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Repro > Infection in pregnancy > Flashcards

Infection in pregnancy Flashcards

1
Q

Classified into screened infections [4] and non-screened infections [8]

A 
Screened infections
Congenital syphilis
Hep B
HIV
Asymptomatic bacteriuria
Non-screened infections
GBS
VZV
Measles
Parvovirus
Listeriosis
Chlamydia trachomatis
Clostridium perfringens
TORCH
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2
Q

Congenital syphilis
Presentation [6]
Investigation [3]

A

Presentation:

  • IUGR, Stillbirth 1/3 cases
  • Haemorrhagic rhinitis, Rash
  • Lymphadenopathy
  • Thrombocytopenia, anemia
  • Hepatosplenomegaly, jaundice, ascites
  • Meningitis, keratitis, sensorineural deafness

Ix:

  • nasal discharge exam for spirochetes
  • CSF (increased monocytes, protein)
  • positive serology
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3
Q

Congenital syphilis
Management
Mother [3]
Neonate [3]

A
  • Maternal syphilis: maternal IM BENZYLPENICILLIN for 10d

* Congenital syphilis: IM BENZYLPENICILLIN for 21d

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4
Q

Vertical Hepatitis B infection
Routes of transmission [2]
Complications [2]
Labour, delivery, breastfeeding implications

A

During labour or transplacental
Complications: chronic hep B infection, HCC
Labour and delivery: normal
Breastfeeding: safe

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5
Q

Vertical Hepatitis B infection

Management of neonate [4]

A
  • Dose of immunisation within 24h of birth (+ HBIG if no anti-Hbe or HBeAg +ve or BW<1500g)
  • 6 in 1 at 8, 12 and 16w
  • then another dose of the monovalent vaccine at 1y
  • serology at 12-15m (protected if HBsAg -ve and anti-HBs +ve)
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6
Q

HIV
Antenatal care [4]
Management of neonate born to positive mothers [2]

A

Antenatal care:

  • Screen for other infections
  • Give pneumococcal, HBV, flu vaccines
  • Start HAART
  • If on cotrimoxazole, give 5mg folic acid in first trimester

Mx:

  • Oral zidovudine if viral load <50
  • > 50 viral load, Triple ART therapy for 4-6w
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7
Q

HIV
Labour and delivery: PROM [4], NVD [1], LSCS [2]
Breastfeeding

A 
o	PROM: 
- deliver if >34w
- give steroids
- ERYTHROMYCIN 
- ensure on HAART if <34w
o	Vaginal delivery: 
- if viral load <50 copies/mL at 36w
o	Caesarean section: 
- ZIDOVUDINE infusion started 4h before

Breastfeeding is not safe - risk of transmission

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8
Q

Asymptomatic bacteriuria
Effect on fetus [3]
Management [3]

A

IUGR, fetal death, premature labour
Mx:
- Cefalexin
- Avoid trimethoprim in first trimester (folate antagonist)
- Avoid nitrofurantoin in third trimester (neonatal hemolytic anaemia)

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9
Q

GBS
Investigation [2]
Effect on fetus [3]
RF [4]

A
  • Urine culture or high vaginal swab
  • Severe/early onset infection - meningitis, pneumonia, sepsis

Risk factors for Group B Streptococcus (GBS) infection:

  • prematurity
  • prolonged rupture of the membranes
  • previous sibling GBS infection
  • maternal pyrexia e.g. secondary to chorioamnionitis
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10
Q 
Rubella
Maternal consequences
How is it spread?
Investigation
If exposed, management? [2]
If no autoantibodies, management?
A
  • Stillbirth, miscarriage
  • Spread by respiratory droplets
  • Ix: rubella autoabs (means previous infection or immunization)
  • Exposure: contact health protection, offer TOP if confirmed in first trimester
  • No autoantibodies: offer mum post-natal immunisation
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11
Q

If a mother tests negative for rubella autoantibodies what precautions should you advise?

A

Avoid anyone with rubella

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12
Q

Congenital rubella syndrome features [8]

A 
Deafness
Cardiac lesions
Purpura
Jaundice, hepatosplenomegaly
CP, LD, microcephaly
Cerebral calcification
Micropthalmia, salt and pepper chorioretinitis
Cataract
Growth disorder
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13
Q

Maternal HSV
Why is it only a problem if its a primary infection?
Investigation [3]
Management [2]

A

Only a problem if primary cos secondary infections have maternal antibodies

Ix: refer mum and partner to GUM for PCR of HSV (also check if primary) and other infections

Mx:
- Oral aciclovir until due date with elective LSCS at term

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14
Q

Neonatal HSV
Effects on neonate [7]
Mx [2]

A

Blindness, LD, epilepsy, jaundice, respiratory distress, DIC, death
Mx: high dose IV acyclovir

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15
Q

Maternal chickenpox
Ix
Mx [3]

A

Investigation: varicella ab
Mx:
- If not immune, give VZIG up to 10d after exposure
- Oral acyclovir
- Refer to fetal medicine for detailed scan at 16-20w

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16
Q

Fetal varicella syndrome [6]

A
  • complicates 1% of mothers infected between 3 and 28w due to reactivation in utero
  • skin scarring
  • micropthalmia
  • chorioretinitis, cataracts
  • microcephaly, cortical atrophy, LD
  • bladder and bowel sphincter abnormalities
17
Q

Neonatal varicella prognosis

A

Can cause death if mum pelops rash 2d- 5d before birth

18
Q

Measles
Maternal Ix [2] and Mx
Fetal measles [3]

A

Ix: IgM positive after 4d but before 1m, test viral RNA in saliva
Mx:
- HNIG if maternal rash 6d pre- or post-delivery

Fetal:

  • Fetal loss
  • Preterm delivery
  • No congenital infection unless 6d before/after delivery
19
Q

What does HNIG prevent in measles infection?

