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Y5 OG Conditions > Infections (Obs): CMV, Hep B, HSV > Flashcards

Infections (Obs): CMV, Hep B, HSV Flashcards

1
Q

What is CMV?

A

Common infection in pregnancy associated with severe congenital syndrome in the fetus.

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2
Q

What is the aetiology of CMV?

A

Transmission: sexual, blood, saliva, urine, vertical.

Asociations / Risk factors
Higher SES, immunosuppresson (HIV)

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3
Q

What is the epidemiology of CMV?

A

50% immunity in pregnant women. 1% seronegative pregnant women will contract it.

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4
Q

What is the history/ exam of CMV?

A

Often asymptomatic, ?fever, malaise, fatigue.

No clinical signs, lymphadenopathy.

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5
Q

What is the pathology of CMV?

A

DNA herpes virus. Incubation perios 1 month. Following primary infection, lays dormant and reactivates when immunosuppressed.

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6
Q

What investigations do you do for CMV?

A

Blood: CMV IgM (current)/IgG (past infection)

USS: fetal anomaly scan

Other: amniocentesis for CMV PCR (6-9wk after primary infection)

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7
Q

What is the management of CMV?

A

No treatment to prevent transmission to fetus. May offer TOP if evidence of neural damage. Naonatal ganacyclovir can attenuate hearing impairment.

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8
Q

What are the complications/ prognosis of CMV?

A

High risk of miscarriage, stilbirth, congenital CMV, IUGR, microcephaly, intracerebral calcification, blind, sensorineural deafness, hepatosplenomegaly, skin rash, pneumonitis, mental retardation

40% rate of transmission to fetus if infected mother. Of these, 10% develop fetal CMV syndrome. 90% of children with this develop LT neuro delay.

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9
Q

What is Hep B?

A

Infection caused by the Hep B virus

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10
Q

What is the aetiology of Hep B?

A

Transmission by sexual contact, blood borne, vertical

Asociations / Risk factors
Multiple partners, unprotected sex, IVDU, SE asian.

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11
Q

What is the epidemiology of Hep B?

A

1/100k.

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12
Q

What is the history/ exam of Hep B?

A

Fever, myalgia, N&V, jaundice, abdominal pain. Asymptomaic in 70%.

Jaundice, hepatomegaly, RUQ tenderness

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13
Q

What is the pathology of Hep B?

A

DSDNA virus, hepadenavirus familt. Replicates in the liver and causes hepatic dysfunction. Incubation 2-6 months.

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14
Q

What investigations do you do for Hep B?

A

Bloods: HbsAG (infection), core Ab (anti-HBc IgM acutely), Hep B e-markers (HbeAg – high infectivity strain), LFT.

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15
Q

What is the management of Hep B?

A

Delivery: C seciton NOT INDICATED, AVOID FBS/FSE.

Postnata: mothers can breastfeed.

Neonatal vaccination: IF mother is HbsAg positive at birth, 1 month, 2 months and booster at 1yr.

Neonatal HBIG: within 48h of delivery, if BW <1500g, if acute infection in pregnanct, if mother is HbeAg positive (or HbeAg negative but anti-HbeAg negative).

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16
Q

What are the complications/ prognosis of Hep B?

A

Maternal: 10% chronic cirrhosis, hepatitis. High risk of HCC. 1% fulminating hepatitis.

Neonates: 90% develop chronic hepatitis

With tx, vertical transmission rate 10%. .

17
Q

What is HSV?

A

Infeciton with HSV in pregnancy

18
Q

What is the aetiology of HSV?

A

Transmission by physical contact with open sore. Sex, vertical.

Unprotected sex, immunosuppression, other STIs

19
Q

What is the epidemiology of HSV?

A

2% pregnant women.

20
Q

What is the history/ exam of HSV?

A

Burning, pain, prutitus, dysuria. May be asymptomatic

Clusters of vescicles with surrounding erythema, can progress to ulceration over time, lymphadenopathy.

21
Q

What is the pathology of HSV?

A

DNA herpes virus, 1 is oral 2 is genital.

Dormant period: following primary infection lies dormant in nerve ganglia

Spread to neonate: mainly via direct contact with maternal fluids, but transplacental tranmsission possible. Risk of transmission with vaginal delivery 40% with primary lesions, 2% with recurrent lesions.

22
Q

What investigations do you do for HSV?

A

Clincial diagnosis but support with microbiology (viral culture/PCR, STI screen)

Bloods: HSV Ab (primary infeciton in third trimester)

23
Q

What is the management of HSV?

A

Antenatal: aciclovir in primary infection

Delivery with primary HSV: if within 6wk of infection, advise C section. If opts for vaginal, give IV ACV intrapartum, avoid PROM/FSE/FBS

Delivery with recurrent HSV: No ned for C section. Womn may opt for C section if lesions detected at onset of labour – can offer daily ACV if lseions found from 36/40

24
Q

What are the complications/ prognosis of HSV?

A

Maternal: disseminated herpes (encephalitis, hepatitis, disseminated skin lesions) rare but more common in pregnancy

Neonatal: 1/60k live births – can affect skin, eyes, mouth, CNS, multiple organs. Mortality 2% to 50% depending on local or disseminated.

Y5 OG Conditions (76 decks)

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