Infections of pregnancy, puerperium and neonate. Flashcards
What is Puerperium?
It is a the weeks after delivery during which the mother’s tissues return to their non pregnant state
How is Cytomegalovirus (CMV) acquired and transmitted to the baby?
Acquired:
Respiratory droplets/secretions
Transmission to baby:
Haematogenous (Blood stream via placenta)
How is Parvovirus B19 acquired by the mother and transmitted to the baby?
Acquired:
Respiratory droplets/secretions
Transmission to baby:
Haematogenous (Blood stream via placenta)
How is toxoplasmosis acquired by the mother and transmitted to the baby?
Acquired:
Ingestion of Oocysts (contains parasite, often get from cats)
Transmission to baby:
Haematogenous (Blood stream via placenta)
How is Syphilis acquired by the mother and transmitted to the baby?
Acquired:
Sexually transmitted
Transmission to baby:
Haematogenous via placenta
How is Varicella Zoster Virus (VZV) acquired by the mother and transmitted to the baby?
Acquired:
Respiratory droplets/secretions
Transmission to baby:
Haematogenous (Blood stream via placenta)
How is Zika Virus acquired by the mother and transmitted to the baby?
Acquired:
Mosquito bite
Transmission to baby:
Haematogenous (Blood stream via placenta)
Give 3 examples of infections that can be transmitted from mother to baby during delivery?
- Group B Streptococcus (part of normal vaginal flora can colonise on baby)
- Herpes simplex virus (HSV) (active ulcers)
- Gonorrhoea (can enter via baby’s eyes causing conjuctivitis)
- Chlamydia (can enter via baby’s eyes, can cause blindness)
- HIV (usually transmitted via contact rather than placenta)
- Hepatitis B
What are some of the considerations when prescribing antimicrobials to pregnant or puerperial women?
- Pregnancy increases the glomerular filtration rate resulting in increased renal excretion of antimicrobials. The serum levels of antimicrobials are therfore lower in pregnancy so a LARGER DOSE maybe required.
- antimicrobials are passed on in breast milk. (consequences for baby)
Which antibiotics are considered safe in pregnancy?
- penicillins
- cephalosporins
What antibiotics are considered unsafe in pregnancy?
- chloramphenicol
- tetracycline
- fluoroquinolones
Give an example of a teratogenic (affect foetus) virus?
Rubella
Zika
Describe the management of Urinary Tract Infections.
Treat both asymptomatic and symptomatic bacteriuria (it can progress and cause termination)
Treatment:
Amoxicillin or Cefalexin
What is chorioamnionitis?
Inflammation of umbilical cord, amniotic membrances and placenta caused by intra amniotic infection
What are the clinical features of Intra- amniotic infections?
- maternal fever
- uterine tenderness
- malodorous amniotic fluid
- maternal / foetal tachycardia
- raised white cell count
What are the risk factors of Intra Amniotic Infections?
- prolonged rupture of membranes
- multiple cervical / vaginal examinations
- amniocentesis
- cordocentesis
How do Intra Amniotic Infections occur?
Bacteria in the vagina ascend through cervix to cause infection.
OR
Via blood
what are organisms cause Intra Amniotic Infections?
- Group B Streptococcus (part of normal vaginal flora)
- Enterococci (gastrointestinal tract)
- Escherichia Coli
How is Intra Amniotic infection managed?
-Antimicrobials and delivery ASAP
What is puerperal endometritis?
Infection of womb during puerperium
What are the risk factors of puerperal endometritis?
- prolonged labour
- caesarean section
- Prolonged labour
- prolonged rupture of membranes
- multiple vaginal examinations
What are the Clinical features of puerperal endometritis?
- Fever
- uterine tenderness
- bad smelling vaginal discharge
- increased white cell count
- abdo pain
- malaise
What organisms cause Peurperal Endometritis and how is it treated?
- Escheria Coli
- Beta-haemolytic streptococci
- Anaerobes
Treated with intravenous antimicrobials.
What causes Puerperal Mastitis?
Staphylococcus Aureus
What are the clinical features of Puerperal Mastitis?
- onset 5 weeks post delivery
- fever, chills, breast soreness
- redness, warmth and tenderness of affected breast
What is neonatal sepsis / meningitis?
sepsis is a syndrome resulting from invasion of pathogenic bacteria into the blood. Meningitis is a complication of sepsis.
What are the clinical features of Neonatal sepsis / meningitis?
- Temperature
- Respiratory (dyspnoea, apnoeas, cyanosis)
- Cardiovascular (Tachycardia, bradycardia, hypotension)
- Hepatic (hepatomegaly, jaundice)
- Gastrointestinal (anorexia, vomiting, abdominal distension, diarrhoea)
- Haematological (bleeding disorders)
- CNS (lethargy, irritability and seizures)
What organisms cause neonatal sepsis / meningitis?
- Group B Streptococcus
- Escherichia Coli
- Listeria Monocytogenes
