Infections in pregnancy

Question 1

Management of UTI in pregnancy and why to treat asymptomatic bacteruria?

Answer 1

Asymptomatic bacteruria is treated in pregnant women as may develop into acute cystitis (UTI) or pyelonephritis

For asymtptomatic and UTI:
Cephalexin 500mg oral 2 daily for 5 days OR
Nitrofurantoin 100mg oral 2 daily for 5 days (do not use near term-risk haemolytic anaemia newborn)
Trimethoprim should be avoided 1st trimester

Pyelonephritis:
Admission, IV Amoxicillin + Gent

Question 2

Describe symptoms of Rubella infection and implications of fetus?

Answer 2

Symptoms: 
May be asymptomatic/mild
Runny nose
Rash starting behind ears, spreads to face, neck and body
Joint pain
Mild fever

Congenital Rubella:
Low birth weight
Cataracts
PDA or other cardiac anomaly
Hearing loss
Rash

Question 3

Describe prevention and treatment for Rubella infection in pregnancy?

Answer 3

Prevention:
Rubella vaccine- do not give in pregnancy as live virus, and do not conceive for 1 month following vaccination

Treatment:
Conservative- fluids, paracetamol
May be given hyperimmune globulin to reduce symptoms
Obstetric management throughout pregnancy

Question 4

Describe symptoms of Varicella Zoster (chicken pox) in pregnancy and effects of fetus?

Answer 4

Symptoms:
Malaise
Mild fever
Itchy rash- appears small blisters surrounded by reddened
skin

Effect fetus:
Fetal varicella- benign
Congenital Varicella Syndrome (if infection early pregnancy- 2% risk): Multiple defects, severity dependant

Question 5

Management of Varicella in pregnancy?

Answer 5

Management:
Within 96hrs of exposure: Zoster immunoglobulins
After 96hrs: oral acyclovir (not first trimester)