Infections in pregnancy

Question 1

IUGR, pneumonia, thrombocytopenia, *deafness + other neuro sequelae

Answer 1

CMV

• 40% vertical transmission

• Maternal: CMV IgM, IgG avidity
• Foetal: amniocentesis (6w after infection)
• USS surveillance, foetal blood sampling at 32/40
• No Rx, screening, vaccination

Question 2

38 week year old pregnant got infected with Herpes 2 weeks ago. What should delivery plan be?

Answer 2

C-Section

• ↑risk if <6w after 1° infection, low risk in recurrent herpes.
- C-Section if < 6 w

Transmission through blood mix, neonatal infection rare but can be very fatal

Aciclovir and refer to GUM

Question 3

• Infection in 1st trimester - deafness, cardiac & problems, mental retardation

Childhood infection - mild fever, macular rash

Answer 3

Rubella

Deafness - Rubella

↓ Risk as gestation increases

• Screening at routine booking
• TOP offered (if infected <16/40 + not immune)
• Avoidance + MMR after delivery (if not infected + not immune)

Question 4

Foetal/neonatal effects: early pregnancy ↑ mental retardation, convulsions, spasticities, visual impairment

Answer 4

Toxoplasmosis

Convulsions and spasticity = toxo

Dx
• Maternal: IgM
• Foetal: amniocentesis after 20/40
Management: health education, spiramycin (mother), combination Rx (neonate)

Question 5

Maternal effects: severe illness
• 1st trimester - teratogenic (rare)
• 4w before delivery - severe neonatal infection

Answer 5

Varicella Zoster

• Maternal
o Serology (if exposed)
o VZIg (if non-immune), aciclovir (if infection)
• Neonate (if delivered 5d after/2d before maternal symptoms)
o VZIg, close monitoring, aciclovir if infected

Question 6

Maternal effects: ‘slapped cheek’ appearance (erythema infectiosum), arthralgia, asymptomatic

Answer 6

Parvovirus B19

Dx
• Maternal: IgM
• Foetal if IgM +ve: Middle cerebral artery Doppler & USS (anaemia, hydrops)
Management: in utero transfusion (if severe), excellent prognosis