Infections of pregnancy, puerperium and neonate.

Question 1

What is Puerperium?

Answer 1

It is a the weeks after delivery during which the mother’s tissues return to their non pregnant state

Question 2

How is Cytomegalovirus (CMV) acquired and transmitted to the baby?

Answer 2

Acquired:
Respiratory droplets/secretions

Transmission to baby:
Haematogenous (Blood stream via placenta)

Question 3

How is Parvovirus B19 acquired by the mother and transmitted to the baby?

Answer 3

Acquired:
Respiratory droplets/secretions

Transmission to baby:
Haematogenous (Blood stream via placenta)

Question 4

How is toxoplasmosis acquired by the mother and transmitted to the baby?

Answer 4

Acquired:
Ingestion of Oocysts (contains parasite, often get from cats)

Transmission to baby:
Haematogenous (Blood stream via placenta)

Question 5

How is Syphilis acquired by the mother and transmitted to the baby?

Answer 5

Acquired:
Sexually transmitted

Transmission to baby:
Haematogenous via placenta

Question 6

How is Varicella Zoster Virus (VZV) acquired by the mother and transmitted to the baby?

Answer 6

Acquired:
Respiratory droplets/secretions

Transmission to baby:
Haematogenous (Blood stream via placenta)

Question 7

How is Zika Virus acquired by the mother and transmitted to the baby?

Answer 7

Acquired:
Mosquito bite

Transmission to baby:
Haematogenous (Blood stream via placenta)

Question 8

Give 3 examples of infections that can be transmitted from mother to baby during delivery?

Answer 8

• 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

Question 9

What are some of the considerations when prescribing antimicrobials to pregnant or puerperial women?

Answer 9

• 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)

Question 10

Which antibiotics are considered safe in pregnancy?

Answer 10

• penicillins

- cephalosporins

Question 11

What antibiotics are considered unsafe in pregnancy?

Answer 11

• chloramphenicol
• tetracycline
• fluoroquinolones

Question 12

Give an example of a teratogenic (affect foetus) virus?

Answer 12

Rubella

Zika

Question 13

Describe the management of Urinary Tract Infections.

Answer 13

Treat both asymptomatic and symptomatic bacteriuria (it can progress and cause termination)

Treatment:
Amoxicillin or Cefalexin

Question 14

What is chorioamnionitis?

Answer 14

Inflammation of umbilical cord, amniotic membrances and placenta caused by intra amniotic infection

Question 15

What are the clinical features of Intra- amniotic infections?

Answer 15

• maternal fever
• uterine tenderness
• malodorous amniotic fluid
• maternal / foetal tachycardia
• raised white cell count

Question 16

What are the risk factors of Intra Amniotic Infections?

Answer 16

• prolonged rupture of membranes
• multiple cervical / vaginal examinations
• amniocentesis
• cordocentesis

Question 17

How do Intra Amniotic Infections occur?

Answer 17

Bacteria in the vagina ascend through cervix to cause infection.
OR

Via blood

Question 18

what are organisms cause Intra Amniotic Infections?

Answer 18

• Group B Streptococcus (part of normal vaginal flora)
• Enterococci (gastrointestinal tract)
• Escherichia Coli

Question 19

How is Intra Amniotic infection managed?

Answer 19

-Antimicrobials and delivery ASAP

Question 20

What is puerperal endometritis?

Answer 20

Infection of womb during puerperium

Question 21

What are the risk factors of puerperal endometritis?

Answer 21

• prolonged labour
• caesarean section
• Prolonged labour
• prolonged rupture of membranes
• multiple vaginal examinations

Question 22

What are the Clinical features of puerperal endometritis?

Answer 22

• Fever
• uterine tenderness
• bad smelling vaginal discharge
• increased white cell count
• abdo pain
• malaise

Question 23

What organisms cause Peurperal Endometritis and how is it treated?

Answer 23

• Escheria Coli
• Beta-haemolytic streptococci
• Anaerobes

Treated with intravenous antimicrobials.

Question 24

What causes Puerperal Mastitis?

Answer 24

Staphylococcus Aureus

Question 25

What are the clinical features of Puerperal Mastitis?

Answer 25

• onset 5 weeks post delivery
• fever, chills, breast soreness
• redness, warmth and tenderness of affected breast

Question 26

What is neonatal sepsis / meningitis?

Answer 26

sepsis is a syndrome resulting from invasion of pathogenic bacteria into the blood. Meningitis is a complication of sepsis.

Question 27

What are the clinical features of Neonatal sepsis / meningitis?

Answer 27

• 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)

Question 28

What organisms cause neonatal sepsis / meningitis?

Answer 28

• Group B Streptococcus
• Escherichia Coli
• Listeria Monocytogenes