Infections in pregnancy Flashcards
Is there screening for GBS in the uk
no
Where is GBS found normally?
Bowel
What are RF for GBS?
prematurity
prolonged ROM
prev. GBS infecton
maternal pyrexia e.g. secondary to chorioamnionitis
when should swabs for GBS be offered?
35-37 weeks
3-5 weeks prior to anticipated delivery date
What is the management of women who’ve previously had GBS in pregnancy?
offer maternal IV abx (benzylpenicillin + gentamicin) prophylaxis OR
testing in late pregnancy and then abx if still positive
When should women be given IV abx prophylaxis for GBS?
If had a prev. baby w early/late onset GBS
preterm labour regardless of GBS status
pyrexia during labour
What does CMV cause to children?
handicap
sensorineural deafness
What is transmission rate of CMV
40%
What sx at birth can present in CMV?
IUGR
pneumonia
thrombocytopenia
What are the Ix for cMV?
- paired sera (presence of IgM and IgG abs)
- amniocentesis >20 weeks to detect fatal transmission
- US - intracranial/hepatic calcification
- Throat swab, urine culture and baby’s serum after birth
What is management of CMV?
Most infected neonates not seriously affected
close surveillance for US abnormalities
no prenatal treatment, offer termination
Which types of herpes are responsible of oral and genital herpes?
1 and 2
What are the fetal effects of herpes simplex?
blindess reduced IQ epilepsy jaundice resp distress DIC Death
when does vertical transmission of herpes occur
at vaginal delivery if vesicles are present
how is herpes diagnosed in pregnancy?
clinically
type specific w PCR
What is the management of herpes simplex infection?
last trimester: aciclovir or valociclovir +/- elective CS
what must be avoided in birth involving herpes simplex infection?
FBS
scalp electrodes
instrumental delivery
When are fetuses most at risk of rubella infection?
first 16 weeks
What metal abnormalities are caused by maternal infection of rubella?
- Deafness
- Cardiac disease
- Eye problems - cataracts
- Mental retardation
How does severity of malformation change with advancing gestation?
decreases
What is the management of women w rubella infection before 16 weeks?
offer termination
How is rubella infection diagnosed during pregnancy?
screened for at booking to identify those in need of vaccination after the end of pregnancy
What is the cause of toxoplasmosis?
protozoan parasite toxoplasma gondii
how does someone acquire toxoplasmosis?
contact w faeces soil
eating infected meat
What effects does toxoplasmosis have on the fetus?
mental retardation
convulsions
spasticity
visual impairment
How is toxoplasmosis diagnosed in pregnancy?
IgM/IgG abs w amniocentesis after 20 weeks
diagnose babies w serology
What is the management of toxoplasmosis in pregnancy?
spiramycin as soon as diagnosed
What is the management of confirmed vertical transmission of toxoplasmosis in pregnancy?
pyrimethamine
sulfadiazine
calcium folate
ALL until delivery
What are the fetal effects of herpes zoster? what is rx
teratogenicity
oral aciclovir ASAP
What gestation is the neonate at most risk of severe infection of herpes zoster?
4 weeks before delivery
What is the management of a pregnant woman who has had chickenpox contact?
Give VZIG
What is the management of women getting herpes zoster near delivery?
aim for delivery after 7 days,
give baby VZIG and aciclovir
What are the sx of parvovirus in pregnancy? (woman)
slapped cheek maculopapular rash fever arthralgia may be asymptomatic
What are the sx in the fetus w parvovirus?
cardiac failure
fetal hydrops
How is a diagnosis of parvovirus made in pregnancy?
paired samples w IgM/IgG increased
− Anaemia detected on US as increased blood flow velocity in the middle cerebral artery and subsequently as oedema from cardiac failure
What is the management of parvovirus during pregnancy?
serial US looking for signs of fatal anaemia (hydrops)
in utero transfusion if hydrops
What factors reduce the vertical transmission rate of HIV?
- maternal antiretroviral therapy
- mode of delivery (caesarean section)
- neonatal antiretroviral therapy
- infant feeding (bottle feeding)
How is HIV detected during pregnancy?
screening
What is the management of HIV during pregnancy?
Antiretroviral therapy
Vaginal delivery if viral load <50copies/ml at 36 weeks, otherwise CS
Zidovudine infusion 4 hrs before CS
What is the management of HIV in the neonate?
Oral zidovudine if maternal viral load <50
otherwise HAART
Continue therapy for 4-6 weeks
dont breastfeed
When are babies tested for HIV?
DAY 1, 6weeks, 12 weeks
18 m
What increases risk of vertical transmission of HIV?
- Vaginal delivery
- Breastfeeding
- Membrane rupture for >4hrs
- Viral load >400copies/ml
- Seroconversion during pregnancy (ab develops and becomes detectable in blood)
- Advanced disease
- Premature labour
- Hep C
What is management of HIV mothers w ROM >34 weeks
speed up delivery
What is management of HIV mothers w ROM <34w
steroids
erythromycin
HAART
What should be avoided during delivery of HIV mothers?
FBS
scalp electrodes
When is CS indicated in HIV motherS?
38 weeks if on zidovudine
what is given postpartum in HIV mothers to suppress lactation?
cabergoline
what should be given to high risk HIV babies?
zidovudine, HAART and cotrimoxazole
When is HIV tested for in pregnancy?
booking
What vaccines should be offered in pregnancy for HIV?
hep B, pneumococcal and influenza vaccines
What is the management of HIV during pregnancy regarding HAART
Continue if already on it
if not start by 24 weeks until delivered
What are chlamydia and gonorrhoea associated w in pregnancy/
preterm labour
neonatal conjunctivitis
What is the treatment of chlamydia during gpregnacy?
azithromycin or erythromycin
What is the treatment gonorrhoea during pregnancy?
cephalosporins e.g. cefuroxime
What is an effect of tetracycline during pregnancy?
causes fetal tooth discolouration
What is the full name of chlamydia?
chlamydia trachomitis
What is chlamydia infection during pregnancy associated with?
low birthweight
prem ROM
fetal death
what is the sign of chlamydia in the newborn?
conjunctivitis 5-14 days after birth
What are complications of chlamydia in pregnancy?
chlamydia pneumonitis
pharyngitis
otitis media
What is the treatment of chlamydia infection in the neonate?
local cleansing of eye
erythromycin for 3 weeks
what is the treatment of parents of chlamydia infection?
erythromycin or azithromycin stat
What gives a high risk of perinatal infection of hepatitis?
development of acute infection during 2nd/3rd trimester
mother not infected and not immunised
Can hep B be transmitted by breastfeeding?
no
What are the long term effects of hep B infection on the neonate?
- Most develop chronic infection and cirrhosis
* Infected males, lifetime risk of hepatocellular cancer is 50%
When are babies usually infected by hep B
during birth
what is the treatment of neonatal Hep B infection?
Immunoglobulin
vaccination
