Infections in pregnancy Flashcards
What causes rubella
togavirus
Why should pregnant women not be offered the MMR vaccine
It is a live vaccine
When is the risk of damage to the fetus from congenital rubella syndrome highest
- in first 8-10 weeks risk of damage to fetus is as high as 90%
- damage is rare after 16 weeks
Give 5 features of congenital rubella syndrome
- Congenital sensorineural deafness
- Congenital cataracts
- Congenital heart disease (Patent ductus arteriosus)
- cerebral palsy
- ‘salt and pepper’ chorioretinitis
How is rubella in pregnancy managed
- non-immune mothers offered MMR vaccine postnatally
- suspected cases should be discussed with the local health protection unit
What is the recommendation for women regarding pregnancy after receiving the MMR
Women should avoid becoming pregnant for 28 days following receipt of the MMR vaccine
Give 5 features of congenital cytomegalovirus
- Low birth weight
- sensorineural deafness
- petechial ‘blueberry muffin’ skin lesions
- seizures
- Microcephaly
Give 4 RFs for group B streptococcus infection in neonates with infected mothers
- prematurity
- prolonged rupture of the membranes (>18h)
- previous sibling GBS infection
- maternal pyrexia e.g. secondary to chorioamnionitis
What is the criteria for maternal prophylactic treatment of group B strep in pregnant women
- women who have had group B detected in a previous pregnancy
- women with a previous baby with GBS
- women in preterm labour regardless of their GBS status
- women with a pyrexia during labour (>38ºC)
What is the prophylactic management of group B strep in pregnancy
- IV benzylpenicillin
- clindamycin/ vancomycin if penicillin CI
what causes toxoplasmosis
infection with toxoplasma gondii parasite
Give 3 ways toxoplasmosis is spread
- cat faeces
- soil
- eating infected meat
When is the risk of congenital toxoplasmosis higher during pregnancy?
risk is higher later in the pregnancy.
Give 3 features of congenital toxoplasmosis
- Intracranial calcification
- Hydrocephalus
- Chorioretinitis (inflammation of the choroid and retina in the eye)
How is herpes simplex virus-2 managed in pregnancy
- elective C-section at term is adviced if a primary attack of herpes occurs during pregnancy >28 weeks
- women with recurrent herpes who are pregnant should be treated with suppressive therapy
- aciclovir for exposed neonates
What are the complications of infection with parvovirus B19 in pregnancy
- miscarriage or fetal death
- severe fetal anaemia
- hydrops fetalis
Give 3 features of parvovirus B19
- diffuse red rash on both cheeks (slapped cheek syndrome)
- reticular erythematous rash affecting trunks/ limbs
- arthralgia
How is Hep B transmitted from pregnant women to babies
vertical transmission at delivery
How is Hep B in pregnancy managed
- all pregnant women are offered screening for hepatitis B
- neonatal vaccinations and hepatitis B immunoglobulin
- antivirals (tenofovir) from 32w in women with high viral loads
Give 2 pregnancy-related complications more common in HIV-infected women?
- pre-eclampsia
- gestational diabetes
Give 3 fetal complications associated with a HIV positive pregnant mother
- still birth
- growth restriction
- prematurity
When does vertical transmission of HIV from mother to baby typically occur?
- after 36 weeks gestation
- during labor (intrapartum)
- during breastfeeding
Give 4 methods to reduce vertical transmission of HIV in infected pregnant women
- maternal antiretroviral therapy
- mode of delivery (caesarean section)
- neonatal antiretroviral therapy
- bottle feeding (avoid breastfeeding)
What is the criteria for HIV screening in pregnant women
all pregnant women are offered HIV screening
How is HIV in pregnant women managed
- maternal antiretroviral therapy
- vaginal delivery if viral load <50 copies/ml at 36w
- prelabour caesarean if viral load >50 copies/ml
neonatal ART depends on mum’s viral load: - <50 copies/ ml: zidovudine for 2-4w
- > 50: triple ART for 4-6w
When should pregnant women be offered the pertussis vaccine
Between 16-32 weeks
