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Year Three - Reproductive System > Infections in Pregnancy > Flashcards

Infections in Pregnancy Flashcards

1
Q

What virus is responsible for chickenpox?

A

Varicella zoster virus (VSV)

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2
Q

What type of antibody is produced after a primary infection of chickenpox?

A

IgG

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3
Q

What are the clinical features of chickenpox?

A

It typically presents with fever, malaise and a pruritic maculopapular rash

The rash characteristically becomes vesicular and crusts before healing

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4
Q

What are the five complications of chickenpox if contracted during pregnancy?

A

Pneumonia

Hepatitis

Encephalitis

Fetal Varicella Syndrome

Neonatal Varicella Infection

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5
Q

What is the incubation period for chickenpox?

A

10-21 days

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6
Q

When is chickenpox infectious?

A

48 hours prior to the rash

UNTIL

The vesicles have crusted, which is usually five to seven days after the rash starts

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7
Q

How to we determine the immunity status of a pregnant woman?

A

We can collect a blood sample and test for IgM and IgG antibodies to varicella zoster

A positive result indicates immunity against the virus

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8
Q

How do we manage patients who have encountered an infectious person however describe previous primary varicella zoster infection?

A

No further action is required as they should have immunity

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9
Q

How do we manage patients who have encountered an infectious person however don’t describe previous primary varicella zoster infection?

A

IgG testing is required to confirm the immunity status

If not immune, the woman should be given zoster immunoglobulin (VZIG) as prophylaxis

This should be given within 10 days of contact.

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10
Q

How do we manage patients who develop chickenpox and present within 24 hours of rash onset (>20 weeks’ gestation)?

A

We should prescribe oral aciclovir

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11
Q

How do we manage patients who develop chickenpox and present after 24 hours of rash onset (>20 weeks’ gestation)?

A

We advise symptomatic treatment and hygiene to prevent secondary bacterial infection

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12
Q

What is congenital varicella syndrome?

A

It is subsequent reactivation of the virus in utero as herpes zoster

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13
Q

When does congenital varicella syndrome occur?

A

When the fetus is infected by maternal varicella in the first 28 weeks of gestation

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14
Q

What are the four clinical features of congenital varicella syndrome?

A

Skin Scarring

Eye Defects, such as cataracts and chorioenitis

Limb Hypoplasia, which affects limbs ipsilaterally

Neurological Abnormalities, such as microcephaly and hydrocephalus

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15
Q

In which circumstance is varicella of the newborn at high risk?

A

If maternal chickenpox occurs within the last 4 weeks of pregnancy

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16
Q

What are the three routes of varicella infection of the newborn?

A

Transplacental

Vaginal

Direct contact after birth

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17
Q

What is shingles?

A

Varicella zoster virus reactivation

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18
Q

Can women be infected with chickenpox from individuals with shingles?

A

Yes

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19
Q

What is parvovirus B19?

A

Single stranded DNA virus

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20
Q

How is parvovirus B19 transmitted?

A

Respiratory droplets

Blood

Vertical transmission to the foetus

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21
Q

What are the clinical features of parvovirus B19?

A

It starts with non-specific viral symptoms, such as malaise, headaches, fever, etc

After 2-5 days, a bright red rash appears diffusely on both cheeks

A few days later a reticular mildly erythematous rash affecting the trunk and limbs appears, which can be raised and itchy

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22
Q

What is the incubation period for parvovirus B19?

A

4-20 days

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23
Q

When is parvovirus B19 infectious?

A

From 7-10 days prior to the rash onset

They are not infectious once the rash has appeared

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24
Q

How do we determine the immunity status of a pregnant women to parvovirus B19?

A

We collect a blood sample and conduct a viral serology, where we check for the presence of IgM antibodies and IgG antibodies

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24
Q

What does the presence of IgM antibodies against parvovirus B19 indicate?

A

An acute infection within the past four weeks

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25
Q

What does the presence of IgG antibodies against parvovirus B19 indicate?

A

A long term immunity to the virus after a previous infection

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26
Q

How do we manage parvovirus B19 infection in pregnant patients?

