Intrapartum Infections Flashcards
Chickenpox is caused by
primary infection with varicella-zoster virus
Shingles is caused by
the reactivation of dormant virus in dorsal root ganglion
In VSV infection in pregnancy, there is a risk to
both the mother and also the fetus, a syndrome now termed fetal varicella syndrome
Chickenpox exposure, Risks to the mother?
5 times greater risk of pneumonitis
Fetal varicella syndrome (FVS)
risk?
risk of FVS following maternal varicella exposure is around 1% if occurs before 20 weeks gestation
studies have shown a very small number of cases occurring between 20-28 weeks gestation and none following 28 weeks
features of FVS
skin scarring, eye defects (microphthalmia), limb hypoplasia, microcephaly and learning disabilities
shingles in infancy:
severe neonatal varicella
severe neonatal varicella occurs when?
if the mother develops rash between 5 days before and 2 days after birth there is a risk of neonatal varicella, which may be fatal to the newborn child in around 20% of cases
shingles in infancy risks
1-2% risk if maternal exposure in the second or third trimester
Management of chickenpox exposure in pregnancy,
if there is any doubt about the mother previously having chickenpox do what
maternal blood should be urgently checked for varicella antibodies
if the pregnant woman <= 20 weeks gestation is not immune to varicella she should be given
varicella-zoster immunoglobulin (VZIG) as soon as possible
RCOG and Greenbook guidelines suggest VZIG is effective up to 10 days post exposure
if the pregnant woman > 20 weeks gestation is not immune to varicella then what should be given
either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure
PEP for chicken pox
The decision on choice of PEP for women exposed from 20 weeks of pregnancy should take into account patient and health professional preference as well as the ability to offer and provide PEP in a timely manner’
true
Management of chickenpox in pregnancy
if a pregnant woman develops chickenpox in pregnancy then specialist advice should be sought
there is an increased risk of serious chickenpox infection (i.e. maternal risk) and fetal varicella risk (i.e. fetal risk) balanced against theoretical concerns about the safety of aciclovir in pregnancy
consensus guidelines (Health Protection Authority and RCOG) suggest oral aciclovir should be given if the pregnant women is ≥ 20 weeks and she presents within 24 hours of onset of the rash
if the woman is < 20 weeks the aciclovir should be ‘considered with caution’
Group B Streptococcus (GBS) is the most common cause of early-onset severe infection in the neonatal period
true
It is thought around ?% of mothers have GBS present in their bowel flora and may therefore be thought of as ‘carriers’ of GBS
20-40%
Infants may be exposed to maternal GBS during labour and subsequently develop potentially serious infections.
true
Risk factors for Group B Streptococcus (GBS) infection:
prematurity
prolonged rupture of the membranes
previous sibling GBS infection
maternal pyrexia e.g. secondary to chorioamnionitis
Mx Group B Streptococcus (GBS) infection
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