Infections in Pregnancy Flashcards
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
How can women planning on becoming pregnant protect against congenital Rubella syndrome?
ensure they have had the MMR vaccine
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
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
What are the features of congenital rubella syndrome?
- congenital deafness
- congenital cataracts
- congenital heart disease
- pulmonary stenosis
- patent ductus arteriosus
- learning disability
What causes chickenpox?
Varicella zoster virus (VZV)
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)
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
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
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
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
When does congenital varicella syndrome occur?
if VZV infection occurs within the first 28 weeks of pregnancy
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
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
What is listeria and what type of infection does it produce?
- gram-positive bacteria that causes listeriosis
- listeriosis is much more likely in pregnancy
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 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
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
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