A

We offer supportive treatment

This involves the conduction of weekly ultrasound scans to monitor for complications and malformations

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27
Q

What are the four complications of parvovirus B19 infection during pregnancy?

A

Fetal Anaemia

Hydrops Fetalis

Maternal Pre-Eclampsia-Like Syndrome

Miscarriage

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28
Q

How does parvovirus B19 infection cause fetal anaemia?

A

It is caused by parvovirus infection of the erythroid progenitor cells in the fetal bone marrow and liver

These cells produce red blood cells, and the infection causes them to produce faulty red blood cells that have a shorter life span

Therefore, fetal anaemia develops

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29
Q

What are the four complications of fetal anaemia?

A

Cardiac failure

Hydrops fetalis

Maternal pre-eclampsia-like syndrome

Fetal death

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30
Q

What is hydrops fetalis?

A

The abnormal accumulation of fluid in two or more fetal compartments

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31
Q

What is maternal pre-eclampsia-like syndrome?

A

It involves a triad of hydrops fetalis, placental oedema and maternal oedema

It also features hypertension and proteinuria

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32
Q

What is toxoplasmosis?

A

It is caused by the parasite Toxoplasma gondii

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33
Q

How is toxoplasmosis transmitted?

A

It is primarily spread by contamination with cat faeces or the ingestion of undercooked meats

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34
Q

When does toxoplasmosis occur after exposure?

A

Within three weeks

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35
Q

What are the clinical features of toxoplasmosis?

A

In most cases, toxoplasmosis is asymptomatic

In cases where patients are symptomatic, they present with mild flu-like symptoms – such as fever, sore throat, coryza and arthralgia

36
Q

How do we diagnose toxoplasmosis during pregnancy?

A

We can conduct a PCR analysis of amniotic fluid

This sample of amniotic fluid can be collected via amniocentesis

37
Q

What is the main complication of toxoplasmosis during pregnancy?

A

Congenital toxoplasmosis

38
Q

What is congenital toxoplasmosis?

A

A disease that occurs when the infection is transmitted from mother to fetus

39
Q

What are the three clinical features of congenital toxoplasmosis?

A

Intracranial Calcification

Hydrocephalus

Chorioretinitis

40
Q

What can congenital toxoplasmosis lead to?

A

Miscarriage

Stillbirth

40
Q

When are the complications of congenital toxoplasmosis greatest?

A

If infection occurs in the third trimester

41
Q

What is HIV?

A

An RNA retrovirus that infects and replicates within the human immune system using host CD4 cells

42
Q

What can HIV lead to without treatment?

A

Acquired immune deficiency syndrome (AIDS)

43
Q

How can HIV be transmitted during pregnancy to the fetus?

A

At delivery

Breastfeeding

44
Q

Which three infections are tested for during antenatal screening?

A

HIV

Hepatitis B

Syphilis

45
Q

What are the four complications of HIV during pregnancy?

A

Pre-Eclampsia

Miscarriage

Preterm Birth

Low Birth Weight

46
Q

What do we prescribe to pregnant HIV patients to reduce fetal transmission?

A

Combined anti-retroviral treatment (cART)

47
Q

How long do we prescribe cART to HIV pregnant patients?

A

During pregnancy and delivery

48
Q

In what three ways does cART reduce the HIV fetal transmission?

A

It will reduce the viral load to allow for vaginal delivery,

It will reduce the risk of vertical transmission

It will improve the mother’s health

49
Q

What is the delivery method of HIV pregnant patients based on?

A

Viral load levels

50
Q

What delivery method is selected for HIV pregnant patients with a viral load <50 copies/ml?

A

Normal vaginal delivery

51
Q

What delivery method is selected for HIV pregnant patients with a viral load >50 copies/ml?

A

C-section

52
Q

When do we prescribe IV zidovudine during a c-section (HIV pregnant patients)?

A

When the viral load is unknown or there are > 10,000 copies/ml

53
Q

How do we manage babies born from a HIV positive mother postnatally?

A

Testing

Prophylaxis treatment

54
Q

What prophylaxis treatment is given to babies born from a HIV positive mother with a viral load < 50 copies per ml?

