Infections in pregnancy

Question 1

contraction of rubella during which stage of pregnancy can cause congenital rubella syndrome?

when is the risk highest?

Answer 1

<20 weeks gestation

<10 weeks gestation (up to 90% chance of damage to the foetus)

Question 2

suggest how to prevent rubella in pregnancy

Answer 2

vaccination prior to falling pregnant

Question 3

why is it not advised to vaccinate patients against MMR during pregnancy?

Answer 3

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)

Question 4

how can patients who have not been vaccinated against rubella receive immunity?

what is the time scale?

Answer 4

2 doses of MMR 3 months apart will provide immunit

Question 5

4 classical features of congenital rubella syndrome

Answer 5

congenital cataracts

congenital heart defects

congenital deafness

learning disability

Question 6

other features of congenital rubella syndrome

Answer 6

purpuric skin lesions

cerebral palsy

hepatosplenomegaly

salt and pepper chorioretinitis

microphthalmia

Question 7

which heart defects are associated with congenital rubella syndrome? (2)

Answer 7

patent ductus arteriosus

pulmonary stenosis

Question 8

clinically, it is very difficult to tell rubella apart from…

therefore…

Answer 8

parvovirus B-19

always check for concurrent infection

Question 9

ith whom should a diagnosis of rubella in pregnancy be “immediately discussed”

Answer 9

the health protection unit

Question 10

implications of new VZV infection in the mother during pregnancy (3)

Answer 10

severe VZV infection can lead to:

VZV pneumonitis
VZV hepatitis
VZV encephalitis

Question 11

risk to the baby if:

VZV is contracted in early pregnancy (<28 weeks)

VZV is contracted in very late pregnancy

Answer 11

congenital varicella syndrome

severe neonatal varicella

Question 12

how commonly is neonatal varicella infection fatal?

Answer 12

around 20% of cases

Question 13

features of congenital varicella syndrome (8)

Answer 13

microcephaly
hydrocephalus
learning disability

limb hypoplasia
scarring + other skin changes on specific dermatomes

foetal growth restriction

cataracts
inflammation around the eye (chorioretinitis)

Question 14

best course of action if patient wishes to become pregnant and is not immune to VZV

Answer 14

offer vaccine prior to pregnancy or afterwards

Question 15

first course of action: pregnant patient with exposure to VZV and unsure of their immunity

Answer 15

test their immunity

if negative, give ZVIG within 10 days or ASAP

Question 16

how does IVIG work when a patient is exposed to VZV?

Answer 16

it is prophylactic (but works up until 10 days after VZV exposure)

Question 17

2 prerequisites for starting aciclovir in a pregnant patient as an alterative to VZIG

Answer 17

must present within 24 hours of developing their rash

must be >20 weeks gestation

Question 18

when is aciclovir given after a pregnant patient is exposed to VZV?

Answer 18

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

Question 19

how common is congenital varicella syndrome amongst mothers who contract VZV at <28 weeks gestation

Answer 19

occurs in only 1%

Question 20

how is listeria transmitted?

Answer 20

consumption of unpasteurised dairy, processed meats, etc

Question 21

consequences of listeria for the mother (3 scenarios)

Answer 21

most commonly asymptomatic

can cause a flu-like illness

can rarely cause pneumonia or meningoencephalitis

Question 22

2 consequences of listeriosis in pregnancy for the foetus

Answer 22

very high rate of miscarriage/foetal death

can also cause severe sepsis in the neonate

Question 23

most common congenital infection in the UK

Answer 23

CMV

Question 24

how is CMV generally spread

Answer 24

through the saliva/urine of asymptomatic children

Question 25

7 features of congenital CMV

Answer 25

foetal growth restriction
hearing loss
vision loss
seizures
microcephaly
learning disability
purpuric skin lesions

Question 26

true or false: most CMV cases in pregnancy lead to congenital CMV

Answer 26

false

Question 27

at what point in the pregnancy is an infection with toxoplasmosis most likely to cause problems in the neonate?

Answer 27

later in the pregnancy

Question 28

How is toxoplasmosis transmitted?

Answer 28

cat feces

Question 29

3 features of congenital toxoplasmosis

Answer 29

intracranial calcification

hydrocephalus

chorioretinitis

Question 30

normal clinical course of parvovirus B-19

Answer 30

1-2 weeks self-limiting infection concluding with a reticular rash

Question 31

how high is the rate of foetal loss if the foetus becomes infected with parvovirus B-19?

Answer 31

5-10%

Question 32

at what point are patients with parvovirus B19 no longer infectious?

Answer 32

once the rash has appeared they are no longer infectious

Question 33

when in the pregnancy is there the highest risk of complications from parvovirus B-19?

Answer 33

in the first and second trimesters

Question 34

4 complications of parvovirus B-19 in pregnancy

Answer 34

foetal death/miscarriage

severe foetal anaemia

hydrops fetalis

pre-eclampsia-like syndrome

Question 35

what is hydrops fetalis?

Answer 35

foetal heart failure

Question 36

pre-eclampsia-like syndrome aka

Answer 36

mirror syndrome

Question 37

triad of mirror syndrome (how it is differentiated from pre-eclampsia)

2 clinical features

Answer 37

hydrops fetalis
placental oedema
oedema

hypertension
proteinuria

Question 38

what is the management of pregnant patients known to have parvovirus B-19?

Answer 38

supportive management

referral to foetal medicine for monitoring of complications

Question 39

2 ways in which Zika is spread

Answer 39

mosquitos

sexual contact

Question 40

consequences of a zika infection in a healthy adul

Answer 40

no symptoms/mild symptoms (at worst a flu-like illness)

Question 41

3 features of congenital zika syndrome

Answer 41

microcephaly

foetal growth restriction

other intracranial abnormalities e.g. cerebellar atrophy/ventriculomegaly

Question 42

management of zika in pregnancy

Answer 42

referral to foetal medicine for monitoring of complications

there is no cure