Infections in Pregnancy Flashcards
What are the symptoms of chicken pox?
Fever, malaise and vesicular rash
What is the period of infectivity of chicken pox?
48hrs before rash develops to once the lesions have crusted over
Normally 5-7 days after rash appears
In adults with chicken pox, what conditions are at risk of developing?
Hepatitis, pneumonitis and encephalitis
When is foetal infection risk the highest during pregnancy if the mother has chicken pox?
In last 4 weeks
Foetal varicella syndrome can occur
What can foetal varicella syndrome cause?
Skin scarring, neuro. abnormalities, congenital eye abnormalities, hypoplasia of ipsilateral limbs and no increased risk of miscarriage
How is immunity for chicken pox tested?
Serum IgG test
If positive then offer VZ immunoglobulin ASAP
What is the management for chicken pox during pregnancy if mild?
Presents within 24hrs of rash
If under 20 weeks gestation - oral aciclovir
Over 20 weeks gestation - advise symptomatic treatment and hygiene
What is the management for chicken pox during pregnancy if severe?
Give IV aciclovir and admit to hospital
What can parvovirus B19 also be called?
Slapped cheek disease, fifth disease or erythema infectosum
How is parvovirus B19 spread?
By resp. secretions
50% of pregnancy
What are the symptoms of parvovirus B19?
Fever, rash and erythema of cheeks
Most adults are asymptomatic
What can parvovirus B19 in immunocompromised person cause?
Aplastic anaemia and haemolysis
Infection in pregnancy can lead to foetal anaemia leading to cardiac failure, hydrops fetalis and foetal death
What is the critical exposure period of parvovirus B19?
12-20 weeks
Foetal infection is 5 weeks after maternal infection
What is toxoplasmosis caused by?
Protozoal organism - toxoplasma gondi
Usually transmitted from infected cat faeces and undercooked meat
What are the symptoms of toxoplasmosis?
Mostly asymptomatic
Mild flu like symptoms - fever, sore throat, coryza and arthralgia
What are the severe complications of toxoplasmosis?
Chorioretinitis, encephalitis, myocarditis and pneumonitis
When does parasitaemia occur in toxoplasmosis?
3 weeks after ingestion
What are the foetal complications of toxoplasmosis?
hydrocephalus, intracranial calcifications, microcephaly, chorioretinitis, ventriculomegaly, IUGR, ascites and hepatosplenomegaly
What investigation is used for toxoplasmosis during pregnancy?
PCR analysis of amniotic fluid from amniocentesis
What does HIV increase the risk of during pregnancy?
Pre-eclampsia, miscarriage, preterm delivery and low birth weight
What are the aims of cART?
Viral load under 50 RNA copies
Reduce risk of vertical transmission
Improve mothers health
Continue cART postnatally
What is reviewed in women if have HIV during pregnancy?
LFTs, CD4 and HIV load
What is the guidelines on delivery if women has HIV?
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
How is hepatitis B spread?
Vertical transmission, bloods and bodily fluids
What are babies at risk of if born from a mother with hep B?
Hep B at birth
Later risk of cirrhosis and hepatocellular cancer
What is given to women with chronic HBV with high viral load?
Tenofovir monotherapy in 3rd trimester to reduce transmission to baby
What women are at high risk of Hep B and can get the vaccine?
IVDU, partner is IVDU or has HBV or HIV
Is vaginal birth safe in hepatitis B?
Yes
What is offered to babies if born from a mother with hep B?
Hep B immunoglobulin
Accelerated immunisation schedule
Initial dose of vaccine at birth
What can hepatitis C lead to?
Severe hepatitis, CLD and liver cancer
Decline in liver function
What are the indications for screening of hepatitis C?
Substance misuse, previous IVDU, HIV or hep B positive and deranged LFTs
How is hepatitis C treated in pregnancy?
Not treated in pregnancy
Vaginal birth and breast feeding are safe
What causes syphilis?
Spriochete treponema palladium
Direct contact with skin lesion
How is syphilis cured?
IM injection of penicillin
What can untreated syphilis lead to?
Neuro, cardio, skeletal and skin problems
What is syphilis associated with during pregnancy?
Miscarriage, stillbirth, hydrops fetalis, growth restriction, congenital infection and serious morbidity
How does syphilis spread to baby if mother has it?
Trans placentally or exposure of infected lesion
What is syphilis characterised by?
Painless local ulcer - canker
When can congenital infection of syphilis present?
First 2 years of life - most asymptomatic at birth then multisystem disease can occur
Describe late congenital syphilis
Usually 2 years old
Hutchinson’s triad - teeth are notched, deafness and interstitial keratitis
Treatment with penicillin
