Infection

Question 1

In what situation should you offer Varicella zoster immunoglobulin to a pregnant woman?

Answer 1

If a pregnant woman is not immune to VZV and has had significant exposure then give as soon as possible
Effective up to 10/7 post exposure

Question 2

How should non immune pregnant patients who have been exposed to chicken pox be managed

Answer 2

Treated as infectious from 8-28 days after exposure if received VZIG or from 8-21 days if they did not receive VZIG

Question 3

what are the maternal risks of varicella in pregnancy?

Answer 3

pneumonia
hepatitis
encephalitis

Question 4

How should non immune women with chicken pox rash be treated in pregnancy?

Answer 4

if present within 24hrs of rash onset + >20 weeks then should have 1/52 of oral aciclovir
Should be isolated from other pregnant women until rash has crusted over or 5/7 has passed

Question 5

how should women with chicken pox be delivered?

Answer 5

ideally a minimum of 7 days between onset of rash and delivery to allow transfer of protective antibodies from mother to fetus
If C/S then epidural placement in site free of lesions recommended

Question 6

what are the fetal risks of maternal infection with chicken pox during pregnancy?

Answer 6

fetal varicella syndrome

Question 7

What are the features of FVS (fetal varicella syndrome)

Answer 7

HENS:
Hypoplasia of limbs
Eye defects
Neurological development
Scarring of skin in dermatomal distribution

Question 8

Can varicella infection be diagnosed prenatally?

Answer 8

MFM referral
Amniocentesis has a strong negative predictive value but a poor positive predictive value
USS can possbly pick up FVS (time lag of at least 5/52 between infection and USS)

Question 9

How is Toxoplasmosis infection contracted?

Answer 9

Eating raw or insufficiently cooked meat
Not washing hands thoroughly after touching raw meat or gardening
Contact with cat faeces
Contact with contaminated raw veges or fruit