Infections in Pregnancy

Question 1

What are the foetal effects common to most TORCH infections?

Answer 1

• Rash, microcephaly, hepatosplenomegaly, IUGR, cataracts

Question 2

If a pregnant woman is exposed to parvovirus B19, how might she be managed? Why is it important to do this?

Answer 2

• Amniocentesis to determine infection and determine risk
  
  • OR monitoring for anaemia (MCA PSV) from 4 weeks after seroconversion - foetus may contract virus but not be affected
• Transfusion to correct anaemia if found
• Important as sequlae (anaemia, hydrops) are severe

Question 3

How is HSV mostly transmitted to a foetus? When is this more likely? How might the birth management change due to HSV infection?

Why is it important HSV infection of a foetus is avoided?

Answer 3

• In birth canal (especially primary infection)
• Management
  
  • Acyclovir
  • Elective LUSCS if active vesicles
• Foetal complications
  
  • Encephalitis
  • 70% mortality

Question 4

List some risk factors for GBS transmission to a foetus. How does this occur?

Answer 4

• Risk factors - prematurity, prolonged ROM, intrapartum fever > 38, GBS affected previously, GBS bacteruria
• Transmitted in birth canal

Question 5

What are the possible maternal/foetal complications with varicella exposure during pregnancy?

Answer 5

• Maternal complications: pneumonia, ICU admission, death
• Foetal complications - limb hypoplasia, dermatomal defects
  
  • Worse with early exposure

Question 6

If you think a pregnant women might have been exposed to VZV, how might you manage the infection?

Answer 6

• Maternal - zoster Ig if IgG negative, within 96 hours. Early acyclovir
• Neonates - zoster Ig and acyclovir if maternal infection around delivery

Question 7

What is the classic triad of birth defects caused by rubella infection?

Answer 7

• Heart defects, sensorineural deafness, cataracts
• More affected if exposed in early pregnancy

Question 8

What are the screening tests for syphilis infection? How might you treat this infection in a pregnant woman?

Answer 8

• TPHA +/- RPR (T. pallidum hemagglutination assay and rapid plasma reagin)
• IM penicillin (x3)

Question 9

How is CMV infection diagnosis made for a pregnant woman? How is it managed?

Answer 9

• IgM/IgG
  
  • Avidity of antibodies is needed for CMV diagnosis (low at first exposure, high at later ones)
• Neonatal antivirals, consider IVIG

Question 10

What foods are a source of Listeria? What complications can it cause for a pregnant woman? How is infection with Listeria treated?

Answer 10

• Can cause maternal sepsis, chorioamnionitis, septic abortion
• Prevention - avoid deli meats, eggs, soft cheeses
• Treatment - IV penicillin, gentamycin

Question 11

What factors increase risk of intrapartum HIV transmission? Should HIV+ mothers breastfeed?

Answer 11

• High viral load, low CD4, prolonged ROM/scalp clip, vaginal delivery
• Breastfeeding not recommended

Question 12

In what situation is intra-partum transmission of hepatitis C increased?

Answer 12

HIV co-infection