Infection in pregnancy Flashcards
What are TORCH infections?
Infectious disease that can pass to baby:
- toxoplasmosis
- other: syphilis, parvovirus, hepatitis, varicella, HIV)
- rubella
- cytomegalovirus
- herpes simplex
What organism causes toxoplasmosis and how does it spread?
toxoplasma gondii parasite, spreads by contamination by cat faeces
What is a risk factor for toxoplasmosis passing to baby?
vertical transmission risk increases with gestational age
Symptoms of congenital toxoplasmosis = 4Cs?
Intracranial calcification
Hydrocephalus
Chorioretinitis
Convulsions
1st line treatment for toxoplasmosis for mum?
Spiramycin for 3 weeks to prevent getting to baby
treatment for foetus infected with toxoplasmosis?
Treat with spiramycin for up to 1 year after their delivery
Prevention of toxoplasmosis?
Avoid eating raw meat
Avoid handling cats and cat litter
What is the protocol is a pregnant women has syphilis?
Refer to GUM clinic for contact tracing
1st line treatment for syphilis in pregnancy?
IM benzylpenicillin for 14 days
Symptoms of a baby born with congenital syphilis?
Rash on soles of feet and hands
Bloody rhinitis
What is the risk period for vertical transmission for parvovirus b19?
<20 weeks - it can cross placentaW
What does parvovirus do to the feotus?
<20 weeks : crosses placenta and destroys RBCs causing hydrops foetalis
Seen as foetal oedema on US
how is hydrops foetalis seen?
Oedema on US
What happens next if a pregnant comes into contact with a person infected with parvovirus b19?
check IgM antibodies to see if they have been infected
-> foetal surveillance required if mother is infected
What is part of regular surveillance if a foetus has been infected with parvovirus b19?
fornightly foetal US and doppler assessment (of middle cerebral artery) to allow for detection of anaemia
-> expectant management
-> in utero blood transfusion if infection in the first 20 weeks
How to management hepatitis B during the pregnancy?
Offer tenofovir if high HBV viral load
How to manage hepatitis B postnatally?
if mum is surface antigen positive:
- Offer hepatitis B immunoglobulins (IgG) to newborn within 12 hours
- hepatitis B vaccine to newborn at birth, 1 month, 6 months
Is breastfeeding encorouged when mum has hepatitis b?
Yes, no risk of transmission
Why is chickenpox vaccine not given during pregnancy
Chickenpox vaccine is contraindicated
If a pregnant women is exposed to varicella and unsure of their history of chicken pox what is the first step?
Check IgG
How to manage a pregnant women who is non-immune and has been exposed to chicken pox?
<20 weeks or >20 weeks with no rash : prophylactic VZ Ig 7-14 days after exposure
How to manage a pregnant women >20 weeks with a chickenpox infection?
if they present within 24 hours of rash onset :
oral acyclovir for 7 days
if infection within last 4 weeks pregnancy, elective delivery should be delayed 7 days after the onset of rash
What examination should be done postnatally if a women got chickenpox during pregnancy?
Opthahalmic examination of neonate
What is foetal varicella syndrome?
Cutaneous scarring, limb hypoplasia and CNS defects
