Infections in pregnancy Flashcards
How can infection spread to baby?
Placenta
Vagina
Breast milk
Infections through breast milk
CMV, HIV, HTLV-1
Screening tests for women
UTIs
Hep B
HIV
Syphylis
How does hep B affect the liver?
Healthy liver -> chronic hepatitis -> cirrhosis -> hepatocellular carcinoma
treatment for baby when mum has hep b
Post-exposure immunisation (dose 1 within 12h of birth)
How does HIV pass to baby?
Placenta/birth/milk
Intervention if mum is HIV +ve
ART for mum, PEP for baby
What is syphilis?
STD from treponema pallidum from placenta/delivery
Sx of syphilis in baby
LBW, anaemia, skin shedding, skeletal abnormalities, anal fissures, Hutchinson’s teeth
Treatment for baby if mum syphilis +ve
1-3 dose IM penicillin
Chlamydia infection
Intracellular bacteria (trachomatis) infects baby in birth canal
Sx chlamydia infection in mum
Neonatal pneumponia and conjunctivitis
Which infections are women vaccinated against?
Flu and pertussis
TORCH screening
- 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
Toxoplasmosis infection
TP lives in animals and reproduces in cat gut
Pregnant women should avoid raw meat/unpasteurised dairy
Treatment for TP infection in mum
Serological and PCR studies on maternal blood, treatment with spiramycin
Varicella zoster virus
Chicken pox and shingles
Managing maternal VZV infection
Serology studies +/- VZV IGs
Mum needs acyclovir and delayed delivery so ABs pass to baby
Congenital varicella syndrome
If mum has chicken pox in T1 or T2 = scarring on limbs, brain, eyes, LBW
Neonatal NZN
Infection from 5 days pre-delivery to 2 days post
Why can we not vaccinate against VZV and rubella in pregnancy?
Live-attenuated so contra-indicated in pregnancy
Sx parvo b19
Slapped cheek/fifth disease
Mum has flu symptoms +/- rash
Treatment for Parvo b19 in pregnancy
None - do regular serum studies and ultrasounds
How does rubella spread?
Aerosolised droplets - causes flu symptoms with a rash
Symptoms of maternal rubella infection
<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
Cytomegalovirus infection sx
IUGR, hydrops fatalis, microcephaly, ventriculomegaly, hearing/vision loss
Managing maternal cytomegalovirus infection
Termination offered/antiviral agents like ganciclovir
Treatment for maternal HSV infection
Acyclovir
Sx of Zika virus for baby
Microcephaly
Neonatal sepsis
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
Sx neonatal sepsis
Altered temperature, raised RR, lethargy, poor feeding, quick deterioration
How do you treat neonatal sepsis?
ABx
How do you culture and treat neonatal sepsis
- Within 1h
- FBC, U and E, CRP
- Gas
- Urinalysis
- Urine culture and PCR
- Eye swabs
- Bloods
- CXR
- CSF
- ABx
Group B strep
Normal in gut and GIT but causes neonatal sepsis/pneumonia/meningitis
Sx include cerebral palsy if untreated
Listeria infection sx
Fever, aches, vomiting, miscarriage, still birth
Pueperal sepsis
Puerperium: ROM to day 42
Pueperal sepsis: sepsis mum in puerperium
