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Maternal Infection and Sepsis Flashcards

1
Q

How common is sepsis as a cause of maternal death?

A

Accounts for 10% of maternal deaths

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2
Q

What are some common viral infections that affect pregnant women?

A

Rubella, measles, influenza, chickenpox, CMV, parovirus, mumps, herpes simplex, HIV

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3
Q

How is rubella transmitted?

A

By direct contact or respiratory droplet contact

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4
Q

What are the symptoms of rubella?

A

Fever, rash, lymphadenopathy, polyarthritis

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5
Q

What can maternal rubella infections cause?

A

Miscarriage, stillbirth, birth defects

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6
Q

What is the triad of congenital rubella syndrome?

A

Cataract, deafness, cardiac abnormalities

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7
Q

Is rubella common?

A

No = MMR vaccine has made it rare

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8
Q

How does the stage of pregnancy affect the outcome of rubella?

A

<8-10 weeks = 90% risk of CRS/multiple defects
11-20 weeks = 10-20% risk of CRS/single defect
16-20 weeks = low chance of deafness

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9
Q

How is rubella diagnosed?

A

Detection of rubella specific IgG antibody

Blood IgM should be done within 10 days of exposure

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10
Q

What should be considered if there is rubella infection in the early stages of pregnancy?

A

Termination of pregnancy = high risk of severe birth defects

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11
Q

What is the treatment of rubella?

A

Supportive = rest, fluids, paracetamol, avoid contact with other pregnant women

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12
Q

What causes measles?

A

Paramyxovirus = highly contagious but non-teratogenic

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13
Q

What are the symptoms of measles?

A

Fever, white spots inside mouth, runny nose, cough, red eyes, red blotchy rash that begins on forehead

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14
Q

What are the complications associated with the high fever that can occur in measles?

A

IUGR, microcephaly, miscarriage, stillbirth, preterm birth

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15
Q

What is associated with a high mortality rate in measles?

A

High mortality rate if mother develops pneumonia or encephalitis

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16
Q

How is measles treated?

A

Supportive care

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17
Q

What causes chickenpox?

A

Varicella zoster virus = DNA virus of herpes family

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18
Q

How is chickenpox transmitted?

A

Mainly via droplets = primary infection rare during pregnancy

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19
Q

How are women with chickenpox during pregnancy managed?

A

Check immunity = offer varicella zoster Ig within 10 days of exposure
Avoid other pregnant women = infectious until lesions crust

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20
Q

What is the supportive treatment for chickenpox?

A

Aciclovir if 20+ weeks gestation = 800mg 5x daily for 7 days

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21
Q

How is severe chickenpox treated?

A

Admitted to hospital for IV aciclovir

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22
Q

What are the complications associated with severe chickenpox?

A

Hepatitis, encephalitis, pneumonia

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23
Q

How does gestation impact the outcome of chickenpox?

A

7-28 weeks = foetal varicella syndrome
4 weeks before delivery = neonatal chickenpox
7 days before delivery = neonatal chickenpox with septicaemia and increased mortality

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24
Q

What causes congenital varicella syndrome?

A

Transplacental infection with chickenpox during pregnancy

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25
Q

How is congenital varicella syndrome managed?

A

Referred to foetal medicine specialist = detailed US and foetal MRI

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26
Q

What are the features of congenital varicella syndrome?

A

Limb hypoplasia, psychomotor retardation, IUGR, chorioretinal scarring, cataracts, microencephaly, cutaneous scarring

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27
Q

What causes CMV?

A

Human herpes virus family = common cause of congenital infections (0.2-2.2%)

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28
Q

What is CMV the leading cause?

A

Leading non-genetic cause of sensorineural deafness

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29
Q

What are the foetal risks of CMV infection?

A

Miscarriage, stillbirth, IUGR, microcephaly, intracranial calcifications, hepatosplenomegaly, thrombocytopenia, chorioretinitis, mental retardation, deafness

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30
Q

What is the risk of congenital CMV infection?

A

30-40% after primary infection
1-2% after recurrent infection
30% if first trimester infection
47% if third trimester infection

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31
Q

How is congenital CMV diagnosed?

A

IgG positive in previously seronegative mother

IgM positive with low avidity index

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32
Q

How common are symptoms in congenital CMV?

A

13% symptomatic at birth

8-23% of asymptomatic go on to have hearing loss

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33
Q

How is CMV managed during pregnancy?

A

Detailed US every 2-4 weeks
Foetal brain MRI at 28-32 weeks
Foetal blood sample

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34
Q

How is an asymptomatic foetus for CMV managed?

A

Expectant management until delivery

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35
Q

How are foetuses symptomatic of CMV managed?

A

Consider in utero treatment

Expectant management until delivery or termination of pregnancy depending on severity

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36
Q

How are mothers with CMV treated?

A

Valacyclovir and hyper-Ig

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37
Q

What are some features of parovirus infection?

A

Maternal infection is usually self limited

Foetal infection occurs in 1/3 of cases following maternal infection

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38
Q

What is the characteristic symptom of parovirus?

A

Rash on face - gives “slapped cheek” appearance

39
Q

What are the foetal complications of parovirus infection?

A

Aplastic anaemia, congenital heart failure, hydrops, foetal death

40
Q

What gestation carries the highest risk of foetal loss due to parovirus infection?

A

Infections occurring <10 weeks gestation

41
Q

How is parovirus diagnosed?

A

Detection of virus specific IgM

42
Q

How is parovirus infection managed?

A

Avoid contact with children and pregnant women

Refer to foetal medicine specialist = serial US, foetal MCA doppler

43
Q

How does parovirus serology guide management?

A

IgG+/IgM- = likely past infection, reassure
IgG+/IgM + = recent infection, US and MCA doppler, consider foetal sampling and delivery
IgG-/IgM- = no infection, counsel

44
Q

When would you consider delivery for a parovirus