Infections in Pregnancy Flashcards
What is the aetiology of chickenpox?
- Varicella-zoster virus
How is varicella-zoster virus transmitted?
- Respiratory droplets
- Period of infectivity is from 48 hours before rash develops to once lesions have ‘crusted over’ (normally 5-7 days)
How long is the period of infectivity for the varicella-zoster virus?
- Period of infectivity is from 48 hours before rash develops to once lesions have ‘crusted over’ (normally 5-7 days)
What is the presentation of chickenpox?
- Children
- Fever
- Malaise
- Itchy, vasicular rash
- Usually harmless, self-limiting in children
- Adults
- Associated with greater morbidity – hepatitis, pneumonitis and encephalitis
What are some infections that cause complications during pregnancy?
- Chickenpox
- Parvovirus B19
- Toxoplasmosis
- HIV
- Hepatitis B
- Hepatitis C
- Syphilis
What are examples of infections that are screened for during pregnancy?
HIV, Hep B and syphilis are screened for at book in
What investigations are done for chicken pox?
- If exposed but unsure check immunity status by taking serum IgG
- If immune (IgG positive) reassure, if non-immune (IgG negative) offer VZ immunoglobulin as soon as possible
Describe the management of chickenpox?
- Advice to avoid contact with susceptible individuals
- If mild and present within 24 hours of onset of rash
- Oral acyclovir
- If mild and present after 24 hours
- Acyclovir has no role, advice symptomatic treatment and hygiene to prevent secondary bacterial infection
- If severe
- IV acyclovir and admit to hospital
What are possible complications of chicken pox in adults?
- Greater risk of complications in immunocompromised and pregnant woman
- Congenital infection if in first 28 weeks of pregnancy
- Foetal varicella syndrome
- Skin scarring, congenital eye abnormalities, hypoplasia of ipsilateral limbs, neurological abnormalities, no increased risk of miscarriage
- Infection in new-born if infection in last 4 weeks gestation
- Shingles
- Caused by activation of dormant chickenpox virus that was in sensory route ganglion since primary infection
What is parovirus B19 also known as?
- Slapped cheek disease
- Fifth disease
- Erythema infectiosum
How is parovirus B19 transmitted?
- Respiratory droplets
What is the presentation of parovirus B19?
- Children
- Mild, febrile illness
- Fever
- Rash
- Erythema of cheeks
- Adults
- Most are asymptomatic
What investigations are done for parovirus B19?
- Blood tests for immunoglobulin testing
- If positive, offer weekly scans for foetal complications
What is the management of parovirus B19?
- No vaccine or treatment available
What are possible complications of parovirus B19?
- In immunocompromised patients can cause a-platelet anaemia and haemolysis
- During pregnancy can cause foetal anaemia resulting in cardiac failure, hydrops fatalis and foetal death
- Can cause pre-eclampsia in pregnant mother
- Critical exposure period is 12-20 weeks
- Foetal infection is 5 weeks after maternal infection
What is the aetiology of toxoplasmosis?
- Toxoplasma gondii parasite
Describe the incidence of toxoplasmosis in pregnancy?
2/1000 pregnancies
How is toxoplasma gondii parasite transmitted?
- Through cat faeces and undercooked meats by ingesting parasites
What is the presentation of toxoplasmosis?
- Asymptomatic usually
- Or mild, flu like symptoms
- Fever, sore throat, coryza, arthralgia
What investigations are done for toxoplasmosis?
PCR analysis of amniotic fluid obtained from amniocentesis
Describe the management for toxoplasmosis?
- Advice pregnant woman to avoid cleaning cat litter and eating undercooked meat
What are possible complications of toxoplasmosis?
- Serious complications occur rarely
- Chorioretinitis
- Encephalitis
- Myocarditis
- Pneumonitis
- Parasitaemia occurs within 3 weeks of ingestion
- Foetal complications
- Hydrocepahlus
- Intracranial calcifications
- Microcephaly
- Chorioretinitis
- Ventriculomegaly
- Miscarriage and intrauterine death
What investigations are done for HIV?
- Monitoring of LFT
- CD4 count and HIV viral load
Describe the management of HIV?
- MDT input throughout pregnancy
- Obstetric consultant team, community midwifery team, HIV specialist, neonatologist, GP
- Offer 4 weekly foetal scans
- Refer to neonatology for HIV testing on new-born
- Combined anti-HIV viral medications (cART)
- Aims are viral load <50 HIV RNA copies/ml (allow for vaginal delivery), reduce risk of vertical transmission, improve mothers health
- Breast feeding increases risk of vertical transmission
At what viral load of HIV is vaginal birth still recomended?
What are possible complications of HIV during pregnancy?
- Increased risk of pre-eclampsia
- Miscarriage
- Preterm delivery
- Low birth weight
What is the incidence of hepatitis B?
- 1/1000 people infected
How is hepatitis B transmitted?
- Often by vertical transmission
- Bloods and other bodily fluids
Describe the management for hepatitis B?
- For woman with chronic Hep B and high viral load
- Tenofovir monotherapy in 3rd trimester to reduce risk of vertical transmission
- Hep B vaccine can be given to pregnant woman who are high risk due to it being inactive
- High risk includes IV drug users, partner who is IV drug user or HBV or HIV positive
- Hep B immunoglobulin to new-born and accelerated immunisation schedule (initial dose of vaccine at birth, with more doses at 4 weeks, 8 weeks and 12 months)
- Test for Hep B at 12 months for chronic infection
What are possible complications of hepatitis B during pregnancy?
- Baby contracts Hep B at birth, putting them at risk of liver cirrhosis and hepatocellular cancer
What kind of virus is hepatitis C?
RNA virus
What is the prevalence of heptatis C in pregnant woman?
1-2%
How is hepatitis C transmitted?
- Vertical transmission
- Occurs in 1/20 birth, risk higher if woman co-infected with HIV
- IV drug users
- Not from breastfeeding
Is heptatis C screened for?
- Not part of routine antenatal screening, but indications for screening are
- Substance misusing pregnant woman
- Previous history of IV drug use
- Current or previous partner has history of IV drug use
- Pregnant woman is HIV or Hep B positive
What are indications for screening for hepatitis C?
- Substance misusing pregnant woman
- Previous history of IV drug use
- Current or previous partner has history of IV drug use
- Pregnant woman is HIV or Hep B positive
Describe the management for hepatitis C?
- No means to stop transmission from mother to baby
- No treatment during pregnancy as drugs are teratogenic and therefore contraindicated
What are possible complications of hepatitis C?
- Severe hepatitis
- Chronic liver disease
- Increased risk of liver cancer
What is the aetiology of syphilis?
- Spirochete treponema pallidum
How is syphilis transmitted?
- Direct contact with skin lesion, usually occurs during sexual contact
- Infection more than once is possible, no immunity acquired due to production of no antibodies
What is the presentation of syphilis?
- Primary syphilis
- Painless, local ulcer
- If untreated, 4-10 weeks later symptoms of secondary syphilis may develop, and then tertiary syphilis (takes 20-40 years)
- Congenital infection presents within first 2 years of life or later
- Most are asymptomatic at birth but have symptoms within 5 weeks
- Hutchinson’s triad – deafness, interstitial keratitis, hutchinson’s teeth (widely spaced, peg like)
What is the management of syphilis?
- Cure with course of IM penicillin
What are possible complications of syphilis?
- Chronic syphilis can cause cardiac, neurological, skeletal and skin abnormalities
- Miscarriage
- Stillbirth
- Hydrops featlis
- Growth restriction
- Congenital infection
