infections in pregnancy

Question 1

rubella

Answer 1

“German measels” can cause congenital rubella syndrome if mother is infected during first 20 weeks of prengnacy

planning to be pregnant:
MMR vaccine
test for rubella immunity (antibodies)
can be vaccinated with 2 doses of MMR, three months apart.

if pregnant:
should NOT receive MMR (live vaccine) but be offered after birth

Question 2

congenital rubella syndrome features

Answer 2

Congenital deafness
Congenital cataracts
Congenital heart disease (PDA and pulmonary stenosis)
Learning disability

Question 3

chickenpox

Answer 3

varicella zoster virus (VZV)

dangerous in pregnancy. can lead to severe cases in mother (varicella pneumonitis, hepatitis, encephalitis), fatal varicella syndrome or neonatal varicella infection

• if vaccinated= safe
• if unsure= check IgG for VZV (+ve immunity) (-ve offer vaccine before or after pregnancy)
• can be treated with IV varicella immunoglobulins as prophylaxis against developing chicken pox, given within 10 days of exposure

Question 4

chickenpox rash in pregnancy

Answer 4

treat with oral acyclovir if present within 24 hours and more than 20 weeks gestation

Question 5

congenital varicella syndrome clinical features

Answer 5

fetal growth restriction
Microcephaly, hydrocephalus and learning disability
Scars and significant skin changes located in specific dermatomes
Limb hypoplasia (underdeveloped limbs)
Cataracts and inflammation in the eye (chorioretinitis)

Question 6

listeria

Answer 6

gram +ve bacteria. transmitted by unpasteurised dairy products, processed meats, contaminated food. avoid high risk (blue cheese)

symptoms:
asymptomatic, flu like illness
high rate of miscarriage / fatal death

Question 7

CMV

Answer 7

cytomegalovirus infection can cause congenital cytomegalovirus infection

spread through saliva / urine of asymptomatic children

features of congenital CMV:
Fetal growth restriction
Microcephaly
Hearing loss
Vision loss
Learning disability
Seizures

Question 8

congenital toxoplasmosis

Answer 8

infection by toxoplasma gondii parasite, usually asymptomatic

contamination with faeces from cat (host)

congenital toxoplasmosis:  
(triad)
1. Intracranial calcification
2. Hydrocephalus
3. Chorioretinitis (inflammation of the choroid and retina in the eye)

Question 9

parvovirus b19

Answer 9

slapped cheek syndrome / fifth disease / erythema infectiosum

• self limiting
• non specific viral symptoms
• rash appears 2-5 days after (slapped cheeks)
• reticular (net like) mild erythematous rash around trunk and limbs, raised and itchy
• infectious for 7-10 before the rash disappears and not infectious once the rash has appeared

significant exposure is 15 minutes

Question 10

complication of parvovirus b19 in pregnancy

Answer 10

1st and 2nd trimester:
Miscarriage or fetal death

Severe fetal anaemia: infection of bone marroww and liver

Hydrops fetalis (fetal heart failure)

Maternal pre-eclampsia-like syndrome: mirror syndrome. hydrous fettles, placental oedema and oedema in the mother.

Question 11

investigation for suspected parvovirus infection

Answer 11

IgM to parvovirus, which tests for acute infection within the past four weeks

IgG to parvovirus, which tests for long term immunity to the virus after a previous infection

Rubella antibodies (as a differential diagnosis)

supportive tx
referral to fetal medicine to monitor complications and malformations

Question 12

Zika virus

Answer 12

aedes mosquitos
spread by sex with someone who is infected

symptoms:
no symptoms / minimum / mild flu like illness

congenital zika syndrome:
Microcephaly
Fetal growth restriction
Other intracranial abnormalities, such as ventriculomegaly and cerebellar atrophy

Question 13

Zika virus testing

Answer 13

test for viral PCR
antibodies to the zika virus

if +ve result refer to fatal medicine

(no tx for virus)

Question 14

UTI in pregnancy

Answer 14

lower UTI involves infection of the bladder (cystitis)

upper UTI (infection up to the kidneys- pyelonephritis)

UTI can increase the risk of pre-term delivery and other adverse outcomes

Question 15

asymptomatic bacteriuria

Answer 15

bacteria in the urine without infection. higher risk of UURTI/LURTI.
MC+S
antibiotics

Question 16

presentation of lower UTI

Answer 16

Dysuria (pain, stinging or burning when passing urine)
Suprapubic pain or discomfort
Increased frequency of urination
Urgency
Incontinence
Haematuria

Question 17

presentation of upper UT (pyelonephritis)

Answer 17

Fever (more prominent than in lower urinary tract infections)
Loin, suprapubic or back pain (this may be bilateral or unilateral)
Looking and feeling generally unwell
Vomiting
Loss of appetite
Haematuria
Renal angle tenderness on examination

Question 18

urine dipstick

Answer 18

nitrates (produced by gram -ve bacteria) E.coli breaks down nitrates into nitrites

leukocytes - WBC

nitrites are more accurate indication of infection than leukocytes

MSU samples

Question 19

causes of UTI

Answer 19

E.coli (g-ve anaerobic rod shape)
Klebsiella pneumoniae (gram-negative anaerobic rod)
Enterococcus
Pseudomonas aeruginosa
Staphylococcus saprophyticus
Candida albicans (fungal)

Question 20

management of UTI

Answer 20

7 days antibiotics

• nitrofurantoin (to be avoided in third trimester, risk of neonatal haemolytic)
• trimethoprim (Avoid in first trimester as it’s a folate antagonist) (not known to be harmful in later pregnancy but avoided unless necessary)
• amoxicillin (once sensitivities are known)
• cefalexin