Infections in pregnancy

Question 1

What foetal effects does CMV have?

Answer 1

IUGR.

Pneumonia.

Thrombocytopaenia.

Neurological sequelae: hearing, visual , mental impairment / death.

Asymptomatic (__90%) neonates at risk of deafness.

Question 2

How would you diagnose foetal CMV?

Answer 2

Amniocentesis 6wks after maternal infection.

USS abnormalities only seen in 20%.

IgM can stay high from before pregnancy.

Question 3

How would you manage CMV in pregnancy?

Answer 3

USS for abnormalities.

Foetal blood sample at 32weeks for platelets.

No prenatal treatment, termination may be offered.

Question 4

When is a foetus at risk of herpes simplex infection?

Answer 4

Vaginal delivery to mother who has had a primary attack within 6wks or primary genital lesions.

Question 5

How would you manage primary herpes in late pregnancy?

Answer 5

Refer to GUM.

C-S.

Neonatal acyclovir if exposed.

Question 6

What effect does toxoplasma have on the foetus?

Answer 6

Mental retardation.

Convulstions.

Spasticity.

Visual impairment.

Question 7

How do you diagnose antenatal toxoplasmosis?

Answer 7

Maternal: IgM.

Foetal: amniocentesis after 20w.

Question 8

What antenatal effects does herpes zoster have?

Answer 8

Rarely teratogenic (1-2%).

Severe neonatal infection if delivery occurs 2 days before / 5 days after maternal symptoms.

Question 9

How do you manage perinatal herpes zoster?

Answer 9

Maternal:

If exposed: test immune status.

If non-immune: immunoglobulin.

If infected: acyclovir.

Baby:

If born -2/+5 of maternal infection, aciclovir.

Question 10

What foetal effects does parvovirus B19 have?

Answer 10

Suppression of erythropoiesis: anaemia. +- thrombocytopaenia.

Fetal death in 10%, usually if infected before 20weeks.

Question 11

How would you investigate parvovirus B19 in a pregnant lady?

Answer 11

Maternal IgM indicates infection has occurred.

Fetal anaemia detected by USS.

Question 12

How would you manage Parvovirus B19 infection in pregnancy?

Answer 12

Regular scans.

In utero transfusion if indicated (hydrops).

Good prognosis if they survive.

Question 13

What effects does group B strep have in pregnancy?

Answer 13

Transmission occurs at birth and causes neonatal sepsis (1:500).

This has a 6% mortality (18% preterm).

Question 14

How do you manage GBS in pregnancy?

Answer 14

IV penicillin during labour.

Question 15

What indicators are used for Hep B infectivity?

Answer 15

Antibodies: Hep B surface antibody implies low infectivity. Hep B surface antigen or Hep B E antitigen implies high infectivity.

Question 16

How would you manage Hep B in the neonate?

Answer 16

Immunisation! Reduces risk of transmission by 90%.

Question 17

What are the effects of HIV in pregnancy?

Answer 17

Maternal: pre-eclampsia and GDM.

Foetal: Stillbirth, IUGR, prematurity.

Vertical transmission occurs mostly after 36wks, intrapartum or from breast feeding.

Question 18

How is HIV managed in pregnancy?

Answer 18

HAART: zidovudine from 28wks. C-S.

Neonatal zidovudine for 6wks. Avoid breastfeeding.

Question 19

How does group A strep (strep pyogenes) present in pregnancy?

Answer 19

Chorioamnionitis with abdo pain, diarrhoea, severe sepsis.

Question 20

What are the foetal effects of group A strep?

Answer 20

Death in Utero.

Question 21

What are the effects of syphylis in pregnancy?

Answer 21

Miscarriage.

Severe congenital disease.

Stillbirth.

Question 22

How do you treat syphilis in pregnancy?

Answer 22

Benzylpenicillin.

Question 23

What do chlamydia and gonorrhoea cause in pregnancy?

Answer 23

Preterm labour and neonatal conjunctivitis.