infections during pregnancy

Question 1

what are the infectious diseases in pregnancy?

Answer 1

Measles, Rubella, Parvovirus B19 cyomegalovirus, herpes simplex, malaria, toxoplasmosis, hep B, group B and Group A strep, HIV

Question 2

What does TORCH stand for?

Answer 2

Toxoplasosis,other (syphillus, parvo) rubella, cytomegalovirus, Herpes simplex

Question 3

rubella

Answer 3

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.

Question 4

measles

Answer 4

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.

Question 5

Parvovirus B19

Answer 5

DNA virus diagnosed by IgM antibodies
fetal risk is thrombocytopenia, and cardiac toxicity–> hydrops fetalis
10% fetus ess than 20 wks will die.

Question 6

Parvo contact

Answer 6

if IgG detected and not IgM –> reassure

if IgM detected send for confirmation.

Question 7

cytomegalovirus

Answer 7

herpes virus- low infectivity. symptoms fever, mailiase, and lymphadenopathy.
defects- IUGR, microcephaly, hepatosplenomegaly and thrombocytopenia, jaundice, chorioretinitis, low IQ and sensorineural hearing loss.

Question 8

varicella

Answer 8

symptoms- fever, maculopapular rash, and feeling unwell.
maternal risk: pneumonia, hepatitis, and encephalitis
fetal risk: skin scarring, limb hypoplasia, and eye lesions, neurological sequele.

Question 9

neonatal risk varicella

Answer 9

severe infection is most likely to occur if rash appears 5 days before delivery or 2 days later need IVIg. treatment is aciclovir.

Question 10

risk to fetus with maternal varicella infection by week

Answer 10

less than 20 than 2% risk of FVS

greater than 20 no associated with any congenial abnormality

Question 11

Herpes simplex

Answer 11

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

Question 12

herpes simplex neonatal risk

Answer 12

appears in 2 weeks of life

75% disseminaed and 70% will die.

Question 13

Malaria

Answer 13

plasmodium falciparum - fever rigors ad mscle pain

dx on blood film

Question 14

malaria maternal risk

Answer 14

severe disease

Question 15

malaria fetal risk

Answer 15

miscarriage, stillbirth, congenital malaria, and low birth rate.

Question 16

malaria management

Answer 16

quinine and clindomycin and antipyretics
screen for anaemia and treat
proguanil and chloroquine best for pregnancy

Question 17

toxoplasmosis

Answer 17

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

Question 18

Hep B

Answer 18

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

Question 19

neonatal Hep B risk

Answer 19

transmission at time of deliver and leads to chronic infection with cirrhosis and hepatocellular carcinoma. HBsAG pos and HBeAG pos 95% risk

Question 20

Group B strep

Answer 20

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

Question 21

neonatal risk group B strep

Answer 21

1% develop sepsis with 20% morality with pneumonia, sepsis and meningitis.

Question 22

Group A strep and disease caused by it

Answer 22

streptococcus pyrogenes

pharyngitis, impetigo, cellulitis, scarlet fever, rheumatic fever and toxic shock syndrome.

Question 23

syphilis fetal problems

Answer 23

CN8th deanfess, hutchinson’s teeth, saddle nose and sabre shins
mgx with penicillin

Question 24

what indicates the likelihood of maternal transmission?

Answer 24

high viral load and low CD4 count

Question 25

what treatment should be used in pregnancy for an HIV positive woman?

Answer 25

an effective HAART regimen- efavirenz and zidovudine

protease inhibitor therapy should be intensified.

Question 26

mgx HIV

Answer 26

antiretrovirals by 24 wks

Question 27

monitoring for hiv pos

Answer 27

screenign at third rimester

one CD4 count before and afer delivery

Question 28

who can get a vaginal delivery if HIV post?

Answer 28

CD4 count greater than 350 and a viral load less than 50 with zidovudine tx can.
if viral load (VL) less than 50 at 36weeks
even if prev. CS can deliver vaginally

Question 29

HIV pos who should get a cs

Answer 29

viral load greater than 400. CS should be undertaken from 38-39 wk gestation

Question 30

premature rupture of membranes in a woman hiv pos.

Answer 30

ROm greater than 34 weeks immediate delivery if less han 34 weeks steroids administered and viral control should be optimised.

Question 31

who needs intrapartum zidovudine

Answer 31

VL over 10000 untreated woman in labourwhere he current VL is unknown.

Question 32

neonatal mgx HIV pos mom

Answer 32

post exposure prophylaxis- 4 h after birth until 4 weeks. co-trimoxazole- pneumonia prevention