Infections in pregnancy

Question 1

How can infection spread to baby?

Answer 1

Placenta
Vagina
Breast milk

Question 2

Infections through breast milk

Answer 2

CMV, HIV, HTLV-1

Question 3

Screening tests for women

Answer 3

UTIs
Hep B
HIV
Syphylis

Question 4

How does hep B affect the liver?

Answer 4

Healthy liver -> chronic hepatitis -> cirrhosis -> hepatocellular carcinoma

Question 5

treatment for baby when mum has hep b

Answer 5

Post-exposure immunisation (dose 1 within 12h of birth)

Question 6

How does HIV pass to baby?

Answer 6

Placenta/birth/milk

Question 7

Intervention if mum is HIV +ve

Answer 7

ART for mum, PEP for baby

Question 8

What is syphilis?

Answer 8

STD from treponema pallidum from placenta/delivery

Question 9

Sx of syphilis in baby

Answer 9

LBW, anaemia, skin shedding, skeletal abnormalities, anal fissures, Hutchinson’s teeth

Question 10

Treatment for baby if mum syphilis +ve

Answer 10

1-3 dose IM penicillin

Question 11

Chlamydia infection

Answer 11

Intracellular bacteria (trachomatis) infects baby in birth canal

Question 12

Sx chlamydia infection in mum

Answer 12

Neonatal pneumponia and conjunctivitis

Question 13

Which infections are women vaccinated against?

Answer 13

Flu and pertussis

Question 14

TORCH screening

Answer 14

• Toxoplasmosis: protozoa, mother generally asymptomatic, chance of foetal infection depends on trimester, baby sx (convulsions microcephaly, retinitis, learning difficulties)
• Other: VZV, parvovirus B19
• Rubella
• Cytomegalovirus
• HSV

Question 15

Toxoplasmosis infection

Answer 15

TP lives in animals and reproduces in cat gut

Pregnant women should avoid raw meat/unpasteurised dairy

Question 16

Treatment for TP infection in mum

Answer 16

Serological and PCR studies on maternal blood, treatment with spiramycin

Question 17

Varicella zoster virus

Answer 17

Chicken pox and shingles

Question 18

Managing maternal VZV infection

Answer 18

Serology studies +/- VZV IGs

Mum needs acyclovir and delayed delivery so ABs pass to baby

Question 19

Congenital varicella syndrome

Answer 19

If mum has chicken pox in T1 or T2 = scarring on limbs, brain, eyes, LBW

Question 20

Neonatal NZN

Answer 20

Infection from 5 days pre-delivery to 2 days post

Question 21

Why can we not vaccinate against VZV and rubella in pregnancy?

Answer 21

Live-attenuated so contra-indicated in pregnancy

Question 22

Sx parvo b19

Answer 22

Slapped cheek/fifth disease

Mum has flu symptoms +/- rash

Question 23

Treatment for Parvo b19 in pregnancy

Answer 23

None - do regular serum studies and ultrasounds

Question 24

How does rubella spread?

Answer 24

Aerosolised droplets - causes flu symptoms with a rash

Question 25

Symptoms of maternal rubella infection

Answer 25

<16 weeks = miscarriage or severe disease 16-20 weeks = minimal risk of deafness only >20 weeks is not documented Sx: sensorineural deafness, cataracts, heart defects, hepatomegaly, disabilities, LBW

Question 26

Cytomegalovirus infection sx

Answer 26

IUGR, hydrops fatalis, microcephaly, ventriculomegaly, hearing/vision loss

Question 27

Managing maternal cytomegalovirus infection

Answer 27

Termination offered/antiviral agents like ganciclovir

Question 28

Treatment for maternal HSV infection

Answer 28

Acyclovir

Question 29

Sx of Zika virus for baby

Answer 29

Microcephaly

Question 30

Neonatal sepsis

Answer 30

Early onset is <72h and late is >72h Early is caused by group B strep and e.coli Late I caused by staph and enterobacters

Question 31

Sx neonatal sepsis

Answer 31

Altered temperature, raised RR, lethargy, poor feeding, quick deterioration

Question 32

How do you treat neonatal sepsis?

Answer 32

ABx

Question 33

How do you culture and treat neonatal sepsis

Answer 33

- Within 1h - FBC, U and E, CRP - Gas - Urinalysis - Urine culture and PCR - Eye swabs - Bloods - CXR - CSF - ABx

Question 34

Group B strep

Answer 34

Normal in gut and GIT but causes neonatal sepsis/pneumonia/meningitis Sx include cerebral palsy if untreated

Question 35

Listeria infection sx

Answer 35

Fever, aches, vomiting, miscarriage, still birth

Question 36

Pueperal sepsis

Answer 36

Puerperium: ROM to day 42 Pueperal sepsis: sepsis mum in puerperium