Infections

Question 1

How does CMV present?

Answer 1

Asymptomatic

Mild flu-like illness

Mononucleosis syndrome = fever, splenomegaly, impaired liver function

Question 2

How should suspected CMV be investigated?

Answer 2

Viral serology

Positive =

• CMV IgG in previous -ve
• CMV IgM and low IgG avidity (<30%)

Fetal = amniocentesis >21w

Question 3

Outline the treatment for CMV

Answer 3

Maternal
- Immunocompetent = no treatment

Fetal

• No effective treatment
• Termination offered
• If continuing preg serial USS

Question 4

What problems can be seen in a neonate with CMV?

Answer 4

Intrauterine growth restriction
Hepatosplenomegaly
Thrombocytopaenic purpura
Jaundice
Microencephaly
Chorioretinitis
Sensorineural hearing loss
Psychomotor development delay
Visual impairment

Question 5

How does GBS present?

Answer 5

Maternal vaginal or rectal colonisation does not cause symptoms. However, GBS that leads to infection may manifest in different ways:

• UTI = frequency, urgency, dysuria
• Chorioamnioitis = fevers, lower abdominal/uterine tenderness, foul discharge, maternal and/or fetal tachycardia (occurs intrapartum).
• Endometritis = fevers, lower abdominal pain, intermenstrual bleeding, foul discharge (occurs postpartum).

After delivery, typical symptoms of neonatal infection include pyrexia, cyanosis, difficulty breathing and feeding, and floppiness.

Question 6

How should GBS be investigated?

Answer 6

Vaginal + rectal swab

GBS may be detected on urine cultures if the woman is symptomatic for a UTI

RCOG recommends that it is not screened for routinely, so only women identified as being high risk for GBS infection will be tested

Question 7

Outline the management of GBS in pregnant women

Answer 7

High dose IV penicillin throughout labour in women if =

• GBS positive swabs
• UTI caused by GBS during this pregnancy
• Previous baby with GBS infection.
• Pyrexia during labour
• Labour onset <37 weeks
• Rupture of membranes >18 hours

If there is rupture of membranes in a woman of >37 weeks gestation known to be GBS positive, she will be induced immediately (to reduce the amount of time the fetus is exposed).