Infections in pregancy

Question 1

chickenpox

Answer 1

itchy vesicular rash
fever
malaise

varicella zoster virus

Question 2

when is chickenpox infective

Answer 2

> 48hr before rash develops to once lesions have crusted over (5-7 days) after rash starts

Question 3

foetal varicella syndrome

Answer 3

when infection occurs to the mother in the first 28 weeks of gestation.

skin scarring
underdeveloped limbs
cataracts
chorioretinitis
microcephaly
hydrocephalus
learning disability

Question 4

shingles

Answer 4

herpes zoster

caused by the reactivation of the chickenpox virus which remained dormant in the sensory root ganglion since the primary infection

Question 5

parvovirus B19 presentation and synonyms

Answer 5

slapped cheek
fifth disease
erythema infectiosum

non specific viral infection
2-5 days, a diffuse bright red rash on both cheeks
net like erythematous rash on trunk and limbs

Question 6

complications of parvovirus B19

Answer 6

• Miscarriage or fetal death
• Severe fetal anaemia
• Hydrops fetalis(fetal heart failure)
• Maternal pre-eclampsia-like syndrome (Mirror Syndrome)

critical exposure period is 12-20 weeks

Question 7

maternal toxoplasmosis presentation

Answer 7

Asymptomatic to the mother

Mild flu-like symptoms e.g. fever, sore throat, coryza, arthralgia

Question 8

triad of congenital toxoplasmosis

Answer 8

• Intracranial calcification
• Hydrocephalus
• Chorioretinitis (inflammation of the choroid and retina in the eye)

Question 9

causative organism of toxoplasmosis

Answer 9

Toxoplasma gondiiparasite

Question 10

spread of toxoplasmosis

Answer 10

contamination with cat faeces or eating undercooked meat

Question 11

complications of HIV in pregnancy

Answer 11

pre eclampsia
miscarriage
preterm delivery
low birth weight

Question 12

investigations of chickenpox

Answer 12

serum igG levels of VZV
positive = immunity
negative = offer VZV IgG

Question 13

parvovirus B19 investigations

Answer 13

IgM for parvovirus tests for acute inf in last 4 weeks
IgG tests for long term immunity after previous infection

Question 14

investigation toxoplasmosis

Answer 14

PCR of amniotic fluid via amniocentesis

Question 15

management of chickenpox

Answer 15

if presenting within 24 hours of onset of rash and >20 weeks gestation oral aciclovir
if over 24 hours then just advise symptomatic treatment and hygiene to prevent secondary bacterial infection

if severe admit and IV aciclovir

avoid contact with other pregnant women and neonates

Question 16

parvovirus B19 management

Answer 16

supportive. self limiting

Question 17

management of HIV in pregnancy

Answer 17

undergo ultrasound every 4 weeks
all babies born to HIV pos referred to neonatology and HIV tested
breastfeeding is type of vertical transmission so dont do
Viral load <50 HIV RNA copies/ml

Question 18

HCV management in prgnany

Answer 18

should not be treated as its treatments are teratogenic
HCV antenatal screening offered to women HIV pos or Heb B pos also any past or present IVD users or partner is IVD user or deranged LFTs

increased risk of liver cancer

Question 19

hep b management

Answer 19

chronic HBV with a high viral load should be offered tenofovir monotherapy during the third trimester

HBV vaccine given to IVD users
HBV Ig to babies whose mothers have HBV. first dose at birth, then at 4 weeks, 8 weeks and 12 months. tested at 1 year to find if responded