Infections in pregnancy; Polyhydramnios Flashcards
Describe the risk of infection of chickenpox during pregnancy [+]
Risk of Fetal varicella syndrome (FVS):
- skin scarring
- eye defects (microphthalmia) and cataracts
- scars and significant skin changes located in dermatomes
- limb hypoplasia
- microcephaly
- learning disabilities
Lecture notes:
- soft-tissue calcification
* polyhydramnios,
* limb defects and dermatomal skin scarring (due to fetal herpes zoster),
* soft-tissue calcification
* damage to the eyes and CNS.
Neurological defects include cortical atrophy, microcephaly, limb paresis, spinal cord atrophy, encephalitis, seizures and Horner’s syndrome.
What are the congenital TORCH infections? [5]
Toxoplasmosis
Others (syphilis, VZV, parvovirus B19, listeriorsis)
Rubella
CMV
Herpes Simplex V
severe neonatal varicella:
* if the mother develops rash between [] days before and [] days after birth there is a risk of neonatal varicella, which may be fatal to the newborn child in around 20% of cases
severe neonatal varicella:
- if the mother develops rash between 5 days before and 2 days after birth there is a risk of neonatal varicella, which may be fatal to the newborn child in around 20% of cases
How do you manage a patient who is unsure if they have previously had chickenpox? [1]
maternal blood should be urgently checked for varicella antibodies
Describe how you manage chickenpox exposure during pregnancy [1]
Describe how you manage chickenpox infection during pregnancy [1]
oral aciclovir (or valaciclovir) is now the first choice of PEP for pregnant women at any stage of pregnancy who are exposed to chickenpox
- antivirals should be given at day 7 to day 14 after exposure, NOT immediately
Infection:
- consensus guidelines (Health Protection Authority and RCOG) suggest oral aciclovir should be given if the pregnant women is ≥ 20 weeks and she presents within 24 hours of onset of the rash
- if the woman is < 20 weeks the aciclovir should be ‘considered with caution’
NB why wait: n a study evaluating the comparative effectiveness of 7 days course of aciclovir given either immediately after exposure or starting at day 7 after exposure to healthy children, the incidence and severity of varicella infection was significantly higher in those given aciclovir immediately (10/13 (77%) who received aciclovir immediately developed clinical varicella compared with 3/14 (21%) who started aciclovir at day 7
Rubella infection causing congenital rubella sydnrome is caused by maternal infection within the first [] weeks of pregancy.
When is there the highest risk? [1]
What is the clinical significance of this? [1]
First 20 weeks - but first 10 weeks poses highest risk
When primary infection occurs before 12weeks’ gestation, given the risk of fetal infection and the risk of an infected fetus developing severe abnormalities, it is reasonable to consider termination of pregnancy when appropriate
Describe the features of congenital rubella syndrome [5]
What is the clinical triad? [3]
- Congenital deafness
- Congenital cataracts
- ‘Salt and Pepper’ chorioretinitis
- Congenital heart disease (PDA and pulmonary stenosis)
- Learning disability
- Cerebral palsy
Triad:
- Microcephaly
- PDA
- Cataracts
Lecture:
- Hearing loss, learning disability, heart malformations and eye defects, neurodevelopmental delay, and endocrinopathies.
Describe how should vaccinate with regards to rubella and pregnancy? [1]
Women planning to become pregnant should ensure they have had the MMR vaccine.
- BUT should NOT recieve whilst pregnant as is a live vaccine
How do you manage non-immune mothers to MMR? [1]
non-immune mothers should be offered the MMR vaccination in the post-natal period
* MMR vaccines should not be administered to women known to be pregnant or attempting to become pregnant
Pregnant women are advised to avoid high-risk foods (e.g. blue cheese) and practice good food hygiene to prevent which infection? [1]
What is the clinical manifestation of having this infection in pregnancy? [1]
Listeria:
- Listeriosis in pregnant women has a high rate of miscarriage or fetal death.
- It can also cause severe neonatal infection.
The features of congenital CMV are [5]
The features of congenital CMV are:
* ‘Blueberry muffin rash’
* Petachial rash
* Fetal growth restriction
* Microcephaly
* Hearing loss - this is the key one to remember
* Vision loss
* Learning disability
* Seizures
NB: With approximately 40,000 infected children per year, congenital CMV infection is the most common cause of congenital non-genetic hearing loss
How do you treat congenital CMV? [1]
IV ganciclovir / PO valganciclovir
Bilateral cataracts in a newborn would most likely indicate..[1]
Congential rubella infection
There is a classic triad of features in congenital toxoplasmosis.
What is it? [3]
Intracranial calcification
Hydrocephalus
Chorioretinitis (inflammation of the choroid and retina in the eye)
How do you treat listeriosis infection in pregnancy? [2]
Ampicillin and gentamicin
Parvovirus
Fetal anaemia and fetal hydrops both visible on ultrasound. Anaemia can be assessed measuring at the how exactly? [1]
Fetal anaemia and fetal hydrops both visible on ultrasound. Anaemia can be assessed measuring at the Peak Systolic on Middle Cerebral artery (raised MCA-PSV).
