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Hugh's MD3 Women's > Infectious Diseases in Pregnanct > Flashcards

Infectious Diseases in Pregnanct Flashcards

1
Q

What are prenatal infections?

A

Infection acquired/carried by the mother and transmitted to the developing fetus

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2
Q

What are perinatal infections?

A

Infection transmitted around the time of delivery

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3
Q

What are some complications of chickenpox?

A

Secondary bacterial infection - Staph, strep
Pneumonitis - particularly maternal
Acute cellular ataxis

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4
Q

What manifestations of varicella do we worry about around pregnancy?

A

Severe maternal illness
2nd and 3rd Trimester - fetal anomalies
Perinatal infections

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5
Q

How do mothers die from varicella?

A

Severe pneumonitis, particularly during third trimester

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6
Q

What is the pathophysiology of congenital varicella syndrome?

A

Zoster reactivation in the fetus

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7
Q

What is the risk of developing CVS?

A

2-12 weeks: 0.55%

12-28 weeks: 1.4%

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8
Q

How does perinatal varicella occur?

A

Primary maternal varicella -7 to +2 days from delivery

- 17-30% rate of transmission to baby

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9
Q

How do you treat varicella exposure?

A

If known exposure, no worries

If unknown exposure status
- Test IgG status, if non-immune give VZIG with 96 hours to 10ds

Also give VZIG to preterm baby if exposed

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10
Q

Can you give varicella vaccine in pregnancy?

A

No, live dose

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11
Q

What types of CMV infections are there?

A

Primary
Reactivation
New primary of different strain

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12
Q

What is the most common fetal infection?

A

CMV

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13
Q

What is the pathophysiology of CMV in neonates?

A

90% asymptomatic - 10-15% long term sequelae

10% Symptomatic - 80-100% long term sequelae

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14
Q

How helpful is CMV IgM?

A

Not very, doesn’t only occur in primary infection

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15
Q

Which anti-virals are used in CMV?

A

Ganciclovir
Valganciclovir - oral

For 6 months

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16
Q

What problems does influenza cause in pregnancy?

A 
Maternal - viral pneumonitis or secondary bac pneumonia (particularly third trimester)
Premature birth
?Early and late fetal death
?Congenital neurological defects
Fever - indirect teratogenic effect
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17
Q

What proportion of mothers are carriers of GBS?

A

15-25%

18
Q

How does GBS get to the baby?

A

Up the vagina

During delivery

19
Q

How does GBS present?

A

Early onset - 1-2 days
- Pneumonia, septicaemia

Later onset
- Meningitis

20
Q

How do we predict GBS infection?

A

Identify risk factors

Swab at 35-37 weeks

21
Q

How is GBS screened for?

A

At 35-37 weeks

Vaginal and anal swab

22
Q

When are abx for GBS given?

A

4 hours prior to delivery

23
Q

What abx for are given for GBS?

A

Penicillin

If allergic

  • If rash: cephazolin
  • If anaphylactic: Clindamycin or vancomycin
24
Q

When does hepatitis B transmission occur?

A

Usually labour and birth

25
Q

How do you predict the chance of transmission in Hep B positive mother?

A

eAg
Viral titre
sAg

26
Q

How do you prevent maternal transmission?

A

Vaccine
and Immunoglobulin

Anti-viral therapy in third trimester

27
Q

How do you confirm Hep C status? Why?

A

HCV RNA

Ab positivity continues after cure

28
Q

How do you reduce risk of Hep C transmission?

A

Delay IM injections until after washing the baby

29
Q

How is parvo transmitted?

A

Respiratory
Vertical
Blood products

30
Q

What are complications of maternal primary parvo infection? What is the pathophysiology?

A

Fetal hydrops - 3%
Fetal death - 0.6%

Anaemia and heart failure

31
Q

How do you manage maternal parvo?

A

Weekly US

Treat anaemia

32
Q

How does rubella present?

A 
Low-grade fever
Lymphadenopathy (95%)
– occipital, postauricular, posterior cervical
Exanthem
–maculopapular; face > trunk >limbs
Polyarthralgia / arthritis
33
Q

When is the baby must susceptible?

A

1st trimester

34
Q

What is the classical triad of congenital rubella?

A
  • Ophthalmological – cataracts, glaucoma, retinopathy
  • Cardiac – PDA, PA stenosis
  • Auditory – sensorineural deafness
35
Q

Do you vaccinate for rubella in pregnancy?

A

No, it’s live

36
Q

Which infections are teratogenic?

A 
TORCH
Parvo
Varicella
Syphilis 
Zika
37
Q

How do you manage a fever in pregnancy?

A

Lower the fever - panadol
+/- steroids
+/- tocolytics
+/- abx

38
Q

What are the ddx for fetal hydrops?

A 
Alloimmunisation 
Infections 
- CMV
- Parvo
Congenital
- Heart failure due to structural/rhythm disturbance
- Aneuploidy 
Anaemia
- Thalassaemia 
- Aneuploidy
39
Q

How do you investigate for Parvo?

A

IgM and IgG testing over a period of time

- compare to previous samples that are stored

40
Q

How do you ix fetal hydrops?

A

Cord sampling and blood testing
- Parvo serology
Cross match with mother’s blood

Hugh's MD3 Women's (68 decks)

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