IUI and infections in pregnancy Flashcards
Hutchinson’s triad (from congenital syphylis)
- ocular interstitial keratitis
- 8th nerve deafness
- Hutchinson’s teeth (murberry molars and Hutchinson’s incisors)
The cdc and USPSTF recommend screening for HBV, HCV:
-All adults age 18-79
-Pregnant people, each pregnancy
The incidence of UTI (pyelonephritis, cystitis) asymptomatic bacteriuria in pregnancy
5-10 %
Untreated asymptomatic UTI has 25% risk of pyelonephritis and 2.5% with treatment
وفي رواية:
Pyelonephritis develops in 30-40% w/o treatment and in 3-4% with treatment
Leading bacterial killing in neonate is
GBS
If term 1-2% colonized develops infection, mortality 5%
If preterm, 8% of colonised develop infection, mortality rate 25 %
Complications of pyelonephritis in pregnancy
Sepsis
Cunningham’s syndrome (ARDS)
50% of women who are colonized with GBS will transmit the bacteria to their newborns.
In the absence of intrapartum antibiotic prophylaxis, 1–2% of those newborns will develop GBS EOD.
ACOG recommends performing universal GBS screening between
36 0/7 and 37 6/7 weeks of gestation.
Regardless of planned mode of birth, all pregnant women should undergo antepartum screening for GBS unless
unless intrapartum antibiotic prophylaxis for GBS is indicated because of GBS bacteriuria during the pregnancy or because of a history of a previous GBS-infected newborn.
If the prenatal GBS culture result is unknown when labor starts, intrapartum antibiotic prophylaxis is indicated for women who have risk factors for GBS EOD.
At-risk women include those who present in labor with a substantial risk of preterm birth, who have preterm prelabor rupture of membranes (PPROM) or rupture of membranes for 18 or more hours at term, or who present with intrapartum fever (temperature 100.4°F [38°C] or higher).
If intraamniotic infection is suspected, broad-spectrum antibiotic therapy that provides coverage for poly-microbial infections as well as GBS should replace the antibiotic that provides coverage for GBS prophylaxis specifically.
T
GBS prophylaxis in case of penicillin allergy/anaphylaxis
First-generation cephalosporins (i.e., cefazolin) are recommended for women whose reported penicillin allergy indicates a low risk of anaphylaxis or is of uncertain severity. For women with a high risk of anaphylaxis, clindamycin is the recommended alternative to penicillin only if the GBS isolate is known to be susceptible to clindamycin.
the only pharmacokinetically and microbiologically validated option for intrapartum antibiotic prophylaxis in women who report a high-risk penicillin allergy and whose GBS isolate is not susceptible to clindamycin.
Intravenous vancomycin, The dosage for intrapartum GBS prophylaxis should be based on weight and baseline renal function (20 mg/kg intravenously every 8 hours, with a maximum of 2 g per single dose.)
the most common perinatal infection in the developed world.
(CMV) is a ubiquitous DNA herpes virus that eventually infects most humans. The virus is secreted into all body fluids, and person-to-person contact.
Naturally acquired immunity during pregnancy results in a 70-percent risk reduction of congenital CMV infection in future pregnancies
Transmission rates for primary infection of CMV are – TO – percent in the 1st trimester, –to– percent in the 2nd, and – to – percent in the 3rd trimester
(ACOG, 2017; Picone, 2017).
Transmission rates for primary infection are 30 to 36 percent in the 1st trimester, 34 to 40 percent in the 2nd, and 40 to 72 percent in the 3rd trimester
(ACOG, 2017; Picone, 2017).
CMV infection. Congenital infection is a
syndrome that may include
growth restriction, microcephaly, intracranial calcifications”Periventricular”, chorioretinitis, mental and motor retardation, sensorineural deficits, hepatosplenomegaly, jaundice, hemolytic anemia, and thrombocytopenic purpura
Routine prenatal CMV serological screening is currently not recommended by the Society for Maternal–Fetal Medicine (2016).
Pregnant women should be tested for CMV if they present with a mononucleosis-like illness or if congenital infection is suspected based on
abnormal sonographic findings.
fetal abnormalities associated with CMV infection may be seen antenatal with US, CT, MRI INCLUDES:
Findings include microcephaly, ventriculomegaly, and cerebral calcifications; ascites, hepatomegaly, splenomegaly, and hyperechoic bowel; hydrops; and
oligohydramnios (Society for MFM 2016).
the gold standard for the diagnosis of CMV fetal infection.
CMV nucleic acid amplification testing (NAAT) of amniotic fluid (Sensitivity is highest when
amniocentesis is performed at least 6 weeks after maternal infection and after 21
weeks’ gestation) A negative result from amniotic
fluid polymerase chain reaction (PCR) testing does not exclude fetal infection and
may need to be repeated if suspicion for fetal infection is high.
Varicella–zoster virus VZV Mortality is predominately due to
VZV pneumonia, which is thought to be more
severe during adulthood and particularly in pregnancy, 2 to 5 % of infected pregnant women develop
pneumonitis. Risk factors for VZV pneumonia include
smoking and having more than 100 cutaneous lesions
congenital varicella syndrome. Some features include
chorioretinitis, microphthalmia, cerebral cortical atrophy, growth restriction, hydronephrosis, limb
hypoplasia, and cicatricial skin lesions
If the fetus/neonate is exposed to active infection just before or during delivery, and therefore before maternal antibody has been formed, the newborn
faces a serious threat. Attack rates range from 25 to 50%, and mortality rates approach 30%.
neonates develop disseminated visceral
and CNS disease, which is commonly fatal. For this reason, (VZIG) should be administered to neonates born to mothers who have clinical evidence of varicella 5 days before and up to 2 days after delivery.
