Infection in Pregnancy Flashcards

1
Q

Describe CMV infection in pregnancy (pathology, effects, diagnosis, management)

A

About 1 percent of women will develop CMV in pregnancy

Effects:

  • 10 percent are symptomatic at birth
  • IUGR, pneumonia, thrombocytopaenia
  • Neurological sequelae (deafness, blindness, microcephaly)
  • Liver, lung and heart disease
  • Blue spots

Diagnosis:

  • US (intracranial/hepatic calcification) in a fifth
  • CMV IgM
  • Amniocentesis >6 weeks after infection
  • CMV detection within 3 weeks of life

Management:

  • Close US surveillance
  • TOP may be offered
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2
Q

Describe HSV infection in pregnancy (pathology, effects, diagnosis, management)

A

About 5% of women have HSV

Effects:

  • Severe neonatal infection
  • High mortality
  • In utero: ophthalmic, neurologic and cutaneous malformations
  • Intra-partum: disseminated disease, encephalitis

Diagnosis:
- Clinical

Management:

  • Refer to GUM
  • Elective CS if <6 weeks from primary infection
  • Elective CS if visible lesion
  • Aciclovir for neonate if exposed
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3
Q

Describe VZV infection in pregnancy (pathology, effects, diagnosis, management)

A

Rare, 0.03% of pregnancies

Effects:

  • Early: teratogenicity
  • Severe neonatal infection if <4 weeks before delivery
  • Especially if <5 days pre-partum or <2 days post partum
  • Highest risk of infection if late VZV infection

Management:

  • IVIG to prevent, within 10 days of exposure
  • Aciclovir to treat 7-14 days after exposure
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4
Q

Describe rubella infection in pregnancy (pathology, effects, diagnosis, management)

A

Less than 10 children are born every year with a rubella infection

Effects:

  • Early (Congenital Rubella Syndrome if <10 weeks): multiple foetal abnormalities, deafness, cardiac disease, mental retardation, eye disease
  • After 16 weeks, low risk of disease

Management:

  • Screened
  • If <16 weeks, offer TOP
  • Offer vaccine after pregnancy
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5
Q

Describe parvovirus infection in pregnancy (pathology, effects, diagnosis, management)

A

0.25% of women affected by B19 virus.

Effects:

  • Foetal anaemia
  • Thrombocytopaenia
  • 10% will die, pre 20 weeks gestation

Diagnosis:

  • IgM
  • Serology
  • US: anaemia

Management:

  • Regular US
  • In utero transfusion if severe anaemia
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6
Q

Describe Hep B infection in pregnancy (pathology, effects, diagnosis, management)

A

1% of women in the West

Effects:

  • Transmission occurs at delivery
  • 90% of infected children will become chronic carriers

Management:

  • Screened
  • Neonatal immunisation
  • Antiviral agents from 32 weeks
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7
Q

Describe Hep C infection in pregnancy (pathology, effects, diagnosis, management)

A

0.5% of women are infected

Effects:
- Vertical transmission occurs in 3-5% of cases

Management:
- Elective CS/ stopping breastfeeding or IVIG do not reduce transmission

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8
Q

Describe HIV infection in pregnancy (pathology, effects, diagnosis, management)

A

1000 pregnancies a year

Effects (maternal):

  • No hastening of progression to AIDS
  • Higher risk of pre-eclampsia
  • Higher risk of GDM

Neonatal effects:

  • Still birth, pre-eclampsia, IUGR, prematurity
  • Vertical transmission after 36 weeks, intrapartum or breastfeeding
  • HIV positive neonates will develop AIDS within 1 year (25%) or by 5 years (40%)

Management:

  • Screened
  • Regular CD4 and viral load tests
  • HAART from 28 weeks if not already started
  • HAART for neonate for 6 weeks
  • If detectable viral load, elective CS
  • Do not breastfeed
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9
Q

Describe influenza infection in pregnancy (pathology, effects, diagnosis, management)

A

Maternal effects:
- Can be more morbid in pregnancy

Neonatal effects:

