Infections in Pregnancy

Question 1

What are the symptoms of chicken pox?

Answer 1

Fever, malaise and vesicular rash

Question 2

What is the period of infectivity of chicken pox?

Answer 2

48hrs before rash develops to once the lesions have crusted over
Normally 5-7 days after rash appears

Question 3

In adults with chicken pox, what conditions are at risk of developing?

Answer 3

Hepatitis, pneumonitis and encephalitis

Question 4

When is foetal infection risk the highest during pregnancy if the mother has chicken pox?

Answer 4

In last 4 weeks
Foetal varicella syndrome can occur

Question 5

What can foetal varicella syndrome cause?

Answer 5

Skin scarring, neuro. abnormalities, congenital eye abnormalities, hypoplasia of ipsilateral limbs and no increased risk of miscarriage

Question 6

How is immunity for chicken pox tested?

Answer 6

Serum IgG test
If positive then offer VZ immunoglobulin ASAP

Question 7

What is the management for chicken pox during pregnancy if mild?

Answer 7

Presents within 24hrs of rash
If under 20 weeks gestation - oral aciclovir
Over 20 weeks gestation - advise symptomatic treatment and hygiene

Question 8

What is the management for chicken pox during pregnancy if severe?

Answer 8

Give IV aciclovir and admit to hospital

Question 9

What can parvovirus B19 also be called?

Answer 9

Slapped cheek disease, fifth disease or erythema infectosum

Question 10

How is parvovirus B19 spread?

Answer 10

By resp. secretions
50% of pregnancy

Question 11

What are the symptoms of parvovirus B19?

Answer 11

Fever, rash and erythema of cheeks
Most adults are asymptomatic

Question 12

What can parvovirus B19 in immunocompromised person cause?

Answer 12

Aplastic anaemia and haemolysis
Infection in pregnancy can lead to foetal anaemia leading to cardiac failure, hydrops fetalis and foetal death

Question 13

What is the critical exposure period of parvovirus B19?

Answer 13

12-20 weeks
Foetal infection is 5 weeks after maternal infection

Question 14

What is toxoplasmosis caused by?

Answer 14

Protozoal organism - toxoplasma gondi
Usually transmitted from infected cat faeces and undercooked meat

Question 15

What are the symptoms of toxoplasmosis?

Answer 15

Mostly asymptomatic
Mild flu like symptoms - fever, sore throat, coryza and arthralgia

Question 16

What are the severe complications of toxoplasmosis?

Answer 16

Chorioretinitis, encephalitis, myocarditis and pneumonitis

Question 17

When does parasitaemia occur in toxoplasmosis?

Answer 17

3 weeks after ingestion

Question 18

What are the foetal complications of toxoplasmosis?

Answer 18

hydrocephalus, intracranial calcifications, microcephaly, chorioretinitis, ventriculomegaly, IUGR, ascites and hepatosplenomegaly

Question 19

What investigation is used for toxoplasmosis during pregnancy?

Answer 19

PCR analysis of amniotic fluid from amniocentesis

Question 20

What does HIV increase the risk of during pregnancy?

Answer 20

Pre-eclampsia, miscarriage, preterm delivery and low birth weight

Question 21

What are the aims of cART?

Answer 21

Viral load under 50 RNA copies
Reduce risk of vertical transmission
Improve mothers health
Continue cART postnatally

Question 22

What is reviewed in women if have HIV during pregnancy?

Answer 22

LFTs, CD4 and HIV load

Question 23

What is the guidelines on delivery if women has HIV?

Answer 23

If HIV load is under 50 then vaginal birth is supported
If 50-399 prelabour CS is considered between 38 and 39 weeks
If over 400 then prelabour CS between 38 and 39 weeks

Question 24

How is hepatitis B spread?

Answer 24

Vertical transmission, bloods and bodily fluids

Question 25

What are babies at risk of if born from a mother with hep B?

Answer 25

Hep B at birth
Later risk of cirrhosis and hepatocellular cancer

Question 26

What is given to women with chronic HBV with high viral load?

Answer 26

Tenofovir monotherapy in 3rd trimester to reduce transmission to baby

Question 27

What women are at high risk of Hep B and can get the vaccine?

Answer 27

IVDU, partner is IVDU or has HBV or HIV

Question 28

Is vaginal birth safe in hepatitis B?

Answer 28

Yes

Question 29

What is offered to babies if born from a mother with hep B?

Answer 29

Hep B immunoglobulin
Accelerated immunisation schedule
Initial dose of vaccine at birth

Question 30

What can hepatitis C lead to?

Answer 30

Severe hepatitis, CLD and liver cancer
Decline in liver function

Question 31

What are the indications for screening of hepatitis C?

Answer 31

Substance misuse, previous IVDU, HIV or hep B positive and deranged LFTs

Question 32

How is hepatitis C treated in pregnancy?

Answer 32

Not treated in pregnancy
Vaginal birth and breast feeding are safe

Question 33

What causes syphilis?

Answer 33

Spriochete treponema palladium
Direct contact with skin lesion

Question 34

How is syphilis cured?

Answer 34

IM injection of penicillin

Question 35

What can untreated syphilis lead to?

Answer 35

Neuro, cardio, skeletal and skin problems

Question 36

What is syphilis associated with during pregnancy?

Answer 36

Miscarriage, stillbirth, hydrops fetalis, growth restriction, congenital infection and serious morbidity

Question 37

How does syphilis spread to baby if mother has it?

Answer 37

Trans placentally or exposure of infected lesion

Question 38

What is syphilis characterised by?

Answer 38

Painless local ulcer - canker

Question 39

When can congenital infection of syphilis present?

Answer 39

First 2 years of life - most asymptomatic at birth then multisystem disease can occur

Question 40

Describe late congenital syphilis

Answer 40

Usually 2 years old
Hutchinson’s triad - teeth are notched, deafness and interstitial keratitis
Treatment with penicillin