Maternal varicella Diagnosis
is usually diagnosed clinically. Infection may be confirmed by NAAT of vesicular fluid. The virus may also be isolated by scraping the vesicle base during primary infection and performing a Tzanck smear,
tissue culture, or direct fluorescent antibody testing.
Varicella Management, when to give Varicella Immunoglobulins ?
Although best given within 96 hours of exposure, its use is approved for up to 10 days to prevent or attenuate varicella infection. + Acyclovir to be started 24 hours after the onset of Rash.
In women with known history of varicella, VariZIG is not indicated.
VZIG to the baby»_space; if the fetus was delivered within 5 days of infection.
management of influenza virus?/ what are the available option of antivirals?
Neuraminidase inhibitors are highly effective for the treatment of early influenza A and B. include ORAL oseltamivir (Tamiflu), INHALER zanamivir (Relenza); IV peramivir (Rapivab).
Influenza vaccine in pregnancy
for mothers vaccinated during pregnancy, several studies found lower rates of influenza in their infants up to 6 months of age.
A live attenuated influenza virus vaccine is available for intranasal use but is not recommended for pregnant women
MEASLES characteristics
Fever, coryza, conjunctivitis, and cough are typical symptoms. characteristic erythematous maculopapular rash develops on the face and neck and then spreads
to the back, trunk, and extremities. Koplik spots are small white lesions with surrounding erythema found within the oral cavity. Immediate or delayed
neurological sequelae of measles may manifest in several forms, making diagnosis difficult
Diagnosis of acute measles infection
most commonly performed by serological evidence of IgM antibodies, although RTPCR tests are available.
fetal complications of measles infection
The virus does not appear to be teratogenic (Siegel1973). However, rates of spontaneous abortion, preterm delivery, and low-birthweight neonates are
increased with maternal measles. If a woman develops measles shortly before birth, risk of serious infection developing in the neonate is considerable, especially in a preterm neonate.
fetal complications of rubella infection
poses significant risk for abortion and severe congenital malformations amenable in prenatal diagnosis like cardiac septal defects, pulmonary stenosis, microcephaly, cataracts, microphthalmia, and
hepatosplenomegaly, sensorineural
deafness, intellectual disability, neonatal purpura, and radiolucent bone disease.
rubella infection transmission
Transmission occurs via nasopharyngeal secretions, and the transmission rate is 80% to susceptible individuals. The peak incidence is late winter and spring in endemic areas
clinical presentation of Maternal rubella infection:
Maternal rubella is usually a mild febrile illness with a generalized maculopapular rash beginning on the face and spreading to the trunk and extremities. That said, 25 to 50 percent of infections are asymptomatic.
dx of rubella infection:
Specific IgM antibody can be detected using enzyme-linked immunoassay for 4 to 5 days after onset of clinical disease, but antibody can persist for up to 6 weeks after appearance of the rash.
rubella infection fetal transmission
Pregnant women with rubella and a rash during the first 12 wks GA have an affected fetus with congenital infection in up to 90% of cases, At 13 to 14 wks’ GA, this incidence is 50%, and by the end of the second trimester, it is 25% . Defects are rare after 20 WKS’ GA.
Management and Prevention of rubella infection:
There is no specific treatment for rubella. Droplet precautions for 7 days after the onset of the rash are recommended. Postexposure passive immunization with polyclonal immunoglobulin may be of benefit if given within 5 days of exposure.
causes erythema infectiosum, or fifth disease.
PARVO B19 virus
Fetal infection has been associated
with
anemia, which is its primary fetal effect. (In women with severe hemolytic anemia‒for example, sickle-cell disease‒parvovirus infection may cause an aplastic crisis), abortion, nonimmune hydrops, and stillbirth. Comorbid fetal myocarditis may induce hydrops with
lesser degrees of anemia.
clinical presentation of Maternal Infection of parvo B19 virus
20 to 30% is asymptomatic. Fever, headache, and
flulike symptoms may begin in the last few days of the viremic phase. Several days later, a bright red rash with erythroderma affects the face and gives a slappedcheek appearance. The rash becomes lacelike and spreads to the trunk and extremities. symmetrical
polyarthralgia
vertical transmission rate to the fetus in parvo virus infection
in up to a third of maternal parvovirus
infections
the rate of fetal loss with serologically proven parvovirus infection is
8 to 17 percent before 20 weeks’ gestation, and 2 to 6 percent after midpregnancy.
Hydrops develops in only approximately 1 percent of fetuses of women infected with parvovirus. Still, it is the most frequent infectious agent of nonimmune hydrops in autopsied fetuses
parvo virus Fetal infection is diagnosed by
detection of B19 viral DNA in amniotic fluid or IgM antibodies in fetal serum obtained by cordocentesis
important points to be counseled with a mother with parvo virus induced non-immune hydrops
Mortality rates as high as 30% have been reported in hydropic fetuses without transfusions. With transfusion, 94% of hydrops cases resolve within 6 to 12 wks, and the overall mortality rate is <10%. Most fetuses require only one transfusion because hemopoiesis resumes as infection resolves. Concurrent fetal thrombocytopenia worsens the prognosis.
important points to be counseled with pregnant woman regarding parvo virus infection
Pregnant women should be counseled that risks for infection approximate 5 percent for casual, infrequent contact; 20 percent for intense, prolonged work exposure such as for teachers; and 50 percent for close, frequent interaction such as in the home.
Workers at day-care centers and schools need not avoid infected children because infectivity is greatest before clinical illness. Finally, infected children do not
require isolation.
Toxoplasmosis caused by which organism and mode of transmission?
Syphilis diagnostic tests
Management options of syphilis:
Management (dx and prevention and treatment ) of malaria in pregnancy
Toxoplasmosis management
