Infections in Pregnancy and the Neonate

Question 1

What are the manifestations of congenital infection and examples?

Answer 1

• growth retardation
• congenital malformation
• foetal loss

Examples:

• rubella
• CMV
• HIV

Question 2

What are the manifestations of perinatal infection and examples?

Answer 2

• meningitis
• septicaemia
• pneumonia
• pre-term labour

Examples:

• gonococcus
• chlamydia
• HSV

Question 3

What are the manifestations of post-natal infection and examples?

Answer 3

• meningitis
• septicaemia
• conjunctivitis
• penumonitis

Examples:

• n. gonorrhoea
• chlamydia
• HIV

Question 4

When can a rubella infection arise in pregnancy and the signs of it?

Answer 4

• first trimester (high risk of congenital rubella syndrome)

Signs:

• hepatitis-associated jaundice
• haemolysis
• thrombocytopaenia

Question 5

What are the consequences of congenital rubella syndrome?

Answer 5

• low birth weight
• microcephalus
• cataract
• deafness
• heart defects
• difficulty attaining developmental milestones

Question 6

What are the preventative measures for intra-uterine and perinatal infections?

Answer 6

• MMR vaccine (rubella)
• pre-natal screening (rubella, syphilis, asymptomatic bacteriuria)
• VZV immunoglobulin/live vaccine (VZV)
• HIV testing/counselling/antiretroviral meds/c-section prior to labour/discouraging breastfeeding (HIV)
• barrier contraception/avoi mosquito bites (zika)

Question 7

Describe the consequences of varicella zoster virus (VZV) and treatment

Answer 7

in first 20 weeks gestation:

• congenital varicella syndrome
• eye defects
• hypoplastic limb
• microcephalus

Around delivery:

• neonatal varicella syndrome
• rash
• pneumonitis
• treatment: aciclovir (IV)

Question 8

What are the signs, diagnosis and management of parvovirus B19?

Answer 8

• foetal anaemia
• hydrops (<10%)
• diagnosed by CVS/amniocentesis
• monitor for foetal ascites
• can result in slapped cheek syndrome

Question 9

What are the consequences and method to diagnose CMV during pregnancy?

Answer 9

• can cause deafness and retardation of foetus

- diagnosed using NAAT on amniotic fluid and neonatal blood/urine

Question 10

What are the consequences of listeriosis infection during pregnancy?

Answer 10

• early pregnancy: foetal death
• later pregnancy: premature birth
  intrapartum exposure: meningitis and bacteraemia

Foetal infection:

• bacteraemia
• hepatosplenomegaly
• meningoencephaly
• thrombocytopaenia
• pneumonitis

Question 11

What is the diagnosis, treatment and management of listeriosis during pregnancy?

Answer 11

• diagnosed by culturing blood/CSF/placental tissue/lochia

- treatment: specialist advice on antibiotics

Question 12

What are the consequences of toxoplasmosis infection during the first and second trimester of pregnancy?

Answer 12

• still born
• death soon after birth
• cerebral calcification
• cerebral palsy
• epilepsy
• chorioretinitis

Question 13

How would you confirm maternal infection of toxoplasmosis and treat it?

Answer 13

• confirmed by presence of IgM antibodies

- treated with spiramycin

Question 14

How can a s.aureus infection manifest onto a neonate?

Answer 14

scalded skin syndrome

Question 15

What are the signs of zika virus?

Answer 15

• through a bite: fever, rash, joint pain, conjunctivitis

- through pregnancy: severe congenital brain effects (microencephaly, Guillain-Barre syndrome)

Question 16

Describe opthalmia neonatorum

Answer 16

• conjunctivitis contracted by newborns during delivery
• mother infected with n.gonorrhoeae or c.trachomatis
• can cause blindness without treatment

Question 17

Why are pregnant women more susceptible to pyelonephritis?

Answer 17

• urinary tract changes during pregnancy
• compression of the ureters from the gravid uterus causes ureteral dilation
• progesterone also causes smooth muscle relaxation which also leads to dilation and urinary stasis
• vesicoureteral reflux increases