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Reproductive System > Infections in Pregnancy > Flashcards

Infections in Pregnancy Flashcards

1
Q

What is the aetiology of chickenpox?

A
  • Varicella-zoster virus
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2
Q

How is varicella-zoster virus transmitted?

A
  • Respiratory droplets
  • Period of infectivity is from 48 hours before rash develops to once lesions have ‘crusted over’ (normally 5-7 days)
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3
Q

How long is the period of infectivity for the varicella-zoster virus?

A
  • Period of infectivity is from 48 hours before rash develops to once lesions have ‘crusted over’ (normally 5-7 days)
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4
Q

What is the presentation of chickenpox?

A
  • Children
    • Fever
    • Malaise
    • Itchy, vasicular rash
    • Usually harmless, self-limiting in children
  • Adults
    • Associated with greater morbidity – hepatitis, pneumonitis and encephalitis
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5
Q

What are some infections that cause complications during pregnancy?

A
  • Chickenpox
  • Parvovirus B19
  • Toxoplasmosis
  • HIV
  • Hepatitis B
  • Hepatitis C
  • Syphilis
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6
Q

What are examples of infections that are screened for during pregnancy?

A

HIV, Hep B and syphilis are screened for at book in

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7
Q

What investigations are done for chicken pox?

A
  • If exposed but unsure check immunity status by taking serum IgG
    • If immune (IgG positive) reassure, if non-immune (IgG negative) offer VZ immunoglobulin as soon as possible
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8
Q

Describe the management of chickenpox?

A
  • Advice to avoid contact with susceptible individuals
  • If mild and present within 24 hours of onset of rash
    • Oral acyclovir
  • If mild and present after 24 hours
    • Acyclovir has no role, advice symptomatic treatment and hygiene to prevent secondary bacterial infection
  • If severe
    • IV acyclovir and admit to hospital
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9
Q

What are possible complications of chicken pox in adults?

A
  • Greater risk of complications in immunocompromised and pregnant woman
  • Congenital infection if in first 28 weeks of pregnancy
  • Foetal varicella syndrome
    • Skin scarring, congenital eye abnormalities, hypoplasia of ipsilateral limbs, neurological abnormalities, no increased risk of miscarriage
  • Infection in new-born if infection in last 4 weeks gestation
  • Shingles
    • Caused by activation of dormant chickenpox virus that was in sensory route ganglion since primary infection
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10
Q

What is parovirus B19 also known as?

A
  • Slapped cheek disease
  • Fifth disease
  • Erythema infectiosum
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11
Q

How is parovirus B19 transmitted?

A
  • Respiratory droplets
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12
Q

What is the presentation of parovirus B19?

A
  • Children
    • Mild, febrile illness
    • Fever
    • Rash
    • Erythema of cheeks
  • Adults
    • Most are asymptomatic
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13
Q

What investigations are done for parovirus B19?

A
  • Blood tests for immunoglobulin testing
    • If positive, offer weekly scans for foetal complications
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14
Q

What is the management of parovirus B19?

A
  • No vaccine or treatment available
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15
Q

What are possible complications of parovirus B19?

A
  • In immunocompromised patients can cause a-platelet anaemia and haemolysis
  • During pregnancy can cause foetal anaemia resulting in cardiac failure, hydrops fatalis and foetal death
  • Can cause pre-eclampsia in pregnant mother
  • Critical exposure period is 12-20 weeks
    • Foetal infection is 5 weeks after maternal infection
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16
Q

What is the aetiology of toxoplasmosis?

A
  • Toxoplasma gondii parasite
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17
Q

Describe the incidence of toxoplasmosis in pregnancy?

A

2/1000 pregnancies

18
Q

How is toxoplasma gondii parasite transmitted?

A
  • Through cat faeces and undercooked meats by ingesting parasites
19
Q

What is the presentation of toxoplasmosis?

A
  • Asymptomatic usually
  • Or mild, flu like symptoms
    • Fever, sore throat, coryza, arthralgia
20
Q

What investigations are done for toxoplasmosis?

A

PCR analysis of amniotic fluid obtained from amniocentesis

21
Q

Describe the management for toxoplasmosis?

A
  • Advice pregnant woman to avoid cleaning cat litter and eating undercooked meat
22
Q

What are possible complications of toxoplasmosis?

