Infections in Pregnancy and Postnatal Infection Flashcards
CHEAP TRCHSZ - Important causes of infection in pregnancy
Chickenpox
Hepatitis B and C
Everything else sexually transmitted
AIDS/HIV
Parvovirus
Toxoplasma gondii
Rubella
Cytomegalovirus
HSV
Syphilis
Zika
What type of vaccinations are okay in pregnancy and which aren’t?
DO NOT use live vaccine in pregnancy. All others are okay.
Which vaccines are recommended in vaccination?
Influenza, pertussis.
How does parvovirus B19 present, and what are its implications for pregnancy?
Presentation:
- Flu-like illness
- Erythematous rash
- Joint pain
Pregnancy implications:
- Fetal loss
- HYdrops fetalis
Does past infection of syphilis confer immunity?
NO
How is syphilis screened and diagnosed?
Syphilis serology: Treponemal specific tests
- EIA (enzyme immunoassay automated) test = SCREENING test
- TPAA (treponema pallidum antibody-antigen agglutination) test = CONFIRMATORY test
Non-treponemal tests measure disease activity.
How is syphilis treated?
Early syphilis
- Benzathine pencillin IM single dose
Late syphilis:
- Benzathine pencillin IM once weekly for 3 weeks
What is the name of the common reaction experienced to treatement of syphilis in adults.
Jarisch-Herxheimer reaction
- Fever, chill, malaise, joint pain, hypotension, tachycardia
- Begins within 2 hours of treatment and self-resolves after 24 hours. Management is supportive.
What is the significance of pregnant women in the Jarisch-Herxheimer reaction?
Jarisch-Herxheimer reaction can precipitate pre-term labour.
What important virus in pregnancy is mostly asymptomatic, but can present with fevers and lethargy?
Cytomegalovirus (CMV)
What does CMV avidity tell you?
CMV avidity = strength of binding between antigen and antibody
- weak bond = recent infection
- strong bond = distant infection
What are intra-amniotic infections?
Polymicrobial infections caused by ascending cervico-vaginal organisms.
Involves amniotic fluid, placenta, fetus and fetal membranes.
What streptococcus plays an important role in postnatal infection?
Group B streptococcus - Streptococcus agalactiae.
Gram positive cocci
What can Group B strep cause in the mother and delivered baby?
Mother:
- UTI
- Post-partum endometritis
Baby:
- Sepsis
- Pneumonia
- Meningitis
- Death
What is the most important risk factor in Group B streptococcus (GBS) infection of the mother/baby
Recto-vaginal colonisation of the mother
What are the two methods of prevention of GBS complications?
Screening:
- Swabs from rectum and vagina
- Treated with IAP (intrapartum antibiotic prophylaxis)
Risk-based approach:
- Treat those with risk factors (GBS bacteruria, fever >38 degrees)
What are the cons of screening and risk-based approach?
Screening - increased exposure to antibiotics, increased GBS resistance, increased medicalisation of pregnancy (stress)
Risk-based approach - some women who should be given antibiotics will be missed
Which bacteria, which can cause flu-like symptoms, is found in undercooked meat and multiplies at low-temperatures (e.g. in a fridge)
Listeria monocytogenes
What is the definition of post-partum fever?
Fever >38 degrees 2 to 10 days after birth.
It is normal to have an elevated temperature directly after birth.
What are 4 possible causes of post-partum fever?
- Surgical site infection
- Endometritis
- Mastitis
- UTI
What is endometritis?
Inflammation/infection of the endometrium (lining of the uterus)
What is the most important risk factor for developing endometritis?
Having a Caesarean section.
What can cause endometritis?
Migration of vaginal flora into the uterus
- Aerobes: SEKPEMP
- Anaerobes: Peptostreptococcus, Clostridium
What is the treatment regiment for endometritis?
Since endometritits can be cause by a wide variety of flora from the vagina, the triple drug regimen is used:
- Amoxycillin (Gram +ve)
- Gentamicin (Gram -ve)
- Metronidazole (protozoans + gram +ve/-ve)
