infections in pregnancy

Question 1

what infections can cause miscarriage?

Answer 1

1. chlamydiosis

2. listeria monocytogenes

Question 2

what infections can affect the unborn baby?

Answer 2

1. rubella
2. chicken pox
3. parvo virus
4. CMV
5. Zika virus
6. syphilis
7. toxoplasmosis

Question 3

what are the symptoms of rubella?

Answer 3

fever, malaise, mild conjunctivitis, transitory rash

Question 4

when is rubella a risk in pregnancy?

Answer 4

first trimester, <13 weeks can result in severe fatal damage in up to 90% of cases

Question 5

what anomalies can rubella cause in pregnancy?

Answer 5

cataracts, deafness, cardiac anomalies, microcephaly, growth retardation, inflammatory lesions of brain, liver, lungs, bone marrow

Question 6

what are symptoms of CMV?

Answer 6

malaise, fever, lymphadenopathy

Question 7

how is CMV transmitted?

Answer 7

bodily fluids - saliva, urine, blood

good hand hygiene is important

Question 8

when is CMV harmful to baby?

Answer 8

1st trimester - risk of transplacental infection 40%

Question 9

what are the manifestations ofCMV infection in baby?

Answer 9

microcephaly, neurological abnormalities, growth restriction, mental retardation
20-30% will die
80% survivors have serious disabilities

Question 10

how is rubella transmitted?

Answer 10

droplets

Question 11

how is Parvo virus B19 spread?

Answer 11

droplets

Question 12

why is rubella now rare in women?

Answer 12

immunisations from 1970 for women, then universal MMR from 1988

Question 13

what does Zika virus cause in babies?

Answer 13

microcephaly

major abnormalities

Question 14

what rash does parvo virus produce?

Answer 14

slapped cheeks

Question 15

what does parvo virus do?

Answer 15

attacks red blood cells, leading to fatal anaemia

infection in 1st 20wks may result in miscarriage/ intrauterine death or hydros fetalis

Question 16

what is the presentation o chicken pox?

Answer 16

characteristic vesicular rash, fever, malaise, 2-3 weeks incubation

Question 17

what are the risk of chicken pox to mum?

Answer 17

pneumonia, hepatitis, encephalitis,

Question 18

what are the risks of chicken pox to fetus?

Answer 18

anomaly if infected before 20wks

fetal varicella syndrome = scars, limb development

Question 19

what are the risks of chicken pox to neonate?

Answer 19

varicella infection of newborn (congenital varicella) if mum has it late in pregnancy and then deliver baby. due to mum not being able to pass on IgG to baby, can give baby IgG to protect them

Question 20

where can you get toxoplasmosis?

Answer 20

uncooked meat, contaminated fruit/veg, soil/cat faeces

give health advice

Question 21

when is risk highest baby with toxoplasmosis?

Answer 21

early in pregnancy = severe consequences

rare

Question 22

what infections are pregnancy women screened for?

Answer 22

syphilis
hep b
HIV

Question 23

what is syphilis associated with? and how is it treated?

Answer 23

late miscarriage, hydros, LBW

easily treated with penicillin

Question 24

what are the TORCH infections?

Answer 24

toxoplasmosis 
rubella 
CMV 
herpes 
\+ parvo virus

Question 25

what infections can be transmitted at delivery?

Answer 25

blood borne viruses - hep B,C, HIV
group B strep
herpes
chlamydia

Question 26

what are the risks of hep B?

Answer 26

90% of infected babies will get chronic infection -> 20-25% have progressive liver disease

Question 27

what groups are at risk of hep B?

Answer 27

high prevalence areas
family member with it
IVDU or partner
tattoos/piercing

Question 28

what is the highest risk of HIV transmission?

Answer 28

3rd trimester 
(delivery and breastfeeding)

Question 29

what is the HIV transmission associated with?

Answer 29

maternal viral load
aim to get levels to undetectable, minimise contact with maternal body fluids at birth, avoid breastfeeding, give prophylactic drugs to baby

Question 30

what is the leading cause of serious neonatal infection?

Answer 30

group B strep

Question 31

what can GBS result in?

Answer 31

sepsis, pneumonia, meningitis

incidence not high but devastating

Question 32

what babies are at risk of GBS?

Answer 32

PROM, premature babies, colonised mothers (give mum penicillin before delivery to reduce incidence)

Question 33

why isn’t there screening for GBS?

Answer 33

risk of anaphylaxis to treatment
may contribute to resistance
may change faecal flora and affect immune development

Question 34

what treatment is given to women with herpes in pregnancy?

Answer 34

acyclovir in 3rd trimester
less of a concern if had previous infections
if its new then would recommend c-section

Question 35

what can chlamydia cause to neonates?

Answer 35

pneumonia and conjuncitivitis

Question 36

what infections can affect the mother?

Answer 36

urine infections, mastitis, chicken pox, influenza, pyelonephritis, uterine infections (chorioamnionitis)

Question 37

what is the risk of BV?

Answer 37

premature delivery

treatment given to women at risk with metronidazole

Question 38

what is chorioamnonitis?

Answer 38

ascending infection from vagina
- ruptured membranes
long labour
multiple examinations

Question 39

what are post natal infection?

Answer 39

endometritis
mastitis
wound infections - section or perineal

Question 40

what are symptoms of maternal sepsis?

Answer 40

fever, diarrhoea, vomiting, abode pain, rash, urine symptoms, bleeding, discharge etc
need treatment as causes maternal deaths
normally caused by E.coli, Group A strep, staph a

Question 41

how do you prevent infection in pregnancy?

Answer 41

screening (syphilis, Hep b, HIV)
health advice
public health measures
testing contacts 
awareness and observations