Infections in pregnancy Flashcards
Why are infections in pregnancy important?
Maternal illness may be worse; maternal complications may be more common; preterm labour; vertical transmission; neurological damage is more common in bacterial infection
What is cytomegalovirus?
A herpes virus that is transmitted by personal contact.
Can all women get CMV?
No, 35% of women in the UK are immune.
What are the fetal/neonatal effects of CMV?
Approx 10% are symptomatic at birth, with FGR, pneumonia and thrombocytopaenia. Most of these will develop severe neuro symptoms such as hearing, visual and mental impairment or will die.
How do you diagnose fetal CMV?
US abnormalities are evident in 20%, the others are diagnosed when a specific CMV test is required. Amniocentesis at least 6 wks after maternal infection will confirm or refute vertical transmission
How do you manage fetal CMV?
Close surveillance and fetal blood sampling at 32 weeks for fetal platelet levels will help determine those at most risk for severe sequelae.
What is herpes simplex?
The type 2 DNA virus that is responsible for most genital herpes.
Does a mother have to have herpes symptoms to carry the virus?
No, less than 5% of pregnant women have a history of prior infection, but many more have antibodies.
How common is neonatal herpes infection?
Neonatal infection is rare, but has a high mortality.
When would vertical transmission of herpes occur?
Vertical transmission occurs at vaginal delivery particularly if vesicles are present
Would the timing of the maternal herpes infection affect vertical transmission?
Vertical transmission is more likely to follow recent maternal infection because the fetus will not have passive immunity from maternal antibodies
How do you diagnose fetal herpes simplex?
It is usually clear clinically and swabs are of little use in pregnancy
How would you manage fetal herpes simplex?
Refer to GU clinic, elective section recommended for mothers within 6 weeks of a primary attack. In women with recurrent herpes, even if vesicles are present at time of delivery, C section is not recommended, just daily aciclovir. Exposed neonates are also given aciclovir.
What is rubella?
A virus that usually affects children and causes a mild febrile illness with a macular rash.
Is congenital rubella common?
No, it is very rare in UK women because of widespread immunisations.
What are the fetal/neonatal effects of rubella?
Maternal infection in early pregnancy can cause deafness, cardiac disease, eye problems and mental retardation. The probability and severity of malformation decreases with advancing gestation
What is the management of rubella during pregnancy?
If a non-immune woman develops rubella before 16 weeks gestation, termination is offered.
What are some teratogenic infections?
CMV, rubella, syphilis
Syphilis in pregnancy at a glance:
Rare. Screening routine because treatment prevents congenital syphilis.
Group B strep at a glance:
High maternal carrier rate; major cause of severe neonatal illness
Group B strep treatment?
Intrapartum penicillin of high risk groups and positive third trimester screen greatly reduced neonatal infection
Group A strep at a glance:
Common cause of sore throat; occasionally causes chorioamnioitis or puerperal sepsis.
Group A strep treatment?
Antibiotics and supportive therapy
Hep B at a glance:
Carraige common in high-risk women. High transmission rate, high chronic disease rate and mortality in neonate. Universal screening allows neonatal administration of Ig
Hep C at a glance:
Mostly in high risk (HIV) women: 6% vertical transmission
Chlamydia at a glance:
5% in pregnancy. Neonatal conjunctivitis and preterm labour. Antibiotics may prevent preterm labour
Bacterial vaginosis at a glance:
Common. Associated with preterm labour. Screening and treatment is previous preterm labour
