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Reproductive > Infectiosu Diseases During Pregnancy > Flashcards

Infectiosu Diseases During Pregnancy Flashcards

1
Q

TORCH’S infections

A 
Toxoplasmosis 
Other (parvovirus, VZV, COVID, GBS, Etc.) 
Rubella 
CMV 
Herpes Simplex 
HIV 
Syphilis

need to screen all of these

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2
Q

Toxoplasmosis review

A

Obligate intracellular protozoan that has 2 forms of life

  • trophozoites = invasive
  • cyst/oocyte = latent form

Acquired via

  • raw meat (MOST COMMON)
  • goat milk and unpasteurized dairy
  • cat feeces (only definitive host)
  • organ transplantation

Clinical features
- in immunocompetent = asymptomatic in 90%. 10% = mononucleosis w/ bilateral cervical adenopathy (but presents with a (-) heterophile antibody test

  • in immunocompromised = bad mono illness with ocular or cerebral toxoplasmosis, encephalitis, pneumonitis

Congenital infection:

  • more likely to get It later in gestation but is more dangerous earlier in gestation
  • currently recommendations is to NOT screen for this bug unless you have clinical suspicion

Diagnosis = IgM/IgGtests and PCR sample from amnotic fluid in pregnancy

  • (-) in IgG and IgM = susceptible but no infection
  • (-) IgG w/ (+) IgM = recent infection
  • (+) IgG w/ (-) IgM = past infection and immune

Treatment = pyrimethamine, sulfadiazine

  • leucovorin as last line
    • if before 18week gestation = spiramycin
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3
Q

Ultrasound findings of fetal toxoplasmosis infections

A

Ventriculomegaly. Microcephaly, intracranial calcifications, IUGR, hepatosplenomegaly

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4
Q

Neonatal findings of toxoplasmosis

A

Rash

Hepatosplenomegaly

Ascites

Fever

Periventricular calcifications

Ventriculomegaly

Seizures

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5
Q

Syphilis review

A

Gram (-) spiral shaped bacteria that is spread via sexual contact, blood transfusion

Humans are only natural host and if congenital are pasted by maternal blood

  • CANNOT be transmitted in breast milk
  • frequency of passing it on increases as gestation advances

Ultrasound can detect severely affected fetus
- shows place to eagle, IUGR, microcephaly, Hepatosplenomegaly, hydrops

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6
Q

Congenital syphills symptoms

A

Early

  • maculopapular rash
  • snuffles
  • hepatosplenomegaly
  • jaundice
  • lymphadenopathy
  • osteochondritis
  • iritis

Late

  • Hutchinson (notched teeth)
  • interstital keratitis
  • deafness
  • saber shins
  • hydrocephalus
  • clutter joints
  • optic nerve atrophy
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7
Q

Varicella review

A

Highly contagious (infection rates 60-90%)

Primary infection = fever, malaise and maculopapular rash that becomes vesicular and crust off (chicken pox)
- lasts 6-10 days and once all vesicular lesions crust off you are not infections anymore

Secondary infection = vesicular erythematous skin rashes that usually follow a dermatome pattern (lays dormant in the sensory/dorsal root ganglia)

in pregnancy, risk of fetal transmission = 1/2%
- ONLY seen in 1st and 2nd trimester

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8
Q

Treatment for acute varicella in pregnant patients

A

Supportive care and isolation for mild disease

If IgG (-) for varicella = MUST give VZIG within 96 hrs of exposure

Oral acyclovir (800mg P.O 5xday) for severe varicella

  • **this doesnt prevent congenital varicella however
  • also need hospitalize usually if this bad
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9
Q

Varicella ultrasound findings

A

Hydrops

Hyperechogenic foci in liver and bowels

Cardiac and limb malformations

Microcephaly

Fetal growth restriction

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10
Q

Congenital varicella findings

A

Infection earlier in pregnancy produces worse symptoms

Skeletal malformations

Skin scarring

Chorioretinitis

Microcephaly

Cataracts

high neonatal death rate especially within 5 days of delivery and 48hrs after delivery

