Infections in pregnancy Flashcards
What foetal effects does CMV have?
IUGR.
Pneumonia.
Thrombocytopaenia.
Neurological sequelae: hearing, visual , mental impairment / death.
Asymptomatic (__90%) neonates at risk of deafness.
How would you diagnose foetal CMV?
Amniocentesis 6wks after maternal infection.
USS abnormalities only seen in 20%.
IgM can stay high from before pregnancy.
How would you manage CMV in pregnancy?
USS for abnormalities.
Foetal blood sample at 32weeks for platelets.
No prenatal treatment, termination may be offered.
When is a foetus at risk of herpes simplex infection?
Vaginal delivery to mother who has had a primary attack within 6wks or primary genital lesions.
How would you manage primary herpes in late pregnancy?
Refer to GUM.
C-S.
Neonatal acyclovir if exposed.
What effect does toxoplasma have on the foetus?
Mental retardation.
Convulstions.
Spasticity.
Visual impairment.
How do you diagnose antenatal toxoplasmosis?
Maternal: IgM.
Foetal: amniocentesis after 20w.
What antenatal effects does herpes zoster have?
Rarely teratogenic (1-2%).
Severe neonatal infection if delivery occurs 2 days before / 5 days after maternal symptoms.
How do you manage perinatal herpes zoster?
Maternal:
If exposed: test immune status.
If non-immune: immunoglobulin.
If infected: acyclovir.
Baby:
If born -2/+5 of maternal infection, aciclovir.
What foetal effects does parvovirus B19 have?
Suppression of erythropoiesis: anaemia. +- thrombocytopaenia.
Fetal death in 10%, usually if infected before 20weeks.
How would you investigate parvovirus B19 in a pregnant lady?
Maternal IgM indicates infection has occurred.
Fetal anaemia detected by USS.
How would you manage Parvovirus B19 infection in pregnancy?
Regular scans.
In utero transfusion if indicated (hydrops).
Good prognosis if they survive.
What effects does group B strep have in pregnancy?
Transmission occurs at birth and causes neonatal sepsis (1:500).
This has a 6% mortality (18% preterm).
How do you manage GBS in pregnancy?
IV penicillin during labour.
What indicators are used for Hep B infectivity?
Antibodies: Hep B surface antibody implies low infectivity. Hep B surface antigen or Hep B E antitigen implies high infectivity.
How would you manage Hep B in the neonate?
Immunisation! Reduces risk of transmission by 90%.
What are the effects of HIV in pregnancy?
Maternal: pre-eclampsia and GDM.
Foetal: Stillbirth, IUGR, prematurity.
Vertical transmission occurs mostly after 36wks, intrapartum or from breast feeding.
How is HIV managed in pregnancy?
HAART: zidovudine from 28wks. C-S.
Neonatal zidovudine for 6wks. Avoid breastfeeding.
How does group A strep (strep pyogenes) present in pregnancy?
Chorioamnionitis with abdo pain, diarrhoea, severe sepsis.
What are the foetal effects of group A strep?
Death in Utero.
What are the effects of syphylis in pregnancy?
Miscarriage.
Severe congenital disease.
Stillbirth.
How do you treat syphilis in pregnancy?
Benzylpenicillin.
What do chlamydia and gonorrhoea cause in pregnancy?
Preterm labour and neonatal conjunctivitis.
