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infections in pregnancy Flashcards

1
Q

what % of people in the UK are immune to chicken pox

A

> 90%

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2
Q

how is chicken pox spread

A

respiratory droplets

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3
Q

symptoms of chicken pox

A

fever
malaise
itchy vesicular rash

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4
Q

period of infectivity in chicken pox

A

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

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5
Q

how serious is chicken pox

A

usually harmless and self-limiting in children

higher morbidity in adults - hepatitis, pneumonitis, encephalitis
- especially pronounced risk w/ immunocompromised and pregnant women

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6
Q

how common is chicken pox in pregnancy

A

complicated 3/1000 pregnancies

important to ask women about chicken pox hx at booking appointment

if no hx - avoid exposure to anyone w/ chicken pox/shingles during pregnancy

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7
Q

what is the risk of congenital infection with chicken pox

A

small risk of congenital infection if maternal infection in first 28wks of pregnancy

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8
Q

what is fetal varicella syndrome

A

occurs in 2% of case of maternal 1y chicken pox

skin scarring 
congenital eye abnormalities
hypoplasia of ipsilateral limbs
neurological abnormalities
no increased risk of miscarriage if chicken pox occurs in 1st trimester
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9
Q

maternal chicken pox infection in last 4 weeks of pregnancy

A

risk of infection in newborn

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10
Q

what to do if a pregnant women, who is unsure if she is immune, is exposed to chicken pox

A

check immunity status by taking serum IgG

if immune (IgG +ve) - reassure
if non-immune (IgG -ve) - offer VZ immunoglobulin ASAP
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11
Q

disadvantages of VZ Ig

A

still a small risk of contracting chicken pox

no therapeutic benefit once chicken pox has already developed

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12
Q

what to do with a pregnant woman who develops chicken pox rash

A

inform GP

avoid contact w/ susceptible individuals - other pregnant women, neonates - until lesions crusted over

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13
Q

management of mild chicken pox infection

A

mild infection, if presents within 24hrs from onset of rash:
>20wks - oral aciclovir, also consider if <20wks
symptomatic treatment and hygiene to prevent 2y bacterial infection

mild infection, if presents >24hrs from onset of rash: symptomatic treatment, hygiene to prevent 2y bacterial infection

severe infection: admit to hospital, IV aciclovir

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14
Q

what causes shingles

A

herpes zoster

reactivation of chicken pox virus which has remained dormant in the sensory nerve root ganglion since 1y infection

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15
Q

can you catch chicken pox from someone with shingles

A

yes but it is rare

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16
Q

parvovirus B19 is aka

A

slapped cheek disease
fifth disease
erythema infectiosum

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17
Q

what % of women are immune to parvovirus B19

A

~50%

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18
Q

how severe is parvovirus B19

A

common and mild febrile illness of childhood

adults may be susceptible if never exposed

immunocompromised pts - can cause aplastic anaemia and haemolysis

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19
Q

how is parvovirus B19 spread

A

respiratory secretions

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20
Q

symptoms of parvovirus B19

A

fever
rash
erythema of cheeks

most adults are asymptomatic

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21
Q

treatment for parvovirus B19

A

no vaccine or treatment available

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22
Q

parvovirus B19 infection during pregnancy

A

can lead to fetal anaemia –> cardiac failure, hydrops fetalis and fetal death

rarely causes pre-eclamptic condition in the mother w/ significant oedema

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23
Q

when is the most critical exposure period to parvovirus B19 during pregnancy

A

12-20wks

fetal infection usually occurs 5wks after maternal infection

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24
Q

what to do with a pregnant woman w/ possible parvovirus B19 exposure and possible illness

