Infections during pregnancy

Question 1

Chicken pox

Answer 1

Time of concern: 13-30 wk GA and 5 day pre and 2 days post delivery
Effects: congenital varicella syndrome: Limb aplasia, chorioretinitis, cataracts, cutaneous scars, cortical atrophy, IUGR, hydrous
Preterm labour
Mx: VZIG for mother if exposed

Question 2

CMV

Answer 2

5-10% develop CNS involvement eg mental retardation, cerebral, calcification, hydrocephalus, microcephaly, deafness, chorioretinitis.
Mother: asymptomatic or flu-like.
Serologic screen
Mx to treatment

Question 3

Erythema infectious/fifth disease/parvovirus B 19

Answer 3

fetes: spontaneous abortion, stillbirth, hydrous in utero
Mother: flu-like, rash, arthritis, often asymptomatic
Ix Serology, viral PCR, maternal AFP, if IgM present, follow fetes with U/S for hydrous.
Mx: if hydrous then consider fetal transfusion

Question 4

Hep B

Answer 4

Transmitted: Trimester 3, vertical transmission,
Fetus: prematurity, low birth wt, neonatal death.
Mother: fever, N/V, fatigue, jaundice, elevated liver enzyme
Ix: serology
Mx: Neonate with HBIG and vaccine at birth, 1 m and 6m.

Question 5

Herpes simplex Virus

Answer 5

Transmission at birth
Fetus: disseminated herpes, CNS sequelae, self limited infection
Mother: painful vesicular lesion
Dx is clinical
Mx Acyclovir for symptomatic women, suppressive therapy at 36wk controversial C/S if active genital lesions even if remote from vulva.

Question 6

HIV

Answer 6

1/3 utero, 1/3 delivery and 1/3 breast feeing
Fetus: IUGR, Preterm labor, PROM
Ix: serology, viral PCR,
Mx triple antiretroviral therapy decreases transmission to less 1%. Elective C/S if no previous antivirals

Question 7

Rubella

Answer 7

transmission in 1st trimester
Fetal: SA or congenital rubella syndrome: hearing less, cataracts, CV lesion, MR, IUGR, hepatitis, CNS defects, osseous changes
Mother: rash, fever, posterior auricular or occipital lymphadenopathy, arthralgia
Ix: serologic testing
Mx: no specific tx

Question 8

Syphilis

Answer 8

transmitted: T1-3
Fetal: risk of preterm labour, multi system involvement, fetal death
Ix: VDRL screening for all pregnancies, if positive requires confirmation
Mx: Pen G IM, 1 dose if early, 3 doses if late syphilis.

Question 9

Toxoplasmosis

Answer 9

tranmission via raw meat, unpasteurixed goast’s milk, cat faces/urine. To baby via transplacental. In the T3 but most severe if T1. Only concern if primary infection during pregnancy.
Fetal: Congenital toxoplasmosis: chorioretinitis, hydrocephaly, intracranial calcification, MR, microcephaly
Mother: majority subclinical may have flue-like symptoms
Ix: IgM and IgG serology, PCR of amniotic fluid
Mx: Self-limiting in mother, spiramycin decreases fetal morbidity but not rate of transmission