Infections of pregnancy, puerperium and neonate Flashcards
What is the definition of ‘pregnancy’?
Conception to delivery
What is the puerperium?
- The puerperal state or period.
- Specifically - the few weeks following delivery during which the mother’s tissues return to their non-pregnant state.
- Usually 6-8 weeks post partum
What is a neonate?
An infant less than 4 weeks old.
Which infections can be transmitted to the foetus during pregnancy (i.e. haematogenous spread via placenta)?
- CMV
- Parvovirus B19
- Toxoplasmosis
- Secondary/tertiatry syphilis
- VZV
- Zika virus
Which infections can be transmitted to the baby during delivery?
- Group B Strep
- HSV
- Gonorrhoea
- Chlamydia
- HIV
- Hep B
For which diseases is prophylaxis available and screening undertaken?
- HIV
- Hep B
Why does the handling of drugs differ during pregnancy?
- Increase of GFR results in increased renal excretion of many antimicrobials
- Serum levels of anti-microbials are generally lower during pregancy
What must be considered, with regards to the foetus, when prescribing in pregnancy?
- The potential to cause harm to the embryo/foetus/neonate must be considered
- All antimicrobials cross the placenta to some extent
- Virtually all antimicrobials appear in breast milk if given in therapeutic amounts to breast feeding women
Which antimicrobials are considered ‘safe’ in pregnancy?
- Penicillins
- Cephalosporins
Which antimicrobials are considered ‘unsafe’ in pregnancy?
- Chloramphenicol
- Tetracycline
- Fluoroquinolones (e.g. cipro)
- Trimethoprim-sulphamethoxazole
Which primary viral infections cause mild symptoms/are asymptomatic?
- CMV
- Zika
Which primary viral infections are severe?
- VZV
- HSV
- measles
- influenza
What can be the consequences of foetal viral infections?
- Nothing
- Birth defects
- Stillbirth
- Spontaneous abortion
Which viruses are teratogenic?
- Rubella
- ?Zika
What is involved in the diagnosis of viral infections during pregnancy?
- serology
- and/or PCR relevant samples (blood, vesicle fluid, amniotic fluid)
Why is screening for bacteriuria indicated in pregnancy?
- Asymptomatic bacteriuria = no symptoms of UTI and 2 samples containing >10^5 same organism
- Bacteriuria can develop into symptomatic UTI if untreated
- Continuing bacteriuria is associated with premature delivery and increased perinatal mortality.
What is the recommended treatment for UTI in pregnancy?
- 7 days relatively non-toxic antibiotic e.g. amoxicillin or cefalexin (trimethoprim - give with folate, avoid 1st trimester)
- Repeat urine culture post treatment to confirm cure.
What percentage of term pregnancies have intra-amniotic infections?
1-2%
What percentage of pregnancies with pre-term labour are affected with intra-amniotic infections?
10-25%
Major cause of perinatal morbidity and mortality
What is chorioamnionitis?
Refers to inflammation of umbilical cord, amniotic membranes, placenta.
What are the clinical features of intra-amniotic infections?
- maternal fever
- uterine tenderness
- malodorous amniotic fluid
- maternal or foetal tachycardia
- raised white cell count
What are the risk factors for intra-amniotic infections?
- Prolonged rupture of membranes (most common)
- amniocentesis
- cordocentesis
- cervical cerclage
- multiple vaginal examinations
- BV
What is the pathogenesis of intra-amniotic infections?
- Bacteria present in the vagina cause infection by ascending through the cervix
- Haematogenous (via blood ) infection is rare e.g. Listeria monocytogenes
What are the common causative organisms in intra-amniotic infections?
- group B Streptococcus
- enterococci
- Escherichia coli
