Infection in Pregnancy Flashcards
Describe CMV infection in pregnancy (pathology, effects, diagnosis, management)
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
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
Describe HSV infection in pregnancy (pathology, effects, diagnosis, management)
About 5 percent 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
Describe VZV infection in pregnancy (pathology, effects, diagnosis, management)
Rare, 0.03 percent 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
Describe rubella infection in pregnancy (pathology, effects, diagnosis, management)
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
Describe parvovirus infection in pregnancy (pathology, effects, diagnosis, management)
0.25 percent of women affected by B19 virus.
Effects:
- Foetal anaemia
- Thrombocytopaenia
- 10 percent will die, pre 20 weeks gestation
Diagnosis:
- IgM
- Serology
- US: anaemia
Management:
- Regular US
- In utero transfusion if severe anaemia
Describe Hep B infection in pregnancy (pathology, effects, diagnosis, management)
1 percent of women in the West
Effects:
- Transmission occurs at delivery
- 90 percent of infected children will become chronic carriers
Management:
- Screened
- Neonatal immunisation
- Antiviral agents from 32 weeks
Describe Hep C infection in pregnancy (pathology, effects, diagnosis, management)
0.5 percent of women are infected
Effects:
- Vertical transmission occurs in 3-5 percent of cases
Management:
- Elective CS/ stopping breastfeeding or IVIG do not reduce transmission
Describe HIV infection in pregnancy (pathology, effects, diagnosis, management)
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 percent) or by 5 years (40 percent)
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
Describe influenza infection in pregnancy (pathology, effects, diagnosis, management)
Maternal effects:
- Can be more morbid in pregnancy
Neonatal effects:
- No known adverse effects
Management:
- Administer Tamiflu
- Flu vaccine
Describe ZIKA infection in pregnancy (pathology, effects, diagnosis, management)
Maternal symptoms:
- Mild, rash, fever, GBS
Neonatal effects:
- Severe CNA 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
Describe Group A strep infection in pregnancy (pathology, effects, diagnosis, management)
Usually the pathogen responsible for puerperal sepsis, carried by 5-30 percent of people.
Symptoms:
- Sore throat
- Chorioamnionitis, abdominal pain, diarrhoea, sepsis
Neonatal effects:
- Still birth
Management:
- High dose antibiotics
- ITU
Describe Group B strep infection in pregnancy (pathology, effects, diagnosis, management)
Carried without symptoms by a quarter of women
Neonatal effects
- Infected during labour
- Neonatal sepsis
- Mortality of 6 percent (18 percent in preterm)
Management:
- High dose IV penicillin throughout labour
- Screening not offered but very effective (tested at 35-37 weeks, then given antibiotics)
Describe syphilis infection in pregnancy (pathology, effects, diagnosis, management)
Rare in pregnant women
Neonatal effects:
- Miscarriage
- Stillbirth
- Congenital disease
Management:
- Prompt benzylpenicillin
- Screened: VDRL
Describe toxoplasmosis infection in pregnancy (pathology, effects, diagnosis, management)
0.2 percent 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
Describe TB infection in pregnancy (pathology, effects, diagnosis, management)
Tuberculin testing is safe, BCG is live and contraindicated.
Diagnosis:
- IUGR
- Prematurity
Management:
- TB medications safe (not streptomycin)
- Congenital TB is very rare
