Infections of Pregnancy

Question 1

Complications of and Tx of Coxiella during pregnancy

Answer 1

Complications - thought to be d/t placental insufficiency through inflammation (not congenital malformations reported)

• IUGR, miscarraige/IUFD, preterm

Tx: (doxy/hydroxychloroquine preferred, but CI in pregnancy)

• suppressive tx w/ bactrim until delivery, then standard/definitive tx

Question 2

Clinical presentation and complications of Listeria

Answer 2

• self-limited GI disease most often
• invasive disease (longer incubation - 11-28 days)
  
  • miscarriage, stillbirth, preterm labor, neonatal disease
  • fetal/neonatal death in 25%
  • Neonatal disease
    
    • early (<6 days) d/t transplacental spread = sepsis
      
      • severe presentation = granulomatosis infantiseptica (disseminated abscesses + skin lesions). Usually fatal.
    • late (7-28 days) = often meningitis/encephalitis
• worse outcomes in 1st trimester, but often dx in 3rd trimester

Question 3

RF for GBS neonatal disease

(and how to handle it)

Answer 3

• F in labor (>38C)
• preterm labor (<37wk)
• PROM
• previous infant affected by GBS
• GBS bacteruria in this pregnancy

**above RF only predicts ~30% ⇒ routine genital screening at 35-37WGA

Positive screening - intrapartum abx

If GBS w/ prior pregnancy or +UCx for GBS during current pregnancy - intrapartum abx

Question 4

Risk of and complications of congenital toxoplasmosis

Answer 4

Risk

• 1st trimester - 10-15%, miscarriage or severe abnormalities likely
• 2nd trimester - 25%, neuro/ophtho > miscarriage
• 3rd trimester - >80%, usually limited to chorioretinitis

Complications

• miscarriage (greater if earlier in pregnancy)
• hydrocephalus, cerebral calcifications, chorioretinitis

Question 5

Tx of toxoplasmosis in pregnancy

Answer 5

spiramycin - maternal seroconversion

pyrimethamine/sulfadiazine for confirmed fetal infection

avoidance instructions during pregnancy

Question 6

T cruzi in pregnancy

Complications on fetus/neonate

How to prevent/tx

Answer 6

If child infected:

• increased risk of prematurity, LBW, PPROM
• if untreated - may develop chronic GI/cardiac complications

Screen all pregnant women live/have lived in endemic areas. If seropositive:

• microscopy for blood parasites/PCR at birth, again at 1mo
• serology at >9mos

Tx: benznidazole or nifurtimox x60 days

Question 7

Risk of and complications of Maternal rubella infection

Answer 7

Risk

• 1st trimester - major consequences
  
  • <8wk: 20% spontaneous abortion
  • <10wk: high risk of fetal defects (congenital rubella syndrome)
  • 13-18wk: primarily hearing defects, retinopathy (10-20%)
  • no risk >20wks

Congenital Rubella syndrome

• CV, neuro, ocular
• nerve deafness (b/l sensorineural)
• blueberry muffin rash (d/t dermal extramedullary hematopoiesis)

Question 8

Management of HBV in pregnancy

Answer 8

• Mother: tenofovir to all pregnant women w/ DNA >10⁷ in 3rd trimester
  
  • monitor DNA 2mos after starting, and ALT monthly after birth to detect postnatal HBV flares
  • can dc 4-12wks postpartum if doesn’t meet requirements for tx of chronic HBV
• Child: HB vaccine birth, 1, 2, 12mos + HBIG w/in 48hrs of birth
  
  • follow up long term w/ monitoring