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11
Q

Parvovirus review

A

Single strand DNA virus that is exposed to almost everyone at any point

  • *50% of women are immune**
  • 8% of susceptible pregnant women will become infected if exposed (risk highest in women with school-aged children or work in school settings)

Symptoms of infections

  • reticular rash on trunk and peripheral arthropathies
  • flu-like syndrome
  • low grade fever
  • malaise
  • headache
  • sore throat
  • arthralgia
    • if underlying hemoglobinopathies = aplastic crisis (kills RBC precursors via direct cytotoxic effects) **

follow the same IgG and IgM titers as toxoplasmosis. However if recently exposed patient is IgM negative = need to repeat titers in 3-4 weeks and look for any IgG titer increases

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12
Q

Parvovirus congential infections

A
  • *NOTE: majority of fetus will have NO adverse effects**
  • however there is a risk for spontaneous abortion, stillbirth and non-immune hydrops fetalis(rates increase if infected <20 weeks)

Is confirmed with amniotic fluid PCR showing serology
- weekly MCA Doppler is needed with hydrops evaluation

Treatment = in utero transfusion and treat hydrops (high mortality of hydrops is present)

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13
Q

Rubella review

A

Single strand RNA virus that is transmitted by respiratory droplets

Maternal transmission = hematogenous spread

  • risk of transmission goes up the earlier in pregnancy (highest risk in <8 weeks)
  • is known to cause ischemia and damage to placental blood vessels

Symptoms

  • widespread non pruritic erythematous maculopapular rash with postauricular adenopathy
  • conjunctivitis
  • mild flu-like symptoms

Diagnosis

  • maternal = IgM/IgG levels
  • fetal = PUBS for IgM after 20 weeks and culture of tissue/amniotic fluid
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14
Q

MMR vaccine for rubella

A

95% seroconversion rate

Contraindications in pregnancy!

  • not in breastfeeding though
  • should also avoid getting pregnant 4 weeks after vaccination
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15
Q

Ultrasound findings in congenital rubella

A

IUGR

Microcephaly

Supravalvular pulmonary stenosis

Hydrops

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16
Q

Congential rubella signs

A

Sensorineural deafness

Cataracts

PDA

Microcephaly

Blueberry muffin rash

17
Q

Cytomegalovirus review

A

Double stranded DNA herpes virus

Endemic in the US with 80% of adults infected by age 40

Risk factors: 
Daycare workers 
Multiple sex partners 
Low socioeconomic status 
First pregnancy <15 yrs

DONT screen in pregnancy even for high risk

Symptoms
- most are asymptomatic with mild flu symptoms if present

Diagnosis

  • primary infection = IgM (+) and IgG (-)
  • *possess low IgG avidity**. Transmission risk = 40%
  • reactivation infection = IgM and IgG (+)
  • *possess high IgG avidity**. Transmission risk = 1%

In utero = amniotic fluid PCR is positive

18
Q

Herpes Simplex virus (HSV) review

A

DsDNA virus transmitted by urine, saliva, Semen and blood

  • *is the most common painful genital ulcer disease worldwide**
  • 2nd most common STI worldwide (#1 is HPV)

Clinical presentation

  • exposure to onset = 4 days after incubation
  • typically shows vesicles, tissues and itching of infected areas

New brown infections = disseminated herpes in the temporal lobes, skin and mucous membranes

19
Q

HSV counseling

A

> 85% of patients infected are unaware they are
- asymptomatic shedding > majority of HSV infections

Greatest risk of spreading = 1st 12 months after getting HSV-2
- must get the infected patient on suppressive therapy for the 1st year of diagnosis

Dont let infected patients have sex with partners if they are symptomatic

20
Q

Primary genital symptoms

A

Very painful vesicles/ulcers, burning, itching, dysuria, urinary retention, lymphadenopathy

Antibodies typically appear between weeks 2-12 after symptoms

Viral shedding is possible until vesicles/ulcers are crusted (usually 10-12 days from onset)

