Infections in Pregnancy Flashcards
1
Q
What is the aetiology of chickenpox?
A
- Varicella-zoster virus
2
Q
How is varicella-zoster virus transmitted?
A
- Respiratory droplets
- Period of infectivity is from 48 hours before rash develops to once lesions have ‘crusted over’ (normally 5-7 days)
3
Q
How long is the period of infectivity for the varicella-zoster virus?
A
- Period of infectivity is from 48 hours before rash develops to once lesions have ‘crusted over’ (normally 5-7 days)
4
Q
What is the presentation of chickenpox?
A
- Children
- Fever
- Malaise
- Itchy, vasicular rash
- Usually harmless, self-limiting in children
- Adults
- Associated with greater morbidity – hepatitis, pneumonitis and encephalitis
5
Q
What are some infections that cause complications during pregnancy?
A
- Chickenpox
- Parvovirus B19
- Toxoplasmosis
- HIV
- Hepatitis B
- Hepatitis C
- Syphilis
6
Q
What are examples of infections that are screened for during pregnancy?
A
HIV, Hep B and syphilis are screened for at book in
7
Q
What investigations are done for chicken pox?
A
- 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
8
Q
Describe the management of chickenpox?
A
- 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
9
Q
What are possible complications of chicken pox in adults?
A
- 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
10
Q
What is parovirus B19 also known as?
A
- Slapped cheek disease
- Fifth disease
- Erythema infectiosum
11
Q
How is parovirus B19 transmitted?
A
- Respiratory droplets
12
Q
What is the presentation of parovirus B19?
A
- Children
- Mild, febrile illness
- Fever
- Rash
- Erythema of cheeks
- Adults
- Most are asymptomatic
13
Q
What investigations are done for parovirus B19?
A
- Blood tests for immunoglobulin testing
- If positive, offer weekly scans for foetal complications
14
Q
What is the management of parovirus B19?
A
- No vaccine or treatment available
15
Q
What are possible complications of parovirus B19?
A
- 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
16
Q
What is the aetiology of toxoplasmosis?
A
- Toxoplasma gondii parasite
17
Q
Describe the incidence of toxoplasmosis in pregnancy?
A
2/1000 pregnancies
18
Q
How is toxoplasma gondii parasite transmitted?
A
- Through cat faeces and undercooked meats by ingesting parasites
19
Q
What is the presentation of toxoplasmosis?
A
- Asymptomatic usually
- Or mild, flu like symptoms
- Fever, sore throat, coryza, arthralgia
20
Q
What investigations are done for toxoplasmosis?
A
PCR analysis of amniotic fluid obtained from amniocentesis
21
Q
Describe the management for toxoplasmosis?
A
- Advice pregnant woman to avoid cleaning cat litter and eating undercooked meat
22
Q
What are possible complications of toxoplasmosis?
A
- 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
23
Q
What investigations are done for HIV?
A
- Monitoring of LFT
- CD4 count and HIV viral load
24
Q
Describe the management of HIV?
A
- 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
25
At what viral load of HIV is vaginal birth still recomended?
26
What are possible complications of HIV during pregnancy?
* Increased risk of pre-eclampsia
* Miscarriage
* Preterm delivery
* Low birth weight
27
What is the incidence of hepatitis B?
* 1/1000 people infected
28
How is hepatitis B transmitted?
* Often by vertical transmission
* Bloods and other bodily fluids
29
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
30
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
31
What kind of virus is hepatitis C?
RNA virus
32
What is the prevalence of heptatis C in pregnant woman?
1-2%
33
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
34
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
35
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
36
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
37
What are possible complications of hepatitis C?
* Severe hepatitis
* Chronic liver disease
* Increased risk of liver cancer
38
What is the aetiology of syphilis?
* Spirochete treponema pallidum
39
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
40
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)
41
What is the management of syphilis?
* Cure with course of IM penicillin
42
What are possible complications of syphilis?
* Chronic syphilis can cause cardiac, neurological, skeletal and skin abnormalities
* Miscarriage
* Stillbirth
* Hydrops featlis
* Growth restriction
* Congenital infection
