Infections in Pregnancy

Question 1

clinical features of chickenpox

Answer 1

• fever
• malaise
• itchy vesicular rash

Question 2

what is the period of infectivity of chickenpox?

Answer 2

48hrs before rash develops to once lesions have ‘crusted’ over
- usually takes 5-7 days

Question 3

Fetal Varicella Syndrome occurs in 2% of cases of maternal primary chickenpox. What fetal issues can it cause?

Answer 3

• skin scarring
• neurological abnormalities
• congenital eye abnormalities
• hypoplasia of ipsilateral limbs
• no increased risk miscarriage

Question 4

what is the next step if a pregnant woman has had significant exposure to varicella infection, but in unsure if she is immune?

Answer 4

• check immunity status by taking serum IgG
• if immune (IgG positive) > reassure
• if non-immune (IgG negative) > offer varicella zoster immunoglobulin ASAP

Question 5

what do you do if a pregnant woman does develop chickenpox?

Answer 5

• inform GP
• avoid contact with potentially susceptible individuals e.g. other pregnanct women, neonates until lesions crusted over.
• Mild infection (if presents within 24hrs from onset of rash): > 20 weeks gestation offer oral aciclovir. Also consider if under 20 weeks gestation. Advise symptomatic treatment and hygiene.
• Mild infection (if presents > 24hrs from onset of rash): advise symptomatic treatment and hygiene to prevent secondary bacterial infection.
• severe infection: give IV aciclovir, admit to hospital

Question 6

how does parvovirus B19 typically present?

Answer 6

• fever
• rash
• erythema of the cheeks

Question 7

what complications in pregnancy can parvovirus B19 cause?

Answer 7

• fetal anaemia
• fetal cardiac failure
• hydrops fetalis
• fetal death

Question 8

which is the most critical time period for exposure to parvovirus B19 during pregnancy?

Answer 8

12-20 weeks
- from maternal infection, it usually takes 5 weeks before their are signs of fetal infection

Question 9

if a pregnant women reports possible exposure to parvovirus B19 or possible illness, what are the next steps?

Answer 9

• blood samples should be taken for immunoglobulin testing
• if positive > weekly scans are offered to monitor for fetal complications

Question 10

toxoplasmosis clinical features

Answer 10

• usually asymptomatic in adults but may cause mild, flu-like symptoms e.g. fever, sore throat, coryza, arthralgia

Question 11

list the serious complications of toxoplasmosis

Answer 11

• chorioretinitis
• encephalitis
• myocarditis
• pneumonitis

Question 12

what are the possible fetal complications of toxoplasmosis?

Answer 12

• hydrocephalis
• intracranial calcifications
• microcephaly
• chorioretinitis
• ventriculomegaly
• IUGR
• ascites
• hepatosplenomegaly
• miscarriage and intrauterine death

Question 13

maternal infection of toxoplasmosis in which trimester puts the fetus at the highest risk?

Answer 13

third trimester

Question 14

how can fetal infection with toxoplasmosis be diagnosed?

Answer 14

PCR of amniotic fluid

Question 15

Hiv increases the risk of what during pregnancy?

Answer 15

• pre-eclampsia
• miscarriage
• preterm delivery
• low birth weight

Question 16

list the aims of combined anti-retroviral treatment (cART) in a pregnant woman

Answer 16

1. viral load < 50 HIV RNA copies/ml (allows vaginal delivery)
2. reduce risk of vertical transmission (avoid breastfeeding)
3. improve mothers health

Question 17

pregant women with chronic hepatitis b virus with a high viral load should be offered which treatment?

Answer 17

• tenofovir monotherapy in the 3rd trimester to reduce the risk of transmission of hepatitis B to the baby

Question 18

what is the management of a baby who has been born to a mother with hepatitis B infection?

Answer 18

• hepatitis b immunoglobulin
• accelerated immunisation schedule
• initial dose of vaccine at birth, within 24hrs of delivery, with further doses at 4 weeks and 8 weeks and a fourth dose at 12 months of age
• test for hepatitis at 1 year of age

Question 19

if a pregnant woman if infected with syphilis there is an increased risk of…

Answer 19

• miscarriage
• stillbirth
• hydrops fetalis
• growth restriction
• congenital infection

Question 20

if a pregnant woman is positive for syphilis infection, what is the treatment?

Answer 20

• intramuscular penicillin

Question 21

what is Hutchinson’s triad?

Answer 21

A triad of symptoms frequently found in children with syphilis contracted transplacentally:
- deafness
- interstitial keratitis
- Hutchinson’s teeth: widely spaced, peg-like