Infections in Pregnancy

Question 1

What are features of congenital rubella syndrome?

Answer 1

Sensorineural deafness
Congenital cataracts
Congenital heart disease
growth retardation
Hepatosplenomegaly
Purpuric skin lesions
Salts and pepper chorioretinitis
Micropthalmia
Cerebral Palsy

Question 2

What are clinical features of Rubella in pregnancy?

Answer 2

Develops 2-3 weeks post exposure
Rash- starts on face/neck and spreads to rest of body
Lymphadenopathy
Arthralgia
Low grade fever, Malaise, URTI symptoms

Question 3

What is the management?

Answer 3

Contact local health unit
IgG- ve should avoid exposure and get vaccine post natal
If rubella confirmed then refer to O&G
8-10 weeks 90% of CRS nothing can be done
>20 weeks reassure

Question 4

How should pregnant women with VZV exposure have infection prevented?

Answer 4

1) Take detailled history
2) Blood test to check immunity
- If VZ IgG +ve confirms immunity- reassure
- If VZ IgG -ve then manage as follows
Non immune and significant exposure
Offer Post Exposure Prophylaxis with oral anti-virals (aciclovir/valaciclovir) from days 7-14 post exposure
If PO antivirals contraindicated then VZIG for PEP up to 10 days post exposure

Question 5

What is the care for women who develop chickenpox?

Answer 5

1) PO aciclovir if presenting within 24 hours and >20 weeks
Severe chicken pox- IV aciclovir

Immunoglobulins not beneficial once rash develops

Question 6

What referrals are required for mums with chickenpox?

Answer 6

Refer to foetal medicine specialist at 16-20 weeks or 5 weeks post infection
Discuss risk/benefits of amniocentesis- wait till lesions have healed

Question 7

What are features of congenital toxoplasmosis?

Answer 7

Chorioretinitis
Hydrocephalus
Intracranial calcification