Lec49 Intrauterine and Perinatal Flashcards
What is relationship time of exposure in pregnancy and severity of infection / risk of infection?
- decreasing severity of infection over time of pregnancy
- increasing risk of infection over time [as placental barrier breaks down]
What routes of transmission for CMV – placental, intrapartum, or breast milk?
- placental or breast milk
What routes of transmission for HIV – placental, intrapartum, or breast milk?
- intrapartum or breast milk
- can also cross placenta but only if really serious disease [high VL, bad immune system]
- normally its intrapartum
What routes of transmission for rubella – placental, intrapartum, or breast milk?
placental
What routes of transmission for VZV – placental, intrapartum, or breast milk?
placental
What routes of transmission for toxoplasma – placental, intrapartum, or breast milk?
placental
What routes of transmission for syphilis – placental, intrapartum, or breast milk?
placental
What routes of transmission for listeria – placental, intrapartum, or breast milk?
placental
What are potential effects maternal infection on pregnancy?
- pregnancy loss
- teratogenicity
- in utero infection
- chronic infection of fetus
- acute infection of newborn
What are the torch infection?
- in utero infections that present with ocular findings and rash
T: toxoplasma gondii
O: syphilis, parvo B19, varicella, HIV, Hep B, chlamydia
R:Rubella
C: CMV
H: HSV
What are risk factors of perinatal HIV transmission?
- advanced maternal disease
- high maternal viral load
- ruptured membrane for > 4 hrs [long labor]
- breast feeding
What is current treatment for pregnant HIV+ to prevent transmission?
- multi drug ARV regimen
- cesarean delivery
- ARV prophylaxis
What are signs of group B strep in pregnant woman?
- asymptomatic, UTI, amnionitis, sepsis
How do you prevent baby with strep B?
- screen at 35 wks
- treat during labor or 4 hrs before cesarean
What is risk of mother-infant transmission GBS?
- 50% of infected mothers pass it on, only 2% have symptoms
What are symptoms of infant group B strep?
within first week of life:
- early onset sepsis
- pneumonia
- meningitis
What are indications for giving GBS prophylaxis?
- infant with invasive GBS during previous pregnancy
- pos GBS screening during current pregnancy
- unknown GBS AND deliver < 37 wks
What is treatment for GBS prophylaxis?
first choice: penicillin or ampicillin
2nd: clindamycin
3rd: vancomycin
When is maternal morbidity from pregnant influenza greatest?
highest maternal morbidity later in pregnancy
What are recommendations of influenza vaccine in pregnancy?
- give vaccine in any/all trimesters in pregnancy –> may passively transfer antibodies
- fetus never in danger of picking up virus but itll help protect fetus early in life
What is the most common congenital infection?
CMV
What is effect of congenital CMV?
- congenital hearing loss
- range moderate hepato-splenomegaly to fatal illness
- 80-90% have complications in 1st year of life –> vision impairment, mental retardation, hearing loss
- in 1st trimester –> pregnancy loss
- 2nd or 3rd trimester –> congenital disease
What is risk of vertical transmission of CMV?
30-40%
How do you screen for maternal CMV?
- sometimes do CMV serologic screening
- CMV IgM = not reliable, high false pos rate
- paired serum test
How do you screen for CMV in neonate?
- culture/PCR amniotic fluid but does not predict severity
- ultrasound to assess severity
Is there a vaccine for CMV?
NO
Where does listeria infection come from?
- processed food [deli meats]
When do most listeria infections occur in pregnancy?
- in 3rd trimester usually
- if 1st trimester = worse prognosis
How does vertical listeria transmission occur?
listeria infects placenta = reservoir
How can you get rid of listeria in pregnant woman?
only way is to remove placenta
What is effect of listeria infeciton in mom?
- 20-30% mortality in neonates
- infection in early gestation –> sponatenous abortion
- in late gestation –> risk of preterm birth
How do you prevent pregnant listeria infection?
- no deli meats
- no soft cheeses
- no unpasteurized milk
What is treatment for listeria?
antibiotic [penicillin, ampicillin, amoxicillin] that can cross placenta and penetrate cell wall
Is there higher risk for vertical transmission in early or late pregnancy of toxoplasmosis?
- later in gestation more likely to be transmitted
- early infections more likely to be severe
How do you dx congenital toxoplasmosis?
during pregnancy: serology, amniocentesis, toxoplasmosis test
after birth: serology, CT, neuro exam, toxoplasmosis
classic in utero triad of toxoplasmosis
Chorioretinitis, intracranial calcifications, hydrocephalus
effects of toxoplasmosis?
- most infants asymptomatic but 85% have visual impairment later in life
What is treatment for toxoplasmosis?
in utero: spiramycin then pyrimethamine + sulfadiazine
post natal: pyrimethamine + sulfadiazine for up to yrs
What is preventive measure of HSV in pregnant women and at birth?
- neg women avoid intercourse with pos partner in 3rd trimester
- at 1st episode genital herpes or frequent recurrences –> treat with acyclovir
- C section recommended with active disease
- maybe intrapartum IV acyclovir also
What is risk of vertical transmission HSV?
- 30-50% risk when primary infection near term
- low risk when recurrent infection
How do you prevent neonatal herpes?
- prevent maternal acquition HSV
- avoid exposure to herpetic lesions during delivery
What are effects of congenital rubella syndrome?
- deafness
- blindness
- mental retardation
- fetal death up to 20%, premature delivery
- defects rare after 20 wks gestation
When is highest risk of CRS? highest risk of transmission?
- highest risk of CRS early in pregnancy
What is treatment for congenital rubella?
supportive
What are effects of varicella in maternal?
- increased risk of varicella pneumonia, <1% of maternal infections transmitted vertically
What are signs of congenital varicella syndrome?
- chorioretinitis, congenital cataracts, cerebral cortical atrophy, variable degress of limb atrophy, skin scarring, GI reflux
What does neonatal congenital varicella transmission occur?
less than 5 days before birth
What is treatment of congenital varicella in mom? neonate?
- don’t give vaccine [its life]
- immediately give VZ Ig at exposure
- mother –> hospitalize, acyclovir or valacyclovir
- neonate: VZ Ig
What are signs of neonatal HSV? treatment?
- may be limited to skin/mucous membranes
- may be systemic [including CNS]
- treat: IV acyclovir if sero+ or if maternal infection was primary HSV
