infections in pregnancy Flashcards
what causes congenital rubella syndrome and when is the highest risk?
Caused by maternal infection with rubella virus in first 20 weeks
-highest risk <8-10 weeks
what should women who are planning to get pregnant do to protect them from rubella?
women planning to get pregnant should receive MMR vaccine
-if in doubt can check antibody levels to test for rubella immunity
what should non rubella immune pregnant women do?
-they should NOT receive MMR during pregnancy as it is a live attenuated vaccine
-should be offered the vaccine after giving birth
how does congenital rubella syndrome present?
Triad of:
-Cataracts (congenital blindness)
-Congenital deafness
-Cardiac abnormalities (PDA + pulmonary stenosis)
apart from congenital rubella syndrome- what can a rubella infection cause in pregnancy?
-miscarriage
-still birth
-other birth defects
how does rubella present?
-Fever
-Rash that starts on face and spreads across the body
-lymphadenopathy
-polyarthritis
management of rubella in pregnancy?
Rubella specific IgG antibody can be detected after natural infection or vaccination
-Blood IgM should be done within 10 days of exposure
-If patient not immune consider TOP
-Avoid contact with other pregnant women
suspected cases should be discussed with the local health protection unit
what causes measles?
paramyxovirus
Symptoms of measles?
-fever
-white spots inside mouth (Koplik spots)
-Runny nose
-Cough
-Red eyes
-Rash
what can measles cause in pregnancy?
Non teratogenic!
Can cause very high fever though:
-IUGR
-Microcephaly
-Miscarriage
-Stillbirth and Preterm birth
management of measles in pregnancy?
supportive care
what causes chicken pox?
varicella zoster virus (VZV)
how is chicken pox transmitted?
transmission mainly via droplets
symptoms of chicken pox?
-fever
-malaise
-vesicular rash
are women who have previously been infected with varicella zoster virus at risk?
No
-previous infection of varicella zoster means they are safe
what should be done if women are not sure about their varicella zoster immunity?
Test their VZV IgG levels
-if positive they are safe
what should be done when a rash starts after chicken pox exposure?
if they present within 24 hours and are >20 weeks give oral aciclovir
management of exposure to chicken pox <20 weeks?
<20 weeks give VZIG
when would congenital varicella syndrome occur?
Usually if there is a varicella zoster infection within the first 28 weeks
Presentation of congenital varicella syndrome?
-fetal growth restriction
-Microcephaly, hydrocephalus and learning disability
-Scars and significants skin changes located in specific dermatomes
-Limb hypoplasia (underdeveloped limbs)
-Cataracts and inflammation in the eye (chorioretinitis)
is listeria gram positive or gram negative?
gram positive
is listeriosis more common in pregnant or non pregnant individuals?
much more common in pregnant individuals
how does listeriosis present?
infection in the mother may be asymptomatic or cause a flu like illness
-less commonly cause pneumonia or meningoencephalitis
how is listeria transmitted?
-pasteurised dairy products, processed meats and contaminated foods
e.g. pate and soft cheese
fetal complications if mother is infected with listeriosis?
-Miscarriage
-Fetal death (due to spepticaemia)
-Severe neonatal infection
-Stillbirth
-Preterm labour
treatment- listeriosis?
Ampicillin + gentamicin
Trimethoprim + sulfamethoxazole
what foods should be avoided- listeriosis?
Unpasteurized milk, soft cheese, refrigerated smoked seafood (salmon, trout, cod)
what causes a CMV infection?
-human herpes virus family group
how is CMV infection spread?
usually spread via infected saliva or urine of asymptomatic children
complications of CMV in pregnancy?
Miscarriage, stillbirth, IUGR, microcephaly, mental retardation
Most causes do not cause congenital CMV
-but congenital CMV is a potential complication
presentation of congenital cytomegalovirus?
HEARING LOSS= BIG ONE
-Fetal growth restriction
-Microcephaly
-Hearing loss
-Vision loss
-Learning disability
-Seizures
management of CMV infection?
Check IgG levels in previous seronegative mother
if positive= Valocyclovir
what is Parvovirus also known as?
slapped cheek syndrome
OR
erythema infectiosum
what causes slapped cheek syndrome AKA erythema infectiosum?
Parvovirus B19
presentation of Parvovirus infection?
-Starts with non specific viral symptoms
usually in children
after 2-5 days:
-rash appears quite rapidly as a diffuse bright red rash on both cheeks (slapped cheek)
-Few days later a reticular mildly erythematous rash affecting the trunk and limbs appears (net like rash)
what can being infected with parvovirus in pregnancy leads to?
Infections with Parvovirus B19 in pregnancy can leaf to:
-Hydops fetalis (fetal heart failure)
-Miscarriage or fetal death
-Severe fetal anaemia
-Maternal pre eclampsia like syndrome
management if infected with Parvovirus?
Diagnostic test- Detection of virus with specific IgM
Avoid contact with other children and pregnant women, but only contagious 7-10 days before rash and 24 hours after
Referal to fetal medicine
complications of mumps infection in pregnancy?
No ill effects on pregnancy
remember MMR is CI in pregnancy
is influenzae virus safe during pregnancy and breast feeding?
yes
how does congenital zika syndrome present?
-Microcephly
-Fetal growth restriction
-Caranial abnormalities (ventriculomegaly and cerebellar atrophy)
can HIV be passed through pregnancy and what may affect this?
yes there is vertical transmission of 14-25%
-higher in preterm birth and prolonged rupture of membranes
-lower if viral load is undetectable
what is offered in labour against Group B streptococcus?
Penicillin
what treatment is given for chlamydia in pregnancy?
-erythromycin and amoxicillin
