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Obstetrics > Infections in pregnancy > Flashcards

Infections in pregnancy Flashcards

1
Q

what are the possible consequences for antenatal infection

A

Maternal illness

Maternal complications

Preterm labour

Vertical transmission

Neurological issues with the foetus

Antibiotic use in pregnancy presents several risks

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2
Q

What are viruses that may cause issues during pregnancy

A 
HSV
CMV
HZV
Rubella
Parovirus
Hep B/C
HIV
Influenza 
Zika
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3
Q

what are the foetal/anenatal complications of CMV infection

A

Vertical transmission in 40%

10% are symptomatic at birth, with IUGR, pneumonia and thrombocytopenia

Most have a risk of serious neurological sequalae (hearing impairment, mental impairment, visual impairment)

Asymptomatic neonates (15%) are at risk of deafness

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4
Q

how do you diagnose antenatal CMV infection in the mother and/or baby

A

USS abnormalies are present in 20% of foetuses (intrahepatic/intracranial calcification)

Maternal blood testing may provide an answer to maternal infection:

CMV IgM stays +ve long after infection – may predate pregnancy

Titres

IgG avidity (how strongly antibodies bind to the antigen) is low in acute infection, and allows differentiation

If maternal infection is confirmed, amniocentesis 6 weeks after confirmation of maternal infection will test for vertical transmission

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5
Q

how do you manage antenatal CMV infection

A

Most infected neonates are not seriously affected

No screening programme is currently in place

No vaccine exists

No prenatal treatment and termination may be offered

USS can determine those most at risk

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6
Q

how is HSV usually transmitted to a neonate

A

from mother if she has genital herpes during labour

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7
Q

what are the foetal defects associated with HSV infection

A

Not teratogenic

Foetal infection is rare but has High mortality

Usually from a recent maternal infection, meaning the foetus won’t have passive immunity from maternal antibodies

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8
Q

how do you diagnose a maternal HSV infection

A

swabs technically but it tends to be pretty obvious clinically when examining the mother

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9
Q

how do you manage antenatal Herpes Simplex Virus infection

A

Referral to GUM

C-section reccomended to anyone delivering 6 weeks within a primary infection

There is a lower risk in recurrent herpes so c section is not advised

3rd trimester aciclovir may reduce the frequency of recurrences at term

Exposed neonates are given aciclovir

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10
Q

what are the foetal defects associated with antenatal HZV infection

A

Teratogenicity is rare (1-2%) in early pregnancy if treated immediately with oral aciclovir

Maternal infection up to 4 weeks preceding delivery can cause severe foteal/neonatal infection

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11
Q

how do you manage an antenatal HZV infection

A

Immunoglobin used to prevent

Aciclovir used to treat

Pregnancy women exposed to zoster are tested for immunity and given immunoglobins within 10 days if not immune, or aciclovir if infected

Foetuses born 5 days after maternal signs of infection, or 2 days before, are given immunoglobins and aciclovir

Immunisation is possible

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12
Q

what is the pathology of rubella

A

normall affects children causing a mild fever and a widespread maculopapular rash

extremely rare in UK, <10 in UK

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13
Q

what foetal defects are associated with antenatal rubella infection

A

early infection:

Cardiac abnormalities

Eye problems

Mental retardation

Deafness

complications reduce later on in pregnancy

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14
Q

how do you manag/prevent rubella infection in pregnancy

A

Screening is routine at booking visit

<16 weeks infection, termination is offered

Vaccine is live and contraindicated in pregnancy

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15
Q

what is the pathology of parovirus

A

‘slapped cheek’ presentation +/- arthralgia in kids

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16
Q

what foetal defects are associated with antenatal parovirus infection

A

Suppresses foetal EPO causing anaemia

Variable degrees of thrombocytopenia may also be caused

Foetal death occurs In 10% of pregnancies, usually ones that are below 20 weeks

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17
Q

how do you diagnose antenatal parovirus infection

A

+ve IgM testing prompts foetal surveilance

Anaemia may be detected on USS by increased foetal blood flow through its MCA

There may also be subsequent oedema from cardiac failure (hydrops)

Spontaneous resolution occurs in 50%

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18
Q

how do you manage antenatal parovirus infection

A

Infected are scanned regularly to screen for hydrops/anaemia

If severe, transfusion can be given

Excellent prognosis in survivors

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19
Q

what is the pathology of Hep b infection

A

Transfer by blood products or sexual activity

Resolves in 90%, persists in 10%

Hep B surface antibody +ve people are of low infectious risk

Hep B surface antigen +ve people are of higher risk, along with HBeAG +ve

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20
Q

what are the foetal complications of antenatal hep B infection

A

90% become chronic carriers

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21
Q

how do you diagnose antenatal hep B infection?

A

maternal screening

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22
Q

what is the management of antenatal hep B infection?

