Infections in Pregnancy Flashcards by Charlotte Tebbutt

What causes congenital Rubella syndrome?

maternal infection with the rubella virus during the first 20 weeks of pregnancy
risk is highest during the first 10 weeks

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How can women planning on becoming pregnant protect against congenital Rubella syndrome?

ensure they have had the MMR vaccine

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If someone is unsure whether they have had the MMR vaccine, what is done?

test for rubella immunity by determining the presence of rubella antibodies
if these are NOT** present, **2 doses** of the MMR are given, **3 months apart

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When should the MMR vaccine be given in pregnancy?

!! pregnant women should NOT receive the MMR vaccine !!

it is a live vaccine
non-immune women are offered the vaccine after giving birth

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What are the features of congenital rubella syndrome?

congenital deafness
congenital cataracts
congenital heart disease
- pulmonary stenosis
- patent ductus arteriosus
learning disability

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What causes chickenpox?

Varicella zoster virus (VZV)

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Why is chickenpox dangerous during pregnancy?

more severe cases in the mother
- varicella pneumonitis
- varicella encephalitis
- varicella hepatitis
fetal varicella syndrome
severe neonatal varicella infection (if infected around delivery)

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If in doubt about immunity to VZV, what is done?

IgG levels for VZV are tested
if they are positive, this indicates immunity and no risk of infection during pregnancy
if negative, a vaccination is offered before or after pregnancy

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What is the risk to pregnant women who have previously had chickenpox?

there is NO risk
if VZV IgG levels are positive, this indicates previous infection

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How should women who are not immune to VZV be treated?

IV varicella immunoglobulins

this is given as prophylaxis against developing chickenpox
it is given within 10 days of exposure

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If a chickenpox rash starts in pregnancy, what can be done?

oral aciclovir

given if woman presents within 24 hours

AND

she is more than 20 weeks gestation

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When does congenital varicella syndrome occur?

if VZV infection occurs within the first 28 weeks of pregnancy

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What are the features of congenital varicella syndrome?

fetal growth restriction
microcephaly / hydrocephalus
learning disability
scars / skin changes located in specific dermatomes
limb hypoplasia
cataracts / chorioretinitis

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What is chorioretinitis?

a type of posterior uveitis characterised by inflammation of the choroid and retina

the choroid contains blood vessels that bring oxygen / nutrients to the eye
it is between the sclera and the retina

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What is listeria and what type of infection does it produce?

gram-positive bacteria that causes listeriosis
listeriosis is much more likely in pregnancy

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How does listeriosis infection in the mother present?

may be asymptomatic
may have a flu-like illness
rarely can present with pneumonia or meningoencephalitis

What are the complications associated with listeriosis in pregnancy?

high rate of miscarriage** or **fetal death
can cause severe neonatal infection

How can listeriosis be avoided in pregnancy?

listeria is transmitted by unpasteurised dairy products, processed meats + contaminated foods
women are advised to avoid high-risk foods (e.g. blue cheese)

What causes congenital cytomegalovirus infection?

How is it spread?

occurs due to CMV infection of the mother during pregnancy
most cases of CMV do not result in congenital CMV
it is spread via infected saliva or urine of asymptomatic children

What are the features of congenital CMV?

fetal growth restriction
microcephaly
hearing loss
vision loss
learning difficulty
seizures

How is the Toxoplasma gondii parasite transmitted?

contamination with faeces from a cat that is a host of the parasite

How does Toxoplasma gondii infection present?

What happens when it occurs during pregnancy?

infection is usually asymptomatic
it can lead to congenital toxoplasmosis if contracted during pregnancy
the risk is higher later in the pregnancy

What is the triad of features associated with congenital toxoplasmosis?

intracranial calcification
hydrocephalus
chorioretinitis (cotton-like white/yellow scars on the retina)

What is the triad of features associated with congenital toxoplasmosis?

intracranial calcification
hydrocephalus
chorioretinitis

Who is typically affected by Parvovirus B19 infection? How does the illness progress?

* typically affects **children** * illness is **self-limiting** with the rash / symptoms resolving **within 1-2 weeks** * also called ***_“slapped cheek syndrome”_***, *fifth disease* or *erythema infectiosum*

What are the symptoms associated with Parvovirus B19 infection?

* starts with **non-specific viral symptoms** * after **2-5 days**, a **_diffuse bright red rash**_ appears rapidly across _**both cheeks_** * a few days later, a **_reticular mildly erythematous rash**_ affects the _**trunk / limbs_** * *reticular = “net-like”* * *can be raised / itchy*

When is someone with Parvovirus B19 infection classed as infectious?

**_7 - 10 days before_** the rash appears * they are NOT infectious once the rash has appeared

What is classed as significant exposure to parvovirus?

* **_15 minutes_** in the **same room** as someone with parvovirus OR * **face-to-face contact** with someone with parvovirus

What are the complications associated with parvovirus B19 infection in pregnancy?

* miscarriage / fetal death * severe **_fetal anaemia_** * **_hydrops fetalis_** (fetal heart failure) * maternal **_pre-eclampsia-like syndrome_** ***!! most likely in the first or second trimester !!***

Why does fetal anaemia + heart failure occur in parvovirus B19 infection?

* fetal anaemia is caused by parvovirus infection of the **_erythroid progenitor cells_** in the **fetal bone marrow / liver** * these **make RBCs** * infection causes production of **_faulty RBCs**_ that have a _**shorter life span_** * less RBCs = anaemia * the anaemia leads to **heart failure** (hydrops fetalis)

What is maternal pre-eclampsia-like-syndrome and why does it occur?

* also called ***“mirror syndrome”*** * occurs as a result of **severe fetal heart failure** * involves a triad of: * *hydrops fetalis* * *placental oedema / placetomegaly* * *oedema in the mother* * also associated with **_hypertension + proteinuria_**

What tests are required in women suspected to have parvovirus B19 infection?

**_IgM to parvovirus:_** * tests for acute infection within the ***past 4 weeks*** **_IgG to parvovirus:_** * tests for ***long term immunity*** to the virus after a previous infection **_Rubella antibodies:_** * as a differential diagnosis

What is the treatment for parvovirus B19 infection during pregnancy?

treatment is **_supportive_** * women are referred to fetal medicine to monitor for complications / malformations

How is the Zika virus spread?

* by the ***Aedes mosquito*** in areas of the world where the virus is prevalent OR * **having sex** with an infected individual

What are the symptoms of Zika virus?

* it often causes **no symptoms** * can cause a **mild flu-like illness**

What are the features of congenital Zika syndrome?

* microcephaly * fetal growth restriction * intracranial abnormalities * *ventriculomegaly* * *cerebellar atrophy*

How are women tested to see if they have contracted Zika virus? What is the treatment?

* tested with **viral PCR** and **antibodies** to the Zika virus * anyone with a positive result is referred to fetal medicine for close monitoring * there is **_NO treatment_**