Infections in Pregnancy and the Neonate

Question 1

Define:

• Congenital,
• Perinatal period,
• Neonatal period,
• Postnatal period,

Answer 1

• Congenital - Condition presents at birth.
• Perinatal period - Commences at 22 weeks of gestation and ends 7 days after birth.
• Neonatal period - First 29 days of life.
• Postnatal period - First 6 weeks after birth.

Question 2

What are some of the vertical transmission pathways?

Answer 2

• Across placenta (intrauterine)
• During birth,
• Direct contact with maternal body fluids,
• Prolonged rupture of membranes (only safe for 12 hours after a membrane is ruptured),
• After birth (from mother or other contacts)

Question 3

How does rubella present?

Answer 3

• Hepatitis-associated jaundice, haemolysis, thrombocytopenia, microcephalus, cataract, deafness, heart-defects in foetus and low birth weight. Potentially need to terminate pregnancy

Question 4

Describe how primary varicella zoster virus presents in the first 20weeks of gestation and how it presents around delivery

Answer 4

20weeks - Congenital varicella syndrome, eye defects, hypoplastic limb and microcephalus.

Delivery - Neonatal varicella syndrome, rash and penumonitis.

Question 5

What is some of the prevention and treatment of varicella zoster virus?

Answer 5

• Aciclovir (IV),
• VZV immunoglobin within 7-10 days of exposure.
• Live vaccine

Question 6

How does parvovirus B19 present?

Answer 6

With foetal anaemia and hydrops (20%)

Question 7

How do you diagnose parvovirus B19?

Answer 7

Amniocentesis or chorionic villus sampling and then you want to monitor for foetal ascites

Question 8

What can the cytomegalovirus cause and how is it diagnosed?

Answer 8

• Can cause deafness or retardation in foetus.

- Diagnosed by NAAT on amniotic fluid or neonatal blood/urine within 3 weeks of birth

Question 9

What can occur with a listeria monocytogenes infection in early pregnancy vs late pregnancy

Answer 9

Early - Foetal death.

Later - Premature birth. Therefore prevention is KEY! eg, avoid unpasteurised foods

Question 10

What are complications of foetal infection of listeria monocytogenes?

Answer 10

Bacteraemia, hepatosplenomegaly, meningocephaly, thrombocytopenia and pneumonitis

Question 11

What can occur if there is a toxoplasmosis infection in the first or second trimester?

Answer 11

Stillborn, Death soon after birth, cerebral calcification, cerebral palsy, epilepsy and chorioretinitis

Question 12

How is toxoplasmosis infection treated?

Answer 12

Spiramycin

Question 13

How can the risk of vertical transmission of HIV be reduced?

Answer 13

• HIV testing,
• Counselling,
• Antiretroviral medication,
• Delivery by caesarean section prior to onset of labour and,
• Discourage breast feeding

Question 14

How does treponema pallidum (syphilis) present and how is it treated?

Answer 14

Presents with fever, rash, condylomata (genital warts) and mucosal fissures. It is treated with benzylpenicillin

Question 15

How does Staph aureus infection present in babies?

Answer 15

Due to the s.aureus toxins it can cause scalded skin syndrome

Question 16

Describe the effects of the Zika virus

Answer 16

If there is infection during pregnancy then is can cause severe brain effects such as microcephaly and guillian-barre syndrome (bodys immune system attacks your nerves)

Question 17

What is ophthalmia neonatorum

Answer 17

Conjunctivitis contracted by newborns during delivery. Can occur when mother is infected with N.gonorrhoeae or C.trachomatis. Without treatment can cause blindness

Question 18

What is the most common serious medical condition seen in pregnancy?

Answer 18

Pyelonephritis. The most predisposing factor is asymptomatic bacteriuria.