A

Zidovudine for four weeks

55
Q

What prophylaxis treatment is given to babies born from a HIV positive mother with a viral load > 50 copies per ml?

A

Zidovudine, lamivudine and nevirapine for four weeks

56
Q

Can HIV positive mothers breastfeed?

A

No

57
Q

What is hepatitis B?

A

An infection of the liver caused by the hepatitis B virus (HBV)

This virus produces E-antigen, which is a protein that is released into circulation to modify the host’s immune system so that it is not detected

58
Q

What are the three main risk factors of hepatitis B?

A

Intravenous drug users

Haemophilic patients

Those that live with an infected person

59
Q

What can be prescribed to pregnant patients to reduce the risk of hepatitis B transmission?

A

Tenofovir

60
Q

In which cases do we prescribe tenofovir to hepatitis B pregnant patients?

A

If they have a high viral load

61
Q

During which trimester is tenofovir prescribed to hepatitis B pregnant patients?

A

Third trimester of pregnancy

62
Q

How does tenofovir treatment reduce the risk of hepatitis B transmission to the fetus?

A

It will reduce the viral load

63
Q

What delivery type do we recommend in hepatitis B pregnant patients?

A

Normal vaginal delivery

64
Q

What are the three postnatal care treatments for babies born from hepatitis B positive patients?

A

Immunoglobulin

Vaccination

Hepatitis B Screening

65
Q

What is immunoglobulin?

A

An injection given to the baby

66
Q

When do we give immunoglobulin to babies?

A

If their mother is positive for hepatitis B and they have a high viral load

67
Q

How many vaccinations are offered to babies born from hepatitis B patients?

A

Four in the first year of life

They will then receive a booster with their preschool vaccinations

68
Q

When is the first hepatitis B vaccination given to babies?

A

Within 24 hours of birth

69
Q

When is the second hepatitis B vaccination given to babies?

A

4 weeks postnatal

70
Q

When is the third hepatitis B vaccination given to babies?

A

8 weeks postnatal

71
Q

When is the fourth hepatitis B vaccination given to babies?

A

12 months of age

72
Q

Can hepatitis B positive mothers breastfeed?

A

Yes as long as the baby has received their first vaccination

73
Q

When do we test babies for hepatitis B?

A

After 12 months of age

74
Q

What is hepatitis C?

A

It is an infection of the liver caused by the hepatitis C virus (HCV)

This virus is a single stranded, enveloped RNA virus

75
Q

In which five cases do we screen pregnant patients for hepatitis C?

A

IVDU use

Substance Misuse

HIV Positive

Hepatitis B Positive

Deranged LFTs

76
Q

How do we manage hepatitis C infection during pregnancy? Why?

A

No treatment

This is due to the fact that the drugs used in treatment are teratogenic

77
Q

How is delivery conducted in hepatitis C patients?

A

Normal vaginal birth

78
Q

Can hepatitis C positive mothers breastfeed?

A

Yes

79
Q

When do we conduct hepatitis C screening?

A

Once the baby reaches 18 months

80
Q

What is syphillis?

A

A spirochete gram-negative bacteria called Treponema pallidum

81
Q

How is syphilis transmitted?

A

A sexually transmitted infection

Vertical, which can be transplacentally or exposure to infected lesions during vaginal birth

82
Q

What are the five complications of syphilis during pregnancy?

A

Miscarriage

Stillbirth

Hydrops Fetalis

Growth Restriction

Congenital Infection

83
Q

How do we manage syphilis during pregnancy?

A

An intramuscular injection of penicillin

84
Q

What is the main complication of syphilis?

A

Congenital syphilis

85
Q

How long does congenital syphilis take to present?

A

Five weeks

86
Q

What are the clinical features of congenital syphilis?

A

Hutchinson’s triad, which includes…

Deafness

Interstitial Keratitis

Hutchinson’s Teeth

87
Q

What are the five clinical features of congenital rubella infection?

A

Sensorineural deafness

Congenital cataracts

Patent ductus arteriosus

Purpuric skin lesions

‘Salt and pepper’ chorioretinitis

Year Three - Reproductive System (52 decks)

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