Infections In Pregnancy Flashcards
How to diagnose parvovirus infections in mothers?
Maternal IgM and IgG
if IgM+ then check US for hydrops
Can check PCR in maternal serum and amniotic fluid
How to treat Hep B transmitted from mother to infant
Give HBIG + Hep B vaccine within 12hrs of delivery (at birth, 1 month, 6 months)
If GBS status unknown, when do you treat them as GBS positive?
- if ROM > 18 hours
- if preterm labour
- if intrapartum fever > 38 C
Intrapartum prophylaxis for GBS
Benpen 3g initially then 1.8g 4hrly till birth
If allergic to penicillin: cefazolin 2g initially then 1g 8hrly till birth
If allergic and anaphylactic: clindamycin 900mg IV 8hrly till birth
What and when to give when mom exposed to varicella in pregnancy
VZIG within 72 hours, must test for the antibody between 24-48 hours after
When to give neonates VZIG
If mother had varicella within 5 days of delivery
Congenital varicella syndrome
Chorioretinitis
Limb hypoplasia
Cicatrial lesions on skin
Cortical atrophy, microcephaly
When to give acyclovir for varicella
If maternal pneumonia
If VZIG not given within 72 hours of exposure
What can varicella cause to the mother in pregnancy
Pneumonia
Hepatitis
Encephalitis
Fetal complications of parvovirus B19 and management
Aplastic anemia
Hydrops fetalis
High-output cardiac failure
Liver congestion
Intrauterine blood transfusion from 20 weeks
How to diagnose parvovirus B19 in mother
Maternal IgM and IgG
If IgM+, check fetal ultrasound for hydrops and sample fetal blood for anemia
What syndrome does rubella cause in the neonate and when is it transmitted?
Congenital rubella syndrome - cataract, deafness, cardiac anomalies like PDA
Very high risk transmission in first 8 weeks, teratogenic in first trimester
How to diagnose rubella infection and what to do if detected?
Paired sera examined 10-14 days apart looking at a change in rubella IgM and IgG.
If there is a significant rise in rubella antibodies in the first 14-16 weeks, offer TOP
Rubella vaccination after pregnancy
What are the neonatal complications of toxoplasma infection and when is it of highest risk to be acquired
Triad: chorioretinitis, intracranial calcification, hydrocephalus
Higher risk if acquired in late pregnancy
How to diagnose toxoplasmosis and treatment
Seroconversion of IgG and IgM or >4 fold rise in paired specimen
PCR for T Gondii in amniotic fluid
Treat with spiramycin
No vaccine, just gotta be hygienic
Congenital CMV complications and how it is spread
Hepatosplenomegaly, chorioretinitis, microcephaly, mental and motor retardation, deafness, periventricular calcification
- jaundice, anemia, rash, ascites
Spread via respiratory droplets
How to diagnose CMV and treat
Maternal serum IgM and IgG, if primary infection confirmed then ultrasound and amniocentesis
No curative or prophylactic agent
Listeria source, presentation and risk
Unpasteurized dairy products, raw meat, soft cheese, raw seafood
Flu-like, fever, malaise
Miscarriage, preterm
Diagnosis of listeria and management
Culture from blood, vaginal swab, placenta
Meconium staining in preterm fetus raises suspicion
Treatment: ampicillin 2g IV 6hrly
Congenital syphilis
Jaundice, hepatosplenomegaly, deafness, persistent rhinitis, bone and teeth abnormalities, osteochonrditis of long bone (pseudoparesis of Parrot), medial erosions of proximal tibia on X-day (wimberger sign), intrauterine death
frontal bossing, short maxilla, saddle nose,
Diagnosis of syphilis and treatment
Screening: RPR, VDRL
Confirmatory: FTA-ABS, Dark field illumination: spiral organisms with characteristic movements
US: edema, ascites, hydrops, thickened placenta
Treatment: IM procaine penicillin/IV benpen
Congenital Zika syndrome
Microcephaly IUGR Craniofacial disproprotion Cerebellar hypoplasia Lissencephaly Hydrocephalus Brainstem dysfunction Seizures Spasticity Arthrogryposis
When is highest risk of abnormality of Zika
First trimester, reduces over time
Don’t get pregnant within 6 months of getting Zika!
What is chlamydia and gonorrhea associated with at birth
PPROM, preterm delivery and LBW
Chlamydia: conjunctivitis and pneumonia
Gonorrhea: ophthalmicus neonatorum
Principles of managing HIV infection pregnancy
- ART in all pregnant women regardless (if refused and not necessary, give at 28-32 weeks)
- monitor CD4+ counts and viral loads every trimester
- c-section if viral load >50 copies at 34-36 weeks
- avoid ARM unless expecting birth in the next 24 hrs
- reduce duration of ROM
- avoid invasive fetal monitoring
- IV Zidovudine for mother 4 hours prior to planned C-section/at onset of labour for vaginal birth
- avoid breast feeding
- Oral zidovudine syrup for newborn no later than 6 hours of life, continue for 4 weeks
- PCR for newborn within 48 hours of life
Tests for chorioamnionitis
High vaginal swab
FBC
Amniotic fluid MCS (if amniocentesis done)
CTG: fetal tachycardia
Management of chorioamnionitis
Antibiotics
- gram positive: ampicillin 2g IV 6hrly
- gram negative: gentamicin 5-6g IV daily
- anaerobes: metronidazole 500mg 8hrly
Consider urgent delivery of the baby, preferably Vaginal cause csect can lead to intraperitoneal sepsis
Managing women with GBS bacteriuria and GBS positive
Bacteriuria: oral antibiotics in pregnancy and intrapartum prophylaxis regardless of symptomatic or not
GBS positive: intrapartum prophylaxis, must come to hosp at onset of labour
