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A1. Women's Health > Infections in pregnancy > Flashcards

Infections in pregnancy Flashcards

1
Q

What are the recommendations for pre-pregnancy screening/vaccinations?

A

Screen for VZV, rubella, CMV if women in close contact with children

Administer MMR and VZV if seronegative. Check rubella immunity 1-2 months after vaccination and revaccinate if necessary

Avoid pregnancy for 1 month after vaccinations

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2
Q

What are the recommendations for pre-pregnancy screening/vaccinations?

A

Screen for VZV, rubella, CMV if women in close contact with children

Administer MMR and VZV if seronegative. Check rubella immunity 1-2 months after vaccination and revaccinate if necessary

Avoid pregnancy for 1 month after vaccinations

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3
Q

Name 8 infectious agents that RANZCOG recommends all women be screened for during pregnancy

A

HBV, HIV, rubella, syphilis, Chlamydia, asymptomatic bacteruria, GBS, VZV, HCV, HSV

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4
Q

What type of infectious agent is rubella? How is it spread? Name 4 symptoms it can present with. How can it affect the foetus? What is the classic triad of symptoms?

A

Virus. Spread by droplets and direct contact. Presents with mild maculopapular rash, lymphadenopathy (often occipital or posterior chains), fever, arthritis.

Spreads to the foetus via the placenta to cause congenital rubella syndrome - neurological disease, blueberry muffin rash, thrombocytopaenia.

Classic triad - ophthalmological (cataracts, glaucoma, retinopathy), cardiac (PDA, PA stenosis) and auditory (sensorineural deafness) effects

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5
Q

How does the gestational age of foetal rubella infection affect the clinical manifestations of the virus on the child?

A

12/40 - retinopathy and deafness only

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6
Q

Name 2 antenatal Ix for congenital rubella syndrome

A

Serology of mother’s blood (IgM), and foetal diagnostic testing (amniocentesis, foetal blood)

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7
Q

When should you ideally give the MMR vaccine in pregnancy and why? What if the woman is seronegative when she becomes pregnant?

A

Before pregnancy - it’s a live vaccine. If woman is seronegative when she becomes pregnant, give vaccine after delivery

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8
Q

What are the 4 stages of syphilis? In which stage is it most likely to spread to the foetus? By what mechanism does it spread to the foetus? What are the 3 main potential effects of congenital syphilis to the foetus?

A

Primary - most likely to spread to the foetus (transplacentally)
Early latent
Late latent
Tertiary

Can cause FDIU, premature delivery, and congenital malformations

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9
Q

How does HBV spread to the foetus? Name 2 consequences of congenital HBV.

A

Intrapartum (95%), occasionally transplacental or postpartum.

Consequences - cirrhosis and HCC

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10
Q

Which serology marker correlates best with transmission from mother to foetus? What should you give all neonates whose mothers are positive for this marker?

A

HBeAg correlates best with transmission. Give Hep B Ig to all neonates whose mothers are HBeAg +ve, within 12 hours

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11
Q

Name 3 red flags on Hx of a pregnant mother that would encourage you to screen for Chlamydia

A
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12
Q

What is the most common congenital infection during pregnancy?

A

CMV

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13
Q

How is CMV spread between people? What symptoms does it give the mother? How does it spread from the mother to foetus?

A

Via secretions or fomites. Causes rash and fever in mother. Spreads to foetus transplacentally.

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14
Q

What are the 3 forms of CMV infection? Which is most likely to cause congenital CMV? What Ix can you do to tell which form the mother has?

A

Primary maternal infection - most dangerous to foetus
Re-infection (with another strain of CMV)
Reactivation of previous CMV

Use serology to Ix - IgM suggests primary infection, but can remain +ve 2 years after initial infection. Can also look at IgG and IgG avidity (low avidity = recent infection)

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15
Q

How do you investigate whether CMV has transmitted to the foetus? In a neonate?

A

Foetus - amniotic fluid sampling (CMV spreads from foetal urine into amniotic fluid)
Neonate - CMV urine test, MRI brain

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16
Q

Name 4 complications of congenital CMV. What medication can you give a symptomatic newborn?

A

Death (10-30%) - in utero or postpartum
Hepatosplenomegaly (in neonate)
Psychomotor/visual problems (can take up to 5 years to develop)

Give ganciclovir to symptomatic newborn

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17
Q

What are the consequences of parvovirus infection during pregnancy on the foetus? How do you manage this?

A

Can lead to aplastic crisis (enters bone marrow and suppresses RBC production) = foetal anaemia, hydrops, death (worse if

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18
Q

What effects can a primary HSV infection during pregnancy have on the foetus? What effects can it have if infected near delivery?

A

During pregnancy - abortion, IUGR

Near delivery - skin-eye-mouth disease, encephalitis

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19
Q

What is the management of primary vs recurrent HSV infection in pregnancy?

A

Primary - Acyclovir + C/S

Secondary - C/S

20
Q

How does GBS infect the foetus? Name 2 potential consequences on both the mother and the foetus

A

Infected via ascending infection (vagina to amnion) or during delivery.

Consequences to mother - preterm delivery, PROM, intrapartum fever, chorioamnionitis
Consequences to fetus - pneumonia, sepsis, meningitis, death

21
Q

When is GBS screened for and how?

A

36 weeks with low vaginal and anal swab

22
Q

How do you treat neonatal GBS?

A

Penicillin and gentamicin (want broad coverage because sepsis could be caused by GNB too)

23
Q

How can varicella infection during pregnancy affect the mother and foetus?