A
  • Serious complications occur rarely
    • Chorioretinitis
    • Encephalitis
    • Myocarditis
    • Pneumonitis
  • Parasitaemia occurs within 3 weeks of ingestion
  • Foetal complications
    • Hydrocepahlus
    • Intracranial calcifications
    • Microcephaly
    • Chorioretinitis
    • Ventriculomegaly
    • Miscarriage and intrauterine death
23
Q

What investigations are done for HIV?

A
  • Monitoring of LFT
  • CD4 count and HIV viral load
24
Q

Describe the management of HIV?

A
  • MDT input throughout pregnancy
    • Obstetric consultant team, community midwifery team, HIV specialist, neonatologist, GP
  • Offer 4 weekly foetal scans
  • Refer to neonatology for HIV testing on new-born
  • Combined anti-HIV viral medications (cART)
    • Aims are viral load <50 HIV RNA copies/ml (allow for vaginal delivery), reduce risk of vertical transmission, improve mothers health
    • Breast feeding increases risk of vertical transmission
25
Q

At what viral load of HIV is vaginal birth still recomended?

A
26
Q

What are possible complications of HIV during pregnancy?

A
  • Increased risk of pre-eclampsia
  • Miscarriage
  • Preterm delivery
  • Low birth weight
27
Q

What is the incidence of hepatitis B?

A
  • 1/1000 people infected
28
Q

How is hepatitis B transmitted?

A
  • Often by vertical transmission
  • Bloods and other bodily fluids
29
Q

Describe the management for hepatitis B?

A
  • For woman with chronic Hep B and high viral load
    • Tenofovir monotherapy in 3rd trimester to reduce risk of vertical transmission
  • Hep B vaccine can be given to pregnant woman who are high risk due to it being inactive
    • High risk includes IV drug users, partner who is IV drug user or HBV or HIV positive
  • Hep B immunoglobulin to new-born and accelerated immunisation schedule (initial dose of vaccine at birth, with more doses at 4 weeks, 8 weeks and 12 months)
    • Test for Hep B at 12 months for chronic infection
30
Q

What are possible complications of hepatitis B during pregnancy?

A
  • Baby contracts Hep B at birth, putting them at risk of liver cirrhosis and hepatocellular cancer
31
Q

What kind of virus is hepatitis C?

A

RNA virus

32
Q

What is the prevalence of heptatis C in pregnant woman?

A

1-2%

33
Q

How is hepatitis C transmitted?

A
  • Vertical transmission
    • Occurs in 1/20 birth, risk higher if woman co-infected with HIV
  • IV drug users
  • Not from breastfeeding
34
Q

Is heptatis C screened for?

A
  • Not part of routine antenatal screening, but indications for screening are
    • Substance misusing pregnant woman
    • Previous history of IV drug use
    • Current or previous partner has history of IV drug use
    • Pregnant woman is HIV or Hep B positive
35
Q

What are indications for screening for hepatitis C?

A
  • Substance misusing pregnant woman
  • Previous history of IV drug use
  • Current or previous partner has history of IV drug use
  • Pregnant woman is HIV or Hep B positive
36
Q

Describe the management for hepatitis C?

A
  • No means to stop transmission from mother to baby
  • No treatment during pregnancy as drugs are teratogenic and therefore contraindicated
37
Q

What are possible complications of hepatitis C?

A
  • Severe hepatitis
  • Chronic liver disease
  • Increased risk of liver cancer
38
Q

What is the aetiology of syphilis?

A
  • Spirochete treponema pallidum
39
Q

How is syphilis transmitted?

A
  • Direct contact with skin lesion, usually occurs during sexual contact
  • Infection more than once is possible, no immunity acquired due to production of no antibodies
40
Q

What is the presentation of syphilis?

A
  • Primary syphilis
    • Painless, local ulcer
    • If untreated, 4-10 weeks later symptoms of secondary syphilis may develop, and then tertiary syphilis (takes 20-40 years)
  • Congenital infection presents within first 2 years of life or later
    • Most are asymptomatic at birth but have symptoms within 5 weeks
    • Hutchinson’s triad – deafness, interstitial keratitis, hutchinson’s teeth (widely spaced, peg like)
41
Q

What is the management of syphilis?

A
  • Cure with course of IM penicillin
42
Q

What are possible complications of syphilis?

A
  • Chronic syphilis can cause cardiac, neurological, skeletal and skin abnormalities
  • Miscarriage
  • Stillbirth
  • Hydrops featlis
  • Growth restriction
  • Congenital infection

Reproductive System (34 decks)

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