A

Csection, avoiding breastfeeding and immunoglobins do not prevent vertical transmission

Screening is restricted to high-risk groups

Antivirals may be used

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23
Q

What does the maternal infection screening test done at the booking (10 week) visit test for

A

HIV

Syphilis

Hep B

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24
Q

How is HZV screened for in pregnancy?

A

based on history (have you had chickenpox) or blood tests (serum antibodies) - if there is no immunity immunoglobulins are recommended

25
Q

how many pregnancies per year are affected by HIV in the UK

A

1000

26
Q

what are the maternal risks of being pregnant whilst HIV positive

A

increased risk of gestational diabetes and pre-eclampsia

27
Q

what are the foetal defects associated with antenatal HIV infection

A

Pre-eclampsia

Growth restriction

Prematurity

Stillbirth

Vertical transmission (beyond 36 weeks)

28
Q

what are risk factors for increased risk of vertical transmission of HIV in pregnancy

A

High viral load/low CD4

Premature birth

Coexistant infection

Ruptured membranes >4 hours

25% of infected neonates will develop AIDS within 1 year, 40% in 5 years

29
Q

how do you diagnose HIV infection in pregnancy

A

Tested for at booking visit

viral load/CD4 count

30
Q

how do you manage HIV infection in pregnancy

A

+ve = regular viral load/CD4 check

Low C4 = PCP prophylaxis given

HAART significantly reduces mortality/morbidity and should be continued in pregnancy and delivery

Foetuses are treated for 6 weeks in maternal infection

If the mother is not on any prenatal treatment for HIV, treatment should be started at 28 weeks

C-section advised if viral load is above 50 copies/ml and there is coexistent hepatitis C

Breast feeding not advised

31
Q

what are the foetal complications associated with antenatal influenza infection

A

none

32
Q

what are the maternal complications associated with antenatal influenza infection

A

swine flu (H1N1) had increased risk of maternal death

33
Q

how do you manage antenatal influenza infection

A

If symptoms are present then oseltamivir should be given, and respiratory infection indicates hospital admission

Seasonal vaccination with inactivated vaccine strongly advised

34
Q

what foetal abnormalities are associated with zika virus infection

A

Ventriculomegaly

Intracranial calcificaiton

Microcephaly

35
Q

what transmits zika virus

A

ades mosquito

36
Q

what are the maternal symptoms of zika virus

A

rash + fever

37
Q

what is a possible complication of zika virus infection

A

guillan-barre syndrome

38
Q

what is the most common bacteria associated with maternal death around pregnancy

A

Group A strep - Strep pyogenes

39
Q

what is the most common symptom of a group A strep infection

A

sore throat

40
Q

how does strep infection present in pregnancy

A

Chorioamnionitis, diarrhoea, severe sepsis and abdominal pain will occur

41
Q

how do you manage ?Group A strep infection in pregnancy

A

early recognition

Cultures

IV Abx

42
Q

what are the complications of antenatal Group B strep (strep agalacticae) infection

A

neonatal sepsis

43
Q

how do you prevent vertical transmission of Group B strep during labour

A

IV penicillin during labour

44
Q

what are the indications for IV penicillin for prevention of group B strep transmission

A

Previous affected neonate

+ve urinary culture

Preterm labour

Prolonged rupture of membranes (>18hr)

Maternal fever in labour

45
Q

what % of women carry group B streptococcus asymptomatically

A

25%

46
Q

what treatment is indicated for syphillis infection antenatally

A

Benzylpenecillin

47
Q

what causes toxoplasmosis infection

A

contact with contaminated cat poo, meat or soil

48
Q

what is associated with more severe complications in toxoplasmosis infection

A

earlier gestational age at infection

49
Q

what are the foetal complications of an antenatal toxoplasmosis infection

A

Convulsions

Spasticities

Visual impairment

Mental handicap

50
Q

how do the majority of toxoplasmosis patients present

A

self-presenting

51
Q

what medication is used as soon as antenatal toxoplasmosis infection is diagnosed

A

spiramycin

52
Q

how is vertical transmission of toxoplasmosis monitored

A

20 week scan

53
Q

what is the treatment if vertical transmission of toxoplasmosis is found

A

Pyrimethamine

Sulfadiazine

Folinic acid

54
Q

what are risk factors for developing a listeria infection in pregnancy

A

consumption of unpasteurised/raw foods like pate, soft cheeses and prepacked meals

55
Q

what is the presentation of an antenatal listeria infection

A

non-specific febrile illness

56
Q

what is the foetal complications of an antenatal listeria infection

A

foetal death

57
Q

how do you establish a diagnosis of antenatal listeria infection

A

blood culture s

58
Q

what is bacterial vaginosis during pregnancy associated with

A

increased risk of preterm labour/miscarriage

Obstetrics (16 decks)

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