A

Mother - maternal varicella can lead to death (more common in 3rd trimester, because of immunosuppression)
Foetus - congenital varicella syndrome (more likely if infected in first trimester). Limb hypoplasia, dermatomal scarring, microcephaly, cataracts, GIT and GU abnormalities

24
Q

Name 2 interventions for varicella infection during pregnancy. What intervention should you not do?

A

Acyclovir or varicella Ig. Don’t give vaccine (live vaccine)!

25
Q

Name 8 infectious agents that RANZCOG recommends all women be screened for during pregnancy

A

HBV, HIV, rubella, syphilis, Chlamydia, asymptomatic bacteruria, GBS, VZV, HCV, HSV

26
Q

What type of infectious agent is rubella? How is it spread? Name 4 symptoms it can present with. How can it affect the foetus? What is the classic triad of symptoms?

A

Virus. Spread by droplets and direct contact. Presents with mild maculopapular rash, lymphadenopathy (often occipital or posterior chains), fever, arthritis.

Spreads to the foetus via the placenta to cause congenital rubella syndrome - neurological disease, blueberry muffin rash, thrombocytopaenia.

Classic triad - ophthalmological (cataracts, glaucoma, retinopathy), cardiac (PDA, PA stenosis) and auditory (sensorineural deafness) effects

27
Q

How does the gestational age of foetal rubella infection affect the clinical manifestations of the virus on the child?

A

12/40 - retinopathy and deafness only

28
Q

Name 2 antenatal Ix for congenital rubella syndrome

A

Serology of mother’s blood (IgM), and foetal diagnostic testing (amniocentesis, foetal blood)

29
Q

When should you ideally give the MMR vaccine in pregnancy and why? What if the woman is seronegative when she becomes pregnant?

A

Before pregnancy - it’s a live vaccine. If woman is seronegative when she becomes pregnant, give vaccine after delivery

30
Q

What are the 4 stages of syphilis? In which stage is it most likely to spread to the foetus? By what mechanism does it spread to the foetus? What are the 3 main potential effects of congenital syphilis to the foetus?

A

Primary - most likely to spread to the foetus (transplacentally)
Early latent
Late latent
Tertiary

Can cause FDIU, premature delivery, and congenital malformations

31
Q

How does HBV spread to the foetus? Name 2 consequences of congenital HBV.

A

Intrapartum (95%), occasionally transplacental or postpartum.

Consequences - cirrhosis and HCC

32
Q

Which serology marker correlates best with transmission from mother to foetus? What should you give all neonates whose mothers are positive for this marker?

A

HBeAg correlates best with transmission. Give Hep B Ig to all neonates whose mothers are HBeAg +ve, within 12 hours

33
Q

Name 3 red flags on Hx of a pregnant mother that would encourage you to screen for Chlamydia

A
34
Q

What is the most common congenital infection during pregnancy?

A

CMV

35
Q

How is CMV spread between people? What symptoms does it give the mother? How does it spread from the mother to foetus?

A

Via secretions or fomites. Causes rash and fever in mother. Spreads to foetus transplacentally.

36
Q

What are the 3 forms of CMV infection? Which is most likely to cause congenital CMV? What Ix can you do to tell which form the mother has?

A

Primary maternal infection - most dangerous to foetus
Re-infection (with another strain of CMV)
Reactivation of previous CMV

Use serology to Ix - IgM suggests primary infection, but can remain +ve 2 years after initial infection. Can also look at IgG and IgG avidity (low avidity = recent infection)

37
Q

How do you investigate whether CMV has transmitted to the foetus? In a neonate?

A

Foetus - amniotic fluid sampling (CMV spreads from foetal urine into amniotic fluid)
Neonate - CMV urine test, MRI brain

38
Q

Name 4 complications of congenital CMV. What medication can you give a symptomatic newborn?

A

Death (10-30%) - in utero or postpartum
Hepatosplenomegaly (in neonate)
Psychomotor/visual problems (can take up to 5 years to develop)

Give ganciclovir to symptomatic newborn

39
Q

What are the consequences of parvovirus infection during pregnancy on the foetus? How do you manage this?

A

Can lead to aplastic crisis (enters bone marrow and suppresses RBC production) = foetal anaemia, hydrops, death (worse if

40
Q

What effects can a primary HSV infection during pregnancy have on the foetus? What effects can it have if infected near delivery?

A

During pregnancy - abortion, IUGR

Near delivery - skin-eye-mouth disease, encephalitis

41
Q

What is the management of primary vs recurrent HSV infection in pregnancy?

A

Primary - Acyclovir + C/S

Secondary - C/S

42
Q

How does GBS infect the foetus? Name 2 potential consequences on both the mother and the foetus

A

Infected via ascending infection (vagina to amnion) or during delivery.

Consequences to mother - preterm delivery, PROM, intrapartum fever, chorioamnionitis
Consequences to fetus - pneumonia, sepsis, meningitis, death

43
Q

When is GBS screened for and how?

A

36 weeks with low vaginal and anal swab

44
Q

How do you treat neonatal GBS?

A

Penicillin and gentamicin (want broad coverage because sepsis could be caused by GNB too)

45
Q

How can varicella infection during pregnancy affect the mother and foetus?

A

Mother - maternal varicella can lead to death (more common in 3rd trimester, because of immunosuppression)
Foetus - congenital varicella syndrome (more likely if infected in first trimester). Limb hypoplasia, dermatomal scarring, microcephaly, cataracts, GIT and GU abnormalities

46
Q

Name 2 interventions for varicella infection during pregnancy. What intervention should you not do?

A

Acyclovir or varicella Ig. Don’t give vaccine (live vaccine)!

A1. Women's Health (40 decks)

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