Infections in Pregnancy

Question 1

What is the commonest cause of neonatal sepsis?

Answer 1

Group B streptoccocus

Question 2

What is the management for definite or suspected Group B strep in a mother?

Answer 2

Intrapartum IV benzypenicillin

Question 3

What are some of the consequences of CMV infection during pregnancy on the foetus?

Answer 3

HEaring loss
Visual impairment / blindness
learning difficulties 
Epilepsy 
Congenital infection complications

Question 4

What are the outcomes seen in a congenital CMV infection in the pregnancy?

Answer 4

IUGR
Pin-point petechial "blueberry muffin appearance" on skin
Jaundice
Microcephaly
Sensorineural hearing loss
Encephalitis
Hepatosplenomegaly
Cataracts 
Developmental delay

Question 5

What is the management of mothers with CMV?

Answer 5

Supportive management

Question 6

At what trimester is HIV the highest risk?

Answer 6

Third trimester (plus delivery and breastfeeding)

Question 7

What is the rate of transmission between HIV mothers and baby when there is no anti-retroviral therapy?

Answer 7

25-30%

Question 8

What is the rate of HIV transmission from mother to foetus if mother is on HAART?

Answer 8

<2%

Question 9

Can HIV positive women delivery vaginally and breastfeed?

Answer 9

They can deliver vaginally if undetectable viral load

Breastfeeding is still not recommended

Question 10

What % of women infected with rubella will show symptoms?

Answer 10

Roughly on 30-50% of women show symptoms

Question 11

What trimester is most dangerous for a pregnant women to have rubella?

Answer 11

1st trimester

very low risk in 2nd and 3rd

Question 12

What are some of the consequences for the foetus if a mother becomes infected with rubella?

Answer 12

Congenital Rubella Syndrome:
Sensorineural deafness
Cataracts
Congenital heart defects
Developmental delay

Question 13

What are some clinical signs and symptoms of a rubella infection?

Answer 13

Maculopapular rash
Lymphadenopathy
Arthritis

Question 14

What is foetal varicella syndrome?

Answer 14

Limb hypoplasia
Skin scarring
Deafness
Developmental delay

Question 15

How is varicella zoster managed in pregnancy?

Answer 15

VZV immunoglobulin to prevent infection if they’ve been potentially exposed and have never been infected.

Question 16

If a mother develops a varicella infection what can be given?

Answer 16

Aciclovir

(and immunoglobulins if needed) + supportive management

Question 17

What are some of the symptoms of a varicella infection in a pregnant mother?

Answer 17

Fever
Lethargy
Pruritic rash with characteristic vesicles
Increased morbidity and mortality due to increased risk of encephalitis, pneumonia and hepatitis

Question 18

At what stage in the pregnancy is there the highest risk of foetal varicella syndrome ?

Answer 18

<20/40 weeks

Question 19

What symptoms might a pregnant woman present with in herpes zoster?

Answer 19

Genital vesicles
Pain
Dysuria

Question 20

Why should a foetus be delivered by c-section if its within six weeks of initial/primary exposure to herpes zoster?

Answer 20

After 6 weeks the mother will have developed maternal antibodies and they can cross the placenta so the foetus will be protected if delivered vaginally.
However if it’s before 6 weeks then those antibodies will not have come into effect yet and a vaginal delivery would be risky for the foetus.

Question 21

Can you treat a pregnant woman with aciclovir if they have an ongoing herpes zoster infection?

Answer 21

Yes but try to only do so if severe.

Question 22

What infection during pregnancy can lead to the foetus developing hydrocephalus, chorioretinitis and intracerebral calcification?

Answer 22

Toxoplasmosis

Question 23

What medications can be used to treat a toxoplasmosis infection in prenancy?

Answer 23

Spiramycin

If severe or foetal infection possible, give pyrimethamine

Question 24

A mother presents with a flu like illness with fever back ache and myalgia. The only thing she can think of that might have caused it was the meal she had at the restaurant a few days ago. What is the probably infective organsim?

Answer 24

Listeria

patient is presenting with signs and symptoms of listeriosis

Question 25

How is listeriosis managed?

Answer 25

Ampicillin or co trimoxazole

Question 26

What are some of the risks to the foetus in a listeriosis infection?

Answer 26

Miscarriage / preterm labour
Meconium stained liquor
Cerebral haemorrhage
Pneumonitis
Developmental delay

Question 27

A pregnant woman was infected with chicken pox. At what stage post infection is the optimum point to check for any foetal abnormalities?

Answer 27

5 weeks post infection

Question 28

What common infection is associated with risk of foetal haemolytic anaemia, hydrops fetalis, IUD and miscarriage?

Answer 28

Parvovirus B19

Question 29

How is parvovirus managed in pregnancy?

Answer 29

Supportive management

If foetus severely affected preterm delivery of an intrauterine transfusion may be required

Question 30

What % of women tend to be carriers of Group B strep?

Answer 30

25%

Question 31

At what point in the pregnancy is the foetus most at risk from Group B strep?

Answer 31

Once membranes have ruptured

Prolonged ROM has an even higher risk

Question 32

In a pregnancy affected by a rubella infection, a reassuring foetal scan rules out the concerns for congenital rubella syndrome. True or false?

Answer 32

False

Aspects of congenital rubella syndrome may not be apparent on a foetal scan