be done if a pregnant person develops mild chickenpox infection and presents within 24hrs of onset of rash?
Advise to avoid other potentially susceptible individuals e.g. other pregnant people or neonates
Oral aciclovir
Advise regarding symptomatic treatment and hygiene to prevent secondary bacterial infection
What shoulder be done if a pregnant person develops mild chickenpox infection and presents after 24hrs of onset of rash?
Advise regarding symptomatic treatment and hygiene to prevent secondary bacterial infection
What shoulder be done if a pregnant person develops severe chickenpox infection?
IV aciclovir
Admit to hospital
What causes shingles?
Reactivation of the chickenpox virus which has remained dormant in the sensory nerve root ganglion
Can you catch chickenpox from someone with shingles?
Yes, but it’s rare
What is parvovirus B19?
Common and mild febrile illness, commonly seen in childhood.
50% approx of women will be immune
How is parvovirus B19 spread?
Respiratory secretions
How does parvovirus B19 present?
Fever
Erythema of cheeks
Rash
->can be known as slapped cheek disease
Most adults are completely asymptomatic
What is the treatment for parvovirus B19?
No treatment or vaccine available as usually harmless
What can parvovirus B19 cause in immunocompromised patients?
Aplastic anaemia
Haemolysis
What can parvovirus B19 infection in pregnancy lead to?
Foetal anaemia leading to cardiac failure, hydrops fatalis and foetal death
->rare but can cause preeclamptic condition in mother with significant oedema
What is the most critical exposure period of parvovirus B19 in pregnant people?
12-20wks
Foetal infection occurs 5wks after maternal infection
What should be done if a pregnant person reports exposure to parvovirus B19?
Blood samples for immunoglobulin testing
What happens if immunoglobulin testing for parvovirus B19 comes back positive?
Weekly scans are offered to monitor foetal complications
Which microorganism causes toxoplasmosis?
Toxoplasma Gondi
How is toxoplasmosis infection usually transmitted?
Usually from infected cat faeces or consumption of undercooked meats
Symptoms of toxoplasmosis?
Usually asymptomatic in adults
Mild, flu-like symptoms e.g. fever, sore throat, arthralgia
What are some of the potential serious complications which can occur as a result of toxoplasmosis?
Chorioretinitis
Encephalitis
Myocarditis
Pneumonitis
How long after ingestion of the parasite does parasitaemia of toxoplasmosis occur?
Within 3wks of ingestion
What measures should pregnant people take to reduce risks of toxoplasmosis?
Avoid cleaning cat litter trays
Avoid consumption of undercooked meats
Congenital infection of toxoplasmosis is rare but can have serious foetal complications if it does occur. What are some of these?
Hydrocephalus
Intracranial calcifications
Microcephaly
Chorioretinitis
Ascites
Hepatosplenomegaly
Can cause miscarriage and intrauterine death
How can toxoplasmosis of the foetus be diagnosed?
PCR of amniotic fluid
A 24wk pregnant woman phones you, her GP, as she has just found out her nephew has chicken pox. She had had significant contact with him on Saturday and the rash appeared on Sunday evening. She is unsure is she has been previously infected. What is the most appropriate action?
A. Give Varicella Zoster immunoglobulin
B. Give IV aciclovir
C. Give oral aciclovir
D. Take serum IgG to check her immunity status
E. No action, as you are not infectious before developing the rash.
D- take serum IgG to check her immunity status
->if found to have no immunity, give Varicella Zoster immunoglobulin
Does HIV increase risks of congenital abnormalities?
No
What can HIV increase risks of in pregnancy?
Pre-eclampsia
Miscarriage
Preterm delivery
Low birth weight
What can be offered to pregnant people with HIV?
Serial four weekly foetal growth scans
What should all babies born to HIV positive mothers be referred to?
Neonatology for HIV testing
How does breastfeeding increases risks of HIV in the foetus?
Can increase risks of vertical transmission
Which type of meds are pregnant people with HIV put on?
Anti-retrovirals
Throughout pregnancy, what do people on anti-retrovirals be monitored for?
LFTs
CD4 count
HIV viral load
->if HIV viral load is low, vaginal birth is supported, otherwise C-section is advised
How can hepB be transmitted?
Many cases spread by vertical transmission
Bloods or other bodily fluids
What can happen to babies born to mothers with acute HepB infection?
Majority will contract HepB
Increased risks of cirrhosis and hepatocellular cancer
What should women with chronic hepatitis B with a high viral load be offered in their third trimester?
Tenofovir monotherapy to reduce risks of HepB transmission to baby
What can be given to pregnant women who are at high risks of HepB?
HepB vaccine as it is inactivated so safe in pregnancy
->just so you know, risks of HepB include IVDU, partner with HIV or HepB
Is vaginal birth safe if the mother has HepB?
Yes
What should be offered to babies who’s mother has HepB?
Hepatitis B immunoglobulin
What can HepC lead to?
Severe hepatitis
Chronic liver disease
Increased risk of liver cancer
What are most cases of HepC associated with?
Prior injecting drug usage
What can decline in pregnancy in those with HeoC?
Liver function
How common is vertical transmission in pregnant people with HIV and their child?
Common, 1 in 20, higher in coinfected with HIV
How is HepC treated in pregnancy?
Should not be treated as the drugs are teratogenic and are contraindicated
Can vaginal birth occur if mother has HepC?
Yes
Which microorganism causes syphilis?
Treponema palladium
How is syphilis transmitted?
Direct contact with skin lesion
How can syphilis be treated?
With a course of antibiotics
If untreated, what can chronic syphilis cause?
Neurological, cardiac, skeletal and skin abnormalities for adults and babies affected in utero
What does syphilis in pregnancy increase risks of?
Miscarriage
Stillbirth
Hydrops fetalis
Growth restriction
Congenital infection
How can syphilis be transmitted to babies?
Via placenta of infected mother
Exposure to infected lesion at time of birth
What is primary syphilis characterized by?
Painless local ulcer known as a canker
What treatment is given if a pregnant person is found to have syphilis infection?
Prompt treatment of intramuscular penicillin
Rarely seen in the UK, late congenital syphilis is a subset of congenital syphilis.
It presents with Hutchinson’s triad. What makes up this?
Deafness
Interstitial keratitis
Hutchinson’s teeth- widely spaced, peg like