A

bloods - Ig testing

if +ve - offer weekly scans to monitor for fetal complications

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25
what causes toxoplasmosis how common is it
protozoa - toxoplasma gondii 2/1000 pregnancies
26
how is toxoplasmosis transmitted
through cat faeces and undercooked meats by directly ingesting the parasite
27
what % of women are immune
~20%
28
symptoms of toxoplasmosis
asymptomatic OR mild flu like symptoms - fever, sore throat, coryza, arthralgia
29
serious complications of toxoplasmosis
rare chorioretinitis encephalitis myocarditis pneumonitis
30
how long does it take for parasitaemia to occur in toxoplasmosis
occurs within 3wks of ingestion
31
advice for pregnant women re. toxoplasmosis
avoid cleaning cat litter trays and eating undercooked meat
32
when can placental infection occur with toxoplasmosis
placental infection is possible both during pregnancy and immediately prior to pregnancy
33
possible fetal complications from toxoplasmosis
``` hydrocephalus intracranial calcifications microcephaly chorioretinitis ventriculomegaly IUGR ascites hepato-splenomegaly ``` miscarriage and IU death infection in the 3rd trimester puts the fetus most at risk
34
how to confirm congenital toxoplasmosis infection
PCR analysis of amniotic fluid obtained from amniocentesis can identify toxoplasmosis and may confirm congenital infection
35
HIV risks if pregnant women if infected
no increased risk of congenital abnormalities increased risk of pre-eclampsia, miscarriage, pre-term delivery and low birth weight
36
what investigations are offered to pregnant women w/ HIV
weekly scans to monitor fetal growth
37
what happens to babies born to HIV +ve mother
should be referred to neonatology | offered HIV testing
38
MDT input for HIV +ve mothers
``` obstetric consultant team community midwifery team HIV specialist neonatologist GP ```
39
aims of combined anti-retroviral treatment (cART)
1. viral load <50 HIV RNA copies/ml - allows vaginal delivery 2. reduce risk of vertical transmission 3. improve mother's health all women are recommended to continue anti-retroviral treatment post-natally
40
what can also increase the risk of vertical HIV transmission
breastfeeding
41
viral load and associated recommendation
<50 - vaginal birth should be supported 50-399 - pre-labour CS considered between 38-39wks ≥400 - pre-labour CS recommended between 38-39wks
42
what antitretroviral therapy can also be offered
sometimes intrapartum antiretroviral infusions are also recommeneded
43
Hep B spread
vertical transmission bloods and bodily fluids 1/1000 affected in UK
44
acute hep B infection during pregnancy
majority of babies born will contract hep B at birth and are at risk of later cirrhosis and hepatocellular cancer
45
chronic hep B with a high viral load - therapy
these women should be offered tenofovir monotherapy in 3rd trimester to reduce risk of transmission to baby
46
can pregnant women be given the hep B vaccine
yes as it is inactivated given to women at high risk - IVDU, partner is IVDU/HBV/HIV
47
is vaginal birth safe if mother is chronic hep B w/ high viral load
yes
48
which babies are offered hep B Ig
babies whose mother has hep B also advised to have accelerated immunisation schedule - initial dose of vaccine at birth (within 24hrs of delivery ) - with further doses at 4 + 8wks then 12mths
49
when is hepatitis tested for in infants
12 mths | identifies any babies where intervention hasn't been successful and have become chronically infected
50
when may response to hep B vaccine be lower
pre-term and low birth weight babies vaccination schedule is the same as with term babies
51
hep C complications
can lead to severe hepatitis, chronic liver disease and increased risk of liver cancer
52
incidence of hep C
1-2% pregnant women most cases associated with prior injecting drug use
53
what type of virus is hep C
RNA
54
pregnancy and liver function
pregnancy associated with a decline in liver function in women w/ hep C
55
how common is vertical transmission fo hep C
1/20 births higher if woman is co-infected with HIV
56
indications to offer hep C antenatal screening
all substance misusing pregnant women any pregnant woman w/: - prev hx IVDU - current/previous partner w/ any hx of IVDU - HIV+ve/hep B +ve - having hepatitis screen for the indication of deranged LFTs
57
preventing transmission of hep C from mother to baby
there are currently no preventative means to prevent transmission
58
is hep C treated in pregnancy
NO | the drugs used are teratogenic and therefore CI
59
hep C and vaginal birth
vaginal birth and breastfeeding is safe
60
what causes syphilis
spirochaete - treponema pallidum
61
spread of syphilis
direct contact w/ skin lesion - most commonly during sexual contact increasing prevalence in UK
62
curing penicillin in pregnancy
course of abx | IM penicillin
63
complications of chronic syphilis i.e. untreated
neurological, cardiac, skeletal and skin abnormalities for adults and babies affected IU
64
are you protected once you've had syphilis once
NO infection more than once is possible past infection w/ syphilis doesn't produce protective antibodies
65
does pregnancy alter the disease course of syphilis
no pregnant women who become infected/ become pregnant while infected should be offered prompt treatment
66
complications of syphilis during pregnancy
``` miscarriage stillbirth hydrops fetalis growth restriction congenital infection ``` can cause serious morbidities for the baby
67
how can syphilis be transmitted to babies of an infected mother
trans-placentally | exposure to infective lesion at time of birth
68
characteristics of 1y syphilis
painless, local ulcer - chancre
69
what happens is 1y syphilis is untreated
4-10wks later | symptoms of 2y syphilis may develop
70
what happens if 2y syphilis is untreated
disease may eventually progress to 3y syphilis | usually takes 20-40yrs
71
when does congenital syphilis infection present
within the 1st 2yrs of life or later 2/3 of infected neonates will be asymptomatic at birth but will develop symptoms within 5wks
72
presentation of congenital syphilis
presentation varies | severe multisystem disease can occur
73
what to do with babies who are at high risk of congenital infection
refer to neonatology urgently
74
what is late congenital syphilis
occurs in children ≥2y/o who acquire the infection trans-placentally Hutchinson's triad
75
what is Hutchinson's triad
deafness interstitial keratitis Hutchinson's teeth - widely spaced, peg like group of symptoms found in late congenital syphilis, occurs in 63% of cases
76
treatment for late congenital syphilis
penicillin

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