Infections of pregnancy, puerperium and neonate Flashcards
What is the definition of puerperium?
Puerperal state where mothers tissue returns to non-pregnant state
- 6-8 weeks post partum
What is the definition of a neonate?
Recently born individual who is less than 4 weeks old
What infections can be spread through haematogenous spread (mother -> baby)?
CMV Zika virus Syphillis Parvovirus B19 Toxoplasmosis VZV
What infection can be transmitted through delivery?
HSV Chlamydia Gonorrhoea HIV* Hep B* Group B strep
HIV and Hep B are screened - prophylaxis available
Why are women more prone to infections during pregnancy?
Physiological/immune changes predisposes women to some infections
Handling of drugs differ e.g. increased GFR/excretion - higher doses required
Serum levels of antibiotics are lower - underdose/treatment failure?
Immune suppression - symptoms might not manifest/dampened with pregnancy
Why consideration must we have for prescribing antimicrobials to pregnant/puerperium mothers?
Antimicrobials might be harmful to embryo/foetus/neonate
Crosses placenta to some extent and all cross in breast milk
What antibiotics are considered safe for use during pregnancy?
Penicillins
Cephlasporins
(provided no allergy)
What antibiotics new considered unsafe for use during pregnancy?
- Trimethoprim-sulphamethoxazole
- Tetracycline
- Fluroquinolones
- Chloramphenicol
(benefit:risk ratio)
What is primary infection and secondary infection?
Primary infection = first episode without immunity
Secondary - latent infection e.g. shingles
Name some primary infections which are asymptomatic or cause very little symptoms to mother
CMV
Pika virus
Name some primary infections which cause severe symptoms/infection to mother
VZV
Herpes
Measles
Influenza
What are the effects of infection to foetus
Spectrum - can range from no illness to serve, still birth or miscarriage, some can be tetranogenic e.g. rubella, toxoplasmosis, zika
What diagnostic procedures can be used?
- Serology (IgG - prior exposure; IgM - current)
- PCR
of relevant samples e.g. blood, vesicle fluid, amniotic fluid
Concerning maternal UTIs, why should asymptomatic bacteriuria be treated?
Can develop to symptomatic bacteria which is associated with premature delivery and perinatal mortality
What is the recommended process by which bacteriuria is diagnosed and treated?
2 samples containing 10^5 of same organism
(asymptomatic bacteriuria)
7 days on non-toxic antibiotics e.g. amoxycillin, cefalexin, even if asymptomatic
Test again to test cure
What can intraamniotic infections cause?
Uncommon but can cause early delivery and perinatal morbidity/mortality
What infection does choropamniotitis cause?
Inflammation of umbilical cord, placenta, amniotic membranes
What are the symptoms of intraamniotic infections?
Maternal fever (>38 degrees)
Malodorous amniotic fluid*
Uterine tenderness
Foetal/maternal tachycardia
Leukocytosis
What are the risk factors for intraamniotic infections?
Premature/rupture of membranes**
Amniocentesis/cordocentesis (i.e. injections)
Cervical cerclage (man made material)
Multiple vaginal examination
BV
What is the pathogenesis for intraamniotic infections?
Vaginal bacteria ascend into cervix
Haematogenous spread is rare eg. listeria
What are the causative organisms for intraamniotic infections?
E coli (GI tract)
Enterococci (GI tract)
Group B strep
Endogenous flora going to wrong place
What is puerperal endometritis?
Infection of the womb (puerperium - after birth)
Major cause of maternal death
What are the risk factors for puerperal endometritis?
- C-section
- Prolonged labour
- Prolonged rupture of membranes
- Multiple vag exams
What are the symptoms of puerperal endometritis?
Fever (38.5 degree in first 24hrs or 38 for 4 hrs, 24 hrs post delivery
Uterine tenderness - should be getting better
General malaise/abdo pain - shouldn’t be feeling systemically unwell!
Leucocytosis
Foul smelling discharge
