Infections in pregnancy Flashcards
contraction of rubella during which stage of pregnancy can cause congenital rubella syndrome?
when is the risk highest?
<20 weeks gestation
<10 weeks gestation (up to 90% chance of damage to the foetus)
suggest how to prevent rubella in pregnancy
vaccination prior to falling pregnant
why is it not advised to vaccinate patients against MMR during pregnancy?
MMR is a live vaccine
NB - it should also not be given to patients who are attempting to become pregnant (as they may already be pregnant and just not know it yet)
how can patients who have not been vaccinated against rubella receive immunity?
what is the time scale?
2 doses of MMR 3 months apart will provide immunit
4 classical features of congenital rubella syndrome
congenital cataracts
congenital heart defects
congenital deafness
learning disability
other features of congenital rubella syndrome
purpuric skin lesions
cerebral palsy
hepatosplenomegaly
salt and pepper chorioretinitis
microphthalmia
which heart defects are associated with congenital rubella syndrome? (2)
patent ductus arteriosus
pulmonary stenosis
clinically, it is very difficult to tell rubella apart from…
therefore…
parvovirus B-19
always check for concurrent infection
ith whom should a diagnosis of rubella in pregnancy be “immediately discussed”
the health protection unit
implications of new VZV infection in the mother during pregnancy (3)
severe VZV infection can lead to:
VZV pneumonitis
VZV hepatitis
VZV encephalitis
risk to the baby if:
VZV is contracted in early pregnancy (<28 weeks)
VZV is contracted in very late pregnancy
congenital varicella syndrome
severe neonatal varicella
how commonly is neonatal varicella infection fatal?
around 20% of cases
features of congenital varicella syndrome (8)
microcephaly
hydrocephalus
learning disability
limb hypoplasia
scarring + other skin changes on specific dermatomes
foetal growth restriction
cataracts
inflammation around the eye (chorioretinitis)
best course of action if patient wishes to become pregnant and is not immune to VZV
offer vaccine prior to pregnancy or afterwards
first course of action: pregnant patient with exposure to VZV and unsure of their immunity
test their immunity
if negative, give ZVIG within 10 days or ASAP
how does IVIG work when a patient is exposed to VZV?
it is prophylactic (but works up until 10 days after VZV exposure)
2 prerequisites for starting aciclovir in a pregnant patient as an alterative to VZIG
must present within 24 hours of developing their rash
must be >20 weeks gestation
when is aciclovir given after a pregnant patient is exposed to VZV?
7-14 days after exposure (it seems to be more effective after this time)
NB they must also present within 24 hours of the onset of rash
how common is congenital varicella syndrome amongst mothers who contract VZV at <28 weeks gestation
occurs in only 1%
how is listeria transmitted?
consumption of unpasteurised dairy, processed meats, etc
consequences of listeria for the mother (3 scenarios)
most commonly asymptomatic
can cause a flu-like illness
can rarely cause pneumonia or meningoencephalitis
2 consequences of listeriosis in pregnancy for the foetus
very high rate of miscarriage/foetal death
can also cause severe sepsis in the neonate
most common congenital infection in the UK
CMV
how is CMV generally spread
through the saliva/urine of asymptomatic children
7 features of congenital CMV
foetal growth restriction hearing loss vision loss seizures microcephaly learning disability purpuric skin lesions
true or false: most CMV cases in pregnancy lead to congenital CMV
false
at what point in the pregnancy is an infection with toxoplasmosis most likely to cause problems in the neonate?
later in the pregnancy
How is toxoplasmosis transmitted?
cat feces
3 features of congenital toxoplasmosis
intracranial calcification
hydrocephalus
chorioretinitis
normal clinical course of parvovirus B-19
1-2 weeks self-limiting infection concluding with a reticular rash
how high is the rate of foetal loss if the foetus becomes infected with parvovirus B-19?
5-10%
at what point are patients with parvovirus B19 no longer infectious?
once the rash has appeared they are no longer infectious
when in the pregnancy is there the highest risk of complications from parvovirus B-19?
in the first and second trimesters
4 complications of parvovirus B-19 in pregnancy
foetal death/miscarriage
severe foetal anaemia
hydrops fetalis
pre-eclampsia-like syndrome
what is hydrops fetalis?
foetal heart failure
pre-eclampsia-like syndrome aka
mirror syndrome
triad of mirror syndrome (how it is differentiated from pre-eclampsia)
2 clinical features
hydrops fetalis
placental oedema
oedema
hypertension
proteinuria
what is the management of pregnant patients known to have parvovirus B-19?
supportive management
referral to foetal medicine for monitoring of complications
2 ways in which Zika is spread
mosquitos
sexual contact
consequences of a zika infection in a healthy adul
no symptoms/mild symptoms (at worst a flu-like illness)
3 features of congenital zika syndrome
microcephaly
foetal growth restriction
other intracranial abnormalities e.g. cerebellar atrophy/ventriculomegaly
management of zika in pregnancy
referral to foetal medicine for monitoring of complications
there is no cure
