infections during pregnancy Flashcards
what are the infectious diseases in pregnancy?
Measles, Rubella, Parvovirus B19 cyomegalovirus, herpes simplex, malaria, toxoplasmosis, hep B, group B and Group A strep, HIV
What does TORCH stand for?
Toxoplasosis,other (syphillus, parvo) rubella, cytomegalovirus, Herpes simplex
rubella
RNA togavirus greatest risk a less than 13 weeks congenital defects
senorineural hearing loss, cardiac abonrmalites (VSD) and PDA. Eye lesions congenital cararacts, micophtalmia and glaucoma
microcephaly and mental retardation
late developing sequelae: diabetes, thyroid disorders and progressive panencephalitis.
measles
RNA paramyxovirus
four c: cough, coryza,conjuctivitis, and koplick spots
complications:
M: pneumonia, acute encephalitis, and corneal ulceration
diagnosis: serological samples acute and convesent phase detect serum IGM
and virus detection in saliva.
contact with measles: reassure if two documented doses of measles vaccine or test showing immunity.
Parvovirus B19
DNA virus diagnosed by IgM antibodies
fetal risk is thrombocytopenia, and cardiac toxicity–> hydrops fetalis
10% fetus ess than 20 wks will die.
Parvo contact
if IgG detected and not IgM –> reassure
if IgM detected send for confirmation.
cytomegalovirus
herpes virus- low infectivity. symptoms fever, mailiase, and lymphadenopathy.
defects- IUGR, microcephaly, hepatosplenomegaly and thrombocytopenia, jaundice, chorioretinitis, low IQ and sensorineural hearing loss.
varicella
symptoms- fever, maculopapular rash, and feeling unwell.
maternal risk: pneumonia, hepatitis, and encephalitis
fetal risk: skin scarring, limb hypoplasia, and eye lesions, neurological sequele.
neonatal risk varicella
severe infection is most likely to occur if rash appears 5 days before delivery or 2 days later need IVIg. treatment is aciclovir.
risk to fetus with maternal varicella infection by week
less than 20 than 2% risk of FVS
greater than 20 no associated with any congenial abnormality
Herpes simplex
sexual contact- mild flu like illness inguinal lymphadenopahy, vescles on the vulva.
Maternal risk- meningitis, sacral radiculopathy -UR and constipation
transverse myelitis, and sepsis
management with aciclovir
herpes simplex neonatal risk
appears in 2 weeks of life
75% disseminaed and 70% will die.
Malaria
plasmodium falciparum - fever rigors ad mscle pain
dx on blood film
malaria maternal risk
severe disease
malaria fetal risk
miscarriage, stillbirth, congenital malaria, and low birth rate.
malaria management
quinine and clindomycin and antipyretics
screen for anaemia and treat
proguanil and chloroquine best for pregnancy
toxoplasmosis
protazoa toxoplasma gondii
fever and lympandenopathy
fetal risks sponatenous miscarriage, chorioretinitis, microcephaly and hydrocephalus, intracranial calcification, and mental retardation. highest risk when less than 12 weeks
Hep B
symptoms prodrome on-specific followed by GI symptoms and jaundice.
maternal risk:
65% subacute disease with full recovery
develop acute hep
become chronic carriers
fetal risk severe acute infection may lead to miscarriage and preterm labour
neonatal Hep B risk
transmission at time of deliver and leads to chronic infection with cirrhosis and hepatocellular carcinoma. HBsAG pos and HBeAG pos 95% risk
Group B strep
20% of woman are positive
dx on vaginal swab
associated with preterm rupture of the membranes and preterm delivery.
prophylaxis in labour benzopenecillin IV and 1.5g every four hours throughout labour
neonatal risk group B strep
1% develop sepsis with 20% morality with pneumonia, sepsis and meningitis.
Group A strep and disease caused by it
streptococcus pyrogenes
pharyngitis, impetigo, cellulitis, scarlet fever, rheumatic fever and toxic shock syndrome.
syphilis fetal problems
CN8th deanfess, hutchinson’s teeth, saddle nose and sabre shins
mgx with penicillin
what indicates the likelihood of maternal transmission?
high viral load and low CD4 count
