Infections in Pregnancy Flashcards
What is cytomegalovirus?
Herpes virus
Transmitted by personal contact
What effect does cytomegalovirus have on the fetus?
Vertical transmission occurs in 40% 10% of affected infants are symptomatic at birth IUGR Pneumonia Thrombocytopenia Deafness
How is cytomegalovirus diagnosed?
Most only diangosed when CMV is specifically requested
If maternal infection is confirmed, amniocentesis 6 weeks after will confirm transmission
How is CMV managed?
Close surveillance for USS abnormalities
Fetal blood sample at 32 weeks for platelet levels
What effect does herpes simplex have on the fetus?
Neonate infection rare but high mortality
Vertical transmission occurs at vaginal delivery if vesicles are present from recent infection (no maternal antibodies for herpes)
How is herpes simplex managed?
Refer to GUM clinic
C-section if delivering within 6 weeks of primary attack or with active lesions
Exposed infants given acyclovir
What effect does rubella have on the fetus?
Maternal infection in early pregnancy results in worse defects Deafness Cardiac disease Eye problems Mental retardation
What is the management of rubella?
If mother develops rubella before 16 weeks, termination is offered
Offer vaccination after pregnancy
How does one become infected with toxoplasmosis?
Contact with cat faeces or soil
Eating infected meat
What effect does toxoplasmosis have on the fetus?
Early infection causes: Mental retardation Convulsions Spasticities Visual impairment
How is toxoplasmosis diagnosed?
USS - hydrocephalus
Maternal testing because of exposure then amniocentesis
How is toxoplasmosis managed?
Spiramycin as soon as mother is diagnosed
What effects does herpes zoster have on the fetus?
Early pregnancy infection -> teratogenicity
If mother is infected in 4 weeks before delivery -> severe infection
How is herpes zoster managed?
Immunoglobulin used for prevention
Aciclovir treats infection
What infections are teratogenic?
CMV Rubella Toxoplasmosis Syphilis Herpes zoster
What is parvovirus?
Slapped cheek appearance with arthralgia
Infection from children
What effect does parvovirus have on the fetus?
Suppresses fetal erythropoiesis -> anaemia
Thrombocytopenia
Fetal death in 10% esp if before 20 weeks gestation
How is parvovirus diagnosed?
Post maternal exposure or symptoms, fetal surveillance
USS - anaemia (increased blood flow in middle cerebral artery), oedema from cardiac failure
How is parvovirus managed?
Scanned regularly for anaemia and blood transfusion offered if severe
What effects does group B strep have on the fetus?
Usually infected during delivery after membranes have ruptured
Pre term labour
Prolonged labour
Maternal fever
Early onset neonatal group B strep sepsis
How is group B strep managed?
Treatment for:
- previous affected neonate
- positive urinary culture
- > 18hr rupture of membranes
What is the effect of hep B on neonates?
Vertical transmission at delivery
- 90% of infected neonates become chronic carriers
How is hep B managed?
Neonatal immunisation
Maternal screening
What effect does HIV have on the mother?
Increased risk of pre-eclampsia
Gestational diabetes
What effect does HIV have on the fetus?
Stillbirth
Pre-eclampsia
IUGR
Prematurity
Vertical transmission mostly after 36 weeks, intrapartum or during breastfeeding
How is HIV managed?
Maternal antiretrovirals
Elective C-section
Avoidance of breastfeeding
Neonatal antiretroviral therapy
How does group A strep (streptococcus pyogenes) present in the population?
Sore throat
Usually passed on form children
What effect does group A strep have on pregnancy?
Choriomanionitis with abdo pain, diarrhoea and severe sepsis
Infected fetus dies in utero and labour ensues
What effect does syphilis have on pregnancy?
Active disease in pregnancy -> miscarriage, severe congenital disease or stillbirth
Benzylpenicillin will prevent but not reverse fetal damage
What effect does TB have on pregnancy?
Prematurity
IUGR
Maternal mortality
Can’t do BCG in pregnancy
What effect does hep C have on pregnancy?
Vertical transmission -> chronic hepatitis
What effect does listeria have on pregnancy?
Infection following consumption of pate, soft cheese, prepacked meals and causes febrile illness
Bacteraemia may cause fatal infection of fetus
What effect does chlamydia and gonorrhoea have on the fetus?
Preterm labour and neonatal conjunctivitis
Chlamydia Tx: azithromycin, erythromycin
Gonorrhoea Tx: cephalosporins
What effect does BV have on pregnancy?
Preterm labour
Late miscarraige
Tx: clindamycin
