Infections in pregnancy

Question 1

Considerations

Answer 1

Maternal illness may be worse
Maternal complications
Preterm labour
Vertical transmission
Neurological damage
Antibiotic usage may be limited

Question 2

CMV

Answer 2

1% pregnant women, usually subclinical
40% vertical transmission
10% infected foetuses severely affected
At birth: IUGR, pneumonia, thrombocytopenia
Neurological sequelae: deafness; visual and mental impairment; death
No screening, vaccine or treatment

Question 3

HSV

Answer 3

Common
Not teratogenic
Neonatal infection rare but has high mortality
C-section indicated if delivery <6w from primary infection
Acyclovir

Question 4

Rubella

Answer 4

Rare (most women immune)
Maternal infection: Mild fever, maculopapular rash
High percentage of foetuses affected if infection <16w, TOP offered
Screening at booking to establish those who need vaccine at end of pregnancy
Vaccine live and contraindicated in pregnancy

Question 5

Toxoplasmosis

Answer 5

Cat faeces, soil, infected meat
Low percentage foetuses severely affected
Mental retardation, convulsions, spasticities, visual impairment
Health education
Spiramycin, combination therapy if vertical transmission

Question 6

Herpes zoster

Answer 6

Severe maternal illness
Teratogenic (1-2%) in early pregnancy
Severe neonatal infection if maternal infection in 4 weeks prior to delivery
Ig to prevent
Oral acyclovir to treat
Neonates closely monitored/given IgG
Vaccination possible

Question 7

Parvovirus

Answer 7

‘Slapped cheek’, arthralgia, asymptomatic
Foetal erythropoiesis suppression => anaemia => hydrops; thrombocytopenia; foetal death
Surveillance for anaemia; foetal blood transfusion in severe hydrops

Question 8

Group B strep

Answer 8

25% pregnant women
Mother asymptomatic
Foetus: infected during labour after ROM; neonatal sepsis; 6% mortality (term) 18% (preterm)
Currently: no screening; treat with IV penicillin in labour if: previous hx, fever >38C, current preterm labour, ROM >18h
(talk about a third trimester screen)

Question 9

Hep B

Answer 9

Important thing: High neonate transmission; 90% infected neonates become chronic carriers, compared to 10% adults; high neonatal mortality
Maternal screening
Neonatal immunisation

Question 10

HIV

Answer 10

Maternal: increased pre-eclampsia (?and GDM)
Foetal: stillbirth, pre-eclampsia, IUGR, prematurity
Risk of vertical transmission
Screening at booking
Regular CD4 and viral load testing
PCP prophylaxis if CD4 low
HAART, C-section and no breastfeeding reduces vert transmission

Question 11

Group A strep

Answer 11

Puerperal sepsis; maternal death
Infection during pregnancy: chorioamnionitis with abdo pain, diarrhoea and sepsis
Intrauterine death
Preterm labout
Early recognition, cultures, high dose abx and ITU

Question 12

Syphilis

Answer 12

Rare
Miscarriage, severe congenital disease, stillbirth
Benzylpenicillin will prevent foetal damage
Screening

Question 13

Hepatitis C

Answer 13

Asymptomatic
Vert transmission 6%
Infected neonates prone to chronic hepatitis
Screening of high risk groups eg HIV+ve

Question 14

Listeriosis

Answer 14

Non-specific febrile illness
Foetal death
Don’t eat pates, soft cheeses and prepacked meals

Question 15

Chlamydia and gonorrhoea

Answer 15

Asymptomatic
Fertility problems and PID
Preterm labour and neonatal conjunctivitis
Chlamydia: azithromycin or erythromycin
Gonorrhoea: cephalosporins
Screening

Question 16

Bacterial vaginosis

Answer 16

Asymptomatic/offensive discharge
Preterm labour and late miscarriage
Screening and oral clindamycin if previous preterm birth