21
Q

HSV in pregnancy

A

MUST start suppressive therapy after 36 weeks of gestation

  • 75% decreases in outbreaks
  • 40% reduction in C-sections

Indications for C-sections in HSV patients

  • active genital lesions on genitalia (if on back/buttock or thigh = cover with teasers and your okay)
  • active prodromal symptoms (vulvar pain, irritation or burning at delivery)
  • *if the lesions are resolved usually need to wait > 6 weeks out just to make sure**
22
Q

Pregnancy with influenza

A

While not dangerous to the fetus for infection, pregnant patients have a more severe symptoms which leads to increase risk of spontaneous abortion, preterm delivery and low birth weight

  • *also during 1st trimester makes fetus even more susceptible to infections/abnormalities
  • **this is because of the hyperthermia that occurs with the flu
  • *you need to get the vaccine IM in pregnancy patients
  • MUST be inactivated vaccine though and ASAP**

If they have active infection = give Oseltamivir

23
Q

HIV in pregnancy

A

40% of HIV postive women are identified in pregnancy

  • MUST screen as soon as possible in pregnancy (repeat in 3rd trimester in high risk factors/areas
  • should also encourage partners to get screened as well

Risk factors for perinatal transmission

  • no antiretroviral therapy
  • no prenatal care
  • presence of AIDS (low CD4 and high viral load)
  • maternal illicit drug use
  • preterm delivery
  • breast feeding

Mother can transmit of HIV either antepartum, intrapartum and post partum
- 70-80% occurs during the delivery process

viral load is the most importiant risk factor for transmission

24
Q

Delivery recommendations with HIV

A

If on no medications and labs:

  • offer C-section at 38 weeks without amniocentesis
  • start mother on ZDV regimen

If the mother is on ARV and viral load is > 1000

  • offer C-section at 38 weeks without amniocentesis
  • continue therapy

If the viral load is <1000

  • NO C-section and you can do normal vaginal birth
  • give ZDV intrapartum and neonatal

If the viral load is > 1000 right before labor
- may allow labor or CS if needed

25
Q

Group B Streptococcus

A

30% of women are colonized naturally
- 40-50% of colonize women’s will pass on to neonate (higher risk if ACOG risk factors are present)

If neonate is infected = 30% mortality

Risk factors

  • prematurity
  • prolonged ROM
  • intrapartum fever
  • previous affected child
  • age is <20
  • heavy maternal colonization
  • low levels of GBS antibodies
  • African Americans
  • late prenatal colonization or heavy bacterial load

Screening = ALL pregnant women 36 weeks need to be screened UNLESS:
- GBS bacteriuria is picked up or previous child had invasive GBS infection = screen earlier and give prophalzis treatment immediately

26
Q

CDC recommendations for GBS screening

A

No prophylaxis antibiotics if

  • positive screen in prior pregnancy (have to rescreen first)
  • elective cesarean without labor or ruptured membranes
  • negative cultures regardless of risk factors

Give prophylaxis if

  • tests postive
  • bacteriuria > 10^3 CFU for GBS
  • previous pregnancy with disseminated GBS

**negative GBS screen is valid for 5 weeks!!*

27
Q

Treatment for GBS

A

No allergies to penicillin = penicillin G IV every 4 hrs until delivery

Allergies to penicillin w/ NO anaphylaxis symptoms with penicillin or cephalosporin noted = cefazolin 2g IV and then 1g IV every 8hrs

Allergies to penicillin w/ anaphylaxis history to penicillin or cephalosporin

  • isolate susceptible to clindamycin = give clindamycin IV
  • isolate NOT susceptible to clindamycin = give vancomycin 1g IV every 12 hrs
28
Q

Coronavirus pregnancy considerations

A

Pregnancy= increased risk of issues in the pregnant patient, but doesnt not increase risk directly to the fetus (does indirectly increase damage to the fetus though)

COVID maternal screening must include for mental health issues

**DONT withhold COVID 19 mRNA vaccines based the patient being pregnant only

29
Q

Treatment of COVID in pregnancy

A

Continuous fetal monitoring, give steroids and lovenox x2 weeks

Reproductive (66 decks)

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