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Clinical Pathology > Infections of pregnancy, puerperium and neonate > Flashcards

Infections of pregnancy, puerperium and neonate Flashcards

1
Q

What is the definition of ‘pregnancy’?

A

Conception to delivery

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2
Q

What is the puerperium?

A
  • 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
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3
Q

What is a neonate?

A

An infant less than 4 weeks old.

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4
Q

Which infections can be transmitted to the foetus during pregnancy (i.e. haematogenous spread via placenta)?

A
  • CMV
  • Parvovirus B19
  • Toxoplasmosis
  • Secondary/tertiatry syphilis
  • VZV
  • Zika virus
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5
Q

Which infections can be transmitted to the baby during delivery?

A
  • Group B Strep
  • HSV
  • Gonorrhoea
  • Chlamydia
  • HIV
  • Hep B
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6
Q

For which diseases is prophylaxis available and screening undertaken?

A
  • HIV

- Hep B

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7
Q

Why does the handling of drugs differ during pregnancy?

A
  • Increase of GFR results in increased renal excretion of many antimicrobials
  • Serum levels of anti-microbials are generally lower during pregancy
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8
Q

What must be considered, with regards to the foetus, when prescribing in pregnancy?

A
  • 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
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9
Q

Which antimicrobials are considered ‘safe’ in pregnancy?

A
  • Penicillins

- Cephalosporins

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10
Q

Which antimicrobials are considered ‘unsafe’ in pregnancy?

A
  • Chloramphenicol
  • Tetracycline
  • Fluoroquinolones (e.g. cipro)
  • Trimethoprim-sulphamethoxazole
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11
Q

Which primary viral infections cause mild symptoms/are asymptomatic?

A
  • CMV

- Zika

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12
Q

Which primary viral infections are severe?

A
  • VZV
  • HSV
  • measles
  • influenza
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13
Q

What can be the consequences of foetal viral infections?

A
  • Nothing
  • Birth defects
  • Stillbirth
  • Spontaneous abortion
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14
Q

Which viruses are teratogenic?

A
  • Rubella

- ?Zika

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15
Q

What is involved in the diagnosis of viral infections during pregnancy?

A
  • serology

- and/or PCR relevant samples (blood, vesicle fluid, amniotic fluid)

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16
Q

Why is screening for bacteriuria indicated in pregnancy?

A
  • 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.
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17
Q

What is the recommended treatment for UTI in pregnancy?

A
  • 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.
18
Q

What percentage of term pregnancies have intra-amniotic infections?

A

1-2%

19
Q

What percentage of pregnancies with pre-term labour are affected with intra-amniotic infections?

A

10-25%

Major cause of perinatal morbidity and mortality

20
Q

What is chorioamnionitis?

A

Refers to inflammation of umbilical cord, amniotic membranes, placenta.

21
Q

What are the clinical features of intra-amniotic infections?

A
  • maternal fever
  • uterine tenderness
  • malodorous amniotic fluid
  • maternal or foetal tachycardia
  • raised white cell count
22
Q

What are the risk factors for intra-amniotic infections?

A
  • Prolonged rupture of membranes (most common)
  • amniocentesis
  • cordocentesis
  • cervical cerclage
  • multiple vaginal examinations
  • BV
23
Q

What is the pathogenesis of intra-amniotic infections?

A
  • Bacteria present in the vagina cause infection by ascending through the cervix
  • Haematogenous (via blood ) infection is rare e.g. Listeria monocytogenes
24
Q

What are the common causative organisms in intra-amniotic infections?

A
  • group B Streptococcus
  • enterococci
  • Escherichia coli
25
Q

What is the management of intra-amniotic infections?

A
  • antimicrobials and delivery of the foetus

- antimicrobials should be administered at the time of diagnosis (not after delivery)

26
Q

What is purperal endometritis?

A
  • infection of the womb during puerperium affects ~5% of pregnancies
  • puerperal sepsis remains a major cause of maternal death
27
Q

What are the risk factors for puerperal endometritis?

A
  • caesarean section
  • prolonged labour
  • prolonged rupture of membranes
  • multiple vaginal examinations
28
Q

What are the clinical features of puerperal endometritis?

A
  • fever (38.5C in first 24h post delivery or >38.0C for 4 hours, 24h+ after delivery)
  • uterine tenderness
  • purulent, foul-smelling lochia
  • increased white cell count
  • general malaise, - abdominal pain
29
Q

What are the common causative organisms in puerperal endometritis?

A
  • Escherichia coli
  • Beta-haemolytic streptococci
  • Anaerobes
30
Q

What is invovled in the diagnosis of puerperal endometritis?

A
  • The role of transvaginal endometrial swabs is controversial
31
Q

What is the treatment for puerperal endometritis?

A

Broad-spectrum intravenous antimicrobials - continued until the patient has been apyrexial for 48 h

32
Q

What are the clinical features of puerperal mastitis?

A
  • mean onset 5.5 weeks post delivery
  • abrupt onset fever, chills and breast soreness
  • redness, warmth and tenderness of affected breast
33
Q

What is the causative organism in puerperal mastitis?

A

S. aureus

34
Q

How is puerperal mastitis diagnosed?

A
  • clinical

- culture of pus

35
Q

What is the management of purperal mastitis?

A
  • continue nursing
  • optimise nursing technique and breast care (also key to prevention)
  • anti-staphylococcal antibiotics (e.g. flucloxacillin)
  • incision/drainage if abscess present
36
Q

What are the unusual causes of puerperal sepsis?

A
  • Pneumonia
  • IV catheter-related infection
  • Wound infection (C-section)
37
Q

What is a common complication of neonatal sepsis?

A

Neonatal meningitis

38
Q

When does early onset infection present?

A

2 weeks

39
Q

What are the clinical features of neonatal sepsis/meningitis?

A

Temperature
- hypothermia or pyrexia

Respiratory

  • dyspnoea
  • apnoeas
  • cyanosis

Cardiovascular

  • tachycardia
  • bradycardia
  • hypotension

Hepatic

  • hepatomegaly
  • jaundice

Gastrointestinal

  • anorexia
  • vomiting
  • abdominal distension
  • diarrhoea

Haematological
- bleeding disorders

Central nervous system

  • lethargy
  • irritability
  • seizure
40
Q

What are the causitive organisms in neonatal sepsis/meningitis?

A
  • Group B Streptococcus
  • Escherichia coli
  • (Listeria monocytogenes)
41
Q

How is neonatal sepsis/meningitis diagnosed?

A

Blood, urine and CSF culture

42
Q

How is neonatal sepsis/meningitis managed?

A

Broad spectrum antimicrobials active against the common causes e.g. amoxicillin plus gentamicin

Clinical Pathology (65 decks)

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