infections in pregnancy

Question 1

which gestational age is most at risk with rubella?

Answer 1

Pregnancies of less than 20 weeks’ gestation are at greatest risk of complications from rubella exposure, however, investigation is required regardless of previous testing, immunization status or stage of pregnancy.

babies can get congenital rubella syndrome (CRS)

Question 2

what are features of congenital rubella syndrome?

Answer 2

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

Question 3

what are features of congenital varicella syndrome?

Answer 3

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 4

how can pregnant women get listeria?

Answer 4

• unpasteurised milk

- blue cheese

Question 5

how is CMV transmitted?

Answer 5

The virus is mostly spread via the infected saliva or urine of asymptomatic children. Most cases of CMV in pregnancy do not cause congenital CMV.

Question 6

what are features of congenital CMV?

Answer 6

Fetal growth restriction
Microcephaly
Hearing loss
Vision loss
Learning disability
Seizures

Question 7

how might pregnant women get toxoplasmosis?

Answer 7

cat faeces contamination

Question 8

what is the classic triad of congenital toxoplasmosis

Answer 8

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

Question 9

what is another name for parvovirus B19?

Answer 9

slapped cheek syndrome

-starts with non-specific viral symptoms. After 2 – 5 days, the rash appears quite rapidly as a diffuse bright red rash on both cheeks, as though they have “slapped cheeks”. A few days later a reticular mildly erythematous rash affecting the trunk and limbs appears, which can be raised and itchy. Reticular means net-like.

Question 10

which investigations need to be done for pregnant lady you suspect to have parvovirus?

Answer 10

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)

Question 11

what are complications of having a parvovirus pregnancy?

Answer 11

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

Question 12

what is management of pregnancy with parvovirus?

Answer 12

Treatment is supportive. Women with parvovirus B19 infection need a referral to fetal medicine to monitor for complications and malformations.

Question 13

what should be given to babies born to mothers with positive Hep B serology?

Answer 13

complete course of vaccination + hepatitis B immunoglobulin