  • No known adverse effects
  • Increased risk of schizophrenia

Management:

  • Administer Tamiflu
  • Flu vaccine
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10
Q

Describe ZIKA infection in pregnancy (pathology, effects, diagnosis, management)

A

Maternal symptoms:
- Mild, rash, fever, GBS

Neonatal effects:

  • Severe CNS deformities
  • Congenital ZIKA Syndrome: microcephaly, decreased brain tissue, retinopathy, deafness, hypertonia

Diagnosis:
- PCR

Management:

  • Do not travel to outbreak areas
  • Foetal assessment
  • Avoid conception for 2-4 months post travel
  • TOP offered to affected foetuses
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11
Q

Describe Group A strep infection in pregnancy (pathology, effects, diagnosis, management)

A

Usually the pathogen responsible for puerperal sepsis, carried by 5-30% of people.

Symptoms:

  • Sore throat
  • Chorioamnionitis, abdominal pain, diarrhoea, sepsis

Neonatal effects:
- Still birth

Management:

  • High dose antibiotics
  • ITU
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12
Q

Describe Group B strep infection in pregnancy (pathology, effects, diagnosis, management)

A

Carried without symptoms by a quarter of women

Neonatal effects

  • Infected during labour
  • Neonatal sepsis
  • Mortality of 6% (18% in preterm)

Management:

  • High dose IV penicillin throughout labour
  • Screening not offered but very effective (tested at 35-37 weeks, then given antibiotics)
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13
Q

Describe syphilis infection in pregnancy (pathology, effects, diagnosis, management)

A

Rare in pregnant women

Neonatal effects:

  • Miscarriage
  • Stillbirth
  • Congenital disease

Management:

  • Prompt benzylpenicillin
  • Screened: VDRL
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14
Q

Describe toxoplasmosis infection in pregnancy (pathology, effects, diagnosis, management)

A

0.2% of women in the UK, more common in mainland Europe (cheeses)

Neonatal effects:

  • Earlier infection = more severe
  • Mental handicap, convulsions, spasticities, visual impairment

Diagnosis:

  • US: hydrocephalus
  • Maternal IgM
  • Amniocentesis

Management:

  • Health education
  • Spiramycin
  • Pyrimethamine and sulfadiazine
  • TOP offered
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15
Q

Describe TB infection in pregnancy (pathology, effects, diagnosis, management)

A

Tuberculin testing is safe, BCG is live and contraindicated.

Diagnosis:

  • IUGR
  • Prematurity

Management:

  • TB medications safe (not streptomycin)
  • Congenital TB is very rare
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16
Q

Describe malaria infection in pregnancy (pathology, effects, diagnosis, management)

A

Maternal complications
- Severe anaemia

Neonatal effects:

  • IUGR
  • Stillbirth

Management:
- Treatment is safe

17
Q

Describe listeriosis infection in pregnancy (pathology, effects, diagnosis, management)

A

If bacteraemia occurs, potentially fatal foetal infection may follow.

Diagnosis:
- Blood cultures

18
Q

Describe chlamydia and gonorrhoea infection in pregnancy (pathology, effects, diagnosis, management)

A

Chlamydia: 5% of women
Gonorrhoea: 0.1% of women

Neonatal affects:

  • Preterm
  • Neonatal conjunctivitis

Management:

  • Do not use tetracyclines (tooth discolouration)
  • Use azithromycin/erythromycin (chlamydia)
  • Use cephalosporins (gonorrhoea)
19
Q

Describe bacterial vaginosis infection in pregnancy (pathology, effects, diagnosis, management)

A

May cause preterm labour or late miscarriage.

Management:

  • Screen and treat
  • Use clindamycin (improves outcome pre 20 weeks)
20
Q

Describe measles infection in pregnancy (pathology, effects, diagnosis, management)

A

Very rare in mothers

Effects:

  • Foetal loss
  • Preterm delivery
  • Increased maternal morbidity
  • No congenital abnormalities

Management:
- Measles IVIG is useless at preventing IUD or preterm