Infections & pregnancy

Question 1

what are some infections that can occur during pregnancy? (9)

Answer 1

1. Rubella
2. CMV
3. Parvovirus B19
4. Congenital Toxoplasmosis
5. Varicella Zoster (chicken pox)
6. Syphilis
7. Zika vrius
8. HIV
9. Covid-19

Question 2

Chickenpox exposure in pregnancy

• what can fetus develop if it caught it?
• managment of chickenpox exposure
• managment of chickenpox pregnany

Answer 2

• fetal varicella syndrome*
• If in doubt about mother previously having chickenpox >> maternal blood should be urgently checked for varicella antibodies*
• if the pregnant woman is NOT IMMUNE to varicella GIVE varicella-zoster immunoglobulin (VZIG) ASAP
• VZIG is effective up to 10 days post exposure
• if the pregnant woman > 20 weeks gestation is NOT IMMUNE to varicella >> either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure

IF HAVE IT:

• ORAL ACICLOVIR should be given if the pregnant women is ≥ 20 weeks and she presents within 24 hrs of onset of the rash
• if is < 20 weeks the aciclovir should be ‘considered with caution’
• IV ACICLOVIR if SEVERE

Question 3

maternal and fetal risks of chicken pox in pregnancy?

what if mum gets it near delivery time?

Answer 3

MATERNAL:

pneumonia, hepatitis, encephalitis, rarely can lead to DEATH

FETAL:

“fetal varicella syndrome”

features:

• Skin scarring,
• EYE defects (microphthalmia, chorioretinitis, cataracts),
• neurological abnormalities (microcephaly, cortical atrophy, LOW IQ, bowel & bladder sphincte prob)

>>> if occurs in the _last month_ of pregnancy, avoid planned delivery for at least 7 days to allow the passive transfer of antibodies from mum to child.

Question 4

Rubella

referrel? screening?

Clinical Features?

Investigations?

Management?

Answer 4

Rubella is a NOTIFIABLE DISEASE

1. Contact the local Health Protection Team immediately.
2. If rubella is confirmed and the woman is 20 weeks or less –> Refer urgently to obstetrics (fetal medicine) for risk-assessment and counselling.

Antenatal Screening

2 tests were performed:

• IgM antibody – present in acute infection.
• IgG antibody – present following infection or vaccination.

if neither was shown, women should take vaccine post delivery (rubella vaccine is a live virus, and should NOT be administered whilst pregnant)

Question 5

Congenital Rubella Syndrome

triad?

Answer 5

Question 6

Group B streptococcus

where is it found?

what sort of infections can it cause? (3)

Risk factors (4)

Answer 6

also known as “Streptococcus agalactiae”

a commensal bacterium found in the vagina or rectum of ~25% of pregnant women.

infections: sepsis, pneumonia, or meningitis

Question 7

Managment GBS

Answer 7

women who’ve had GBS detected in a previous pregnancy should be informed that their risk of maternal GBS carriage in this pregnancy is 50%.

They should be offered intrapartum antibiotic prophylaxis (IAP) OR testing in late pregnancy and then antibiotics if still positive

if women are to have swabs for GBS this should be offered at 35-37 weeks or 3-5 weeks prior to the anticipated delivery date

IAP should be offered to women with a previous baby with early- or late-onset GBS disease

IAP should be offered to women in preterm labour regardless of their GBS status

women with a pyrexia during labour (>38ºC) should also be given IAP

benzylpenicillin is the antibiotic of choice for GBS prophylaxis

Question 8

screening GBS

Question 9

Prophylaxis of GBS

Answer 9

Women with pyrexia >38 degrees during labour should get benzylpenicillin

Question 10

Congenital Cytomegalovirus

Question 11

Parvovirus B19

Question 12

Zika Virus