A

to prevent neonatal subacute sclerosing panencephalitis

20
Q

CMV
Maternal presentation [3]
Ix [3]
Route of transmission

A

Presentation

  • Pyrexia
  • Lymphadenopathy
  • Sore throat

Ix:

  • Paired sera
  • Amniocentesis at >20w
  • Viral shell culture (throat and urine)

Can be transmitted from toddler’s urine

21
Q

Congenital CMV
Features [6]
Mx

A
  • IUGR
  • hepatosplenomegaly, jaundice
  • thrombocytopenia
  • chorioretinitis
  • late onset problems are motor or cognitive impairment
  • sensorineural deafness

90% of affected foetuses normal at birth; 10% are symptomatic (33% of these die)

Mx: supportive care

22
Q

Maternal Toxoplasmosis
Presentation [3]
Ax [3]

A
  • like glandular fever
  • fever, rash
  • eosinophilia
    Ax:
  • transmitted from cat litter, lambing and uncooked meat
23
Q

Maternal Toxoplasmosis
Ix [2]
Mx [5]

A

Ix: IgM and IgG

Mx:
 Infected: SPIRAMYCIN
 Symptomatic non-immune:
- re-test every 10w
- if +ve do amniocentesis to see if fetus infected
- if so give PYREMETHAMINE and SULFADIAZINE

24
Q

Congenital Toxoplasmosis [7]

A
  • intracranial calcification, hydrocephalus
  • choroidoretinitis
  • hepatosplenomegaly
  • thrombocytopenia
  • encephalitis, epilepsy
  • physical and mental developmental delay
  • skin rashes
25
Q

Parvovirus B19
Maternal infection presentation [2]
Ix [3]
Mx [3]

A
  • Asymptomatic
  • Can get slapped cheek appearance
  • Ix IgM and IgG (10d apart)
  • Mx: serial USS looking for fetal anemia using MCA doppler
26
Q

Parvovirus B19
Fetal infection pathophysiology [3]
Management [2]

A

Suppression of erythropoiesis and cardiac toxicity leads to cardiac failure > hydrops fetalis causing fetal loss

Fetal infection: tertiary fetal medicine centre and in utero red cell transfusion

27
Q

Maternal Listeriosis
Presentation [5]
Ax [3]
Fetal listeriosis presentation [2]

A

Presentation

  • fever (suspect in any unexplained fever >48h)
  • shivering, myalgia
  • headache, sore throat
  • coughing, vomiting, diarrhoea
  • vaginitis

Ax: transmitted from infected food (milk, soft cheese, pate)

• Fetal listeriosis: stillbirth, fetal distress in labour

28
Q

Maternal Listeriosis
Ix - why not serology or swabs? [2]
Mx [2]

A

o Ix: blood cultures (serology and swabs unhelpful as can be commensal)
o Mx: IV AMPICILLIN and GENTAMICIN

29
Q

Congenital Listeriosis
Presentation [5]
Ix [2]
Mx [2]

A
  • pneumonia
  • meningitis, convulsions
  • hepatosplenomegaly
  • pustular or petechial rashes
  • fever, leukopenia

Ix: CSF, blood, placenta culture

Mx: IV ampicillin + Gentamicin

30
Q

Chlamydia trachomatis
Fetal effects [3]
Neonatal effects [[2]
Mx [2]

A
  • Fetal effects: LBW, PROM, fetal death
  • Neonatal effects: opthalmia neonatorum
  • Neonatal: cleansing and ERYTHROMYCIN IV
31
Q

Clostridium perfringens maternal
Ax
Sequelae [5]
Mx [3]

A
  • Transmitted during illegal TOP
  • endometritis, sepsis and gangrene, AKI and death

Mx:

  • surgical debridement of all infected tissue
  • hyperbaric oxygen
  • high dose IV BENZYLPENICILLIN
32
Q

Puerperal pyrexia

A

Puerperal pyrexia may be defined as a temperature of > 38ºC in the first 14 days following delivery.

33
Q

Causes of puerperal pyrexia [5]

A 
endometritis: most common cause
Retained placenta?
urinary tract infection
wound infections (perineal tears + caesarean section)
mastitis
venous thromboembolism
34
Q

Endometritis management

A

if endometritis is suspected the patient should be referred to hospital for intravenous antibiotics (clindamycin and gentamicin until afebrile for greater than 24 hours)

35
Q

GBS guidelines
Who to give maternal intravenous antibiotic prophylaxis [2]
Who would you treat for GBS?

A

Maternal intravenous antibiotic prophylaxis:

  • Previous pregnancy GBS carry 50% risk (also offer testing in late pregnancy)
  • Preterm labour

Treat:
- Women with pyrexia during labour

36
Q

How do we carry out late pregnancy testing for GBS?

A

if women are to have swabs for GBS this should be offered at 35-37 weeks or 3-5 weeks prior to the anticipated delivery date

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