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Y3 repro > infections in pregnancy > Flashcards

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
Q

what causes toxoplasmosis

how common is it

A

protozoa - toxoplasma gondii

2/1000 pregnancies

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26
Q

how is toxoplasmosis transmitted

A

through cat faeces and undercooked meats by directly ingesting the parasite

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27
Q

what % of women are immune

A

~20%

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28
Q

symptoms of toxoplasmosis

A

asymptomatic
OR
mild flu like symptoms - fever, sore throat, coryza, arthralgia

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29
Q

serious complications of toxoplasmosis

A

rare

chorioretinitis
encephalitis
myocarditis
pneumonitis

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30
Q

how long does it take for parasitaemia to occur in toxoplasmosis

A

occurs within 3wks of ingestion

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31
Q

advice for pregnant women re. toxoplasmosis

A

avoid cleaning cat litter trays and eating undercooked meat

32
Q

when can placental infection occur with toxoplasmosis

A

placental infection is possible both during pregnancy and immediately prior to pregnancy

33
Q

possible fetal complications from toxoplasmosis

A 
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
Q

how to confirm congenital toxoplasmosis infection

A

PCR analysis of amniotic fluid obtained from amniocentesis can identify toxoplasmosis and may confirm congenital infection

35
Q

HIV risks if pregnant women if infected

A

no increased risk of congenital abnormalities

increased risk of pre-eclampsia, miscarriage, pre-term delivery and low birth weight

36
Q

what investigations are offered to pregnant women w/ HIV

A

weekly scans to monitor fetal growth

37
Q

what happens to babies born to HIV +ve mother

A

should be referred to neonatology

offered HIV testing

38
Q

MDT input for HIV +ve mothers

A 
obstetric consultant team 
community midwifery team 
HIV specialist
neonatologist 
GP
39
Q

aims of combined anti-retroviral treatment (cART)

A
  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
Q

what can also increase the risk of vertical HIV transmission

A

breastfeeding

41
Q

viral load and associated recommendation

A

<50 - vaginal birth should be supported
50-399 - pre-labour CS considered between 38-39wks
≥400 - pre-labour CS recommended between 38-39wks

42
Q

what antitretroviral therapy can also be offered

A

sometimes intrapartum antiretroviral infusions are also recommeneded

43
Q

Hep B spread

A

vertical transmission
bloods and bodily fluids

1/1000 affected in UK

44
Q

acute hep B infection during pregnancy

A

majority of babies born will contract hep B at birth and are at risk of later cirrhosis and hepatocellular cancer

45
Q

chronic hep B with a high viral load - therapy

A

these women should be offered tenofovir monotherapy in 3rd trimester to reduce risk of transmission to baby

46
Q

can pregnant women be given the hep B vaccine

A

yes as it is inactivated

given to women at high risk - IVDU, partner is IVDU/HBV/HIV

47
Q

is vaginal birth safe if mother is chronic hep B w/ high viral load

A

yes

48
Q

which babies are offered hep B Ig

A

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
Q

when is hepatitis tested for in infants

A

12 mths

identifies any babies where intervention hasn’t been successful and have become chronically infected

50
Q

when may response to hep B vaccine be lower

A

pre-term and low birth weight babies

vaccination schedule is the same as with term babies

51
Q

hep C complications

A

can lead to severe hepatitis, chronic liver disease and increased risk of liver cancer

52
Q

incidence of hep C

A

1-2% pregnant women

most cases associated with prior injecting drug use

53
Q

what type of virus is hep C

A

RNA

54
Q

pregnancy and liver function

A

pregnancy associated with a decline in liver function in women w/ hep C

55
Q

how common is vertical transmission fo hep C

A

1/20 births

higher if woman is co-infected with HIV

56
Q

indications to offer hep C antenatal screening

A

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
Q

preventing transmission of hep C from mother to baby

A

there are currently no preventative means to prevent transmission

58
Q

is hep C treated in pregnancy

A

NO

the drugs used are teratogenic and therefore CI

59
Q

hep C and vaginal birth

A

vaginal birth and breastfeeding is safe

60
Q

what causes syphilis

A

spirochaete - treponema pallidum

61
Q

spread of syphilis

A

direct contact w/ skin lesion - most commonly during sexual contact

increasing prevalence in UK

62
Q

curing penicillin in pregnancy

A

course of abx

IM penicillin

63
Q

complications of chronic syphilis i.e. untreated

A

neurological, cardiac, skeletal and skin abnormalities for adults and babies affected IU

64
Q

are you protected once you’ve had syphilis once

A

NO
infection more than once is possible
past infection w/ syphilis doesn’t produce protective antibodies

65
Q

does pregnancy alter the disease course of syphilis

A

no

pregnant women who become infected/ become pregnant while infected should be offered prompt treatment

66
Q

complications of syphilis during pregnancy

A 
miscarriage 
stillbirth 
hydrops fetalis 
growth restriction
congenital infection

can cause serious morbidities for the baby

67
Q

how can syphilis be transmitted to babies of an infected mother

A

trans-placentally

exposure to infective lesion at time of birth

68
Q

characteristics of 1y syphilis

A

painless, local ulcer - chancre

69
Q

what happens is 1y syphilis is untreated

A

4-10wks later

symptoms of 2y syphilis may develop

70
Q

what happens if 2y syphilis is untreated

A

disease may eventually progress to 3y syphilis

usually takes 20-40yrs

71
Q

when does congenital syphilis infection present

A

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
Q

presentation of congenital syphilis

A

presentation varies

severe multisystem disease can occur

73
Q

what to do with babies who are at high risk of congenital infection

A

refer to neonatology urgently

74
Q

what is late congenital syphilis

A

occurs in children ≥2y/o who acquire the infection trans-placentally

Hutchinson’s triad

75
Q

what is Hutchinson’s triad

A

deafness
interstitial keratitis
Hutchinson’s teeth - widely spaced, peg like

group of symptoms found in late congenital syphilis, occurs in 63% of cases

76
Q

treatment for late congenital syphilis

A

penicillin

Y3 repro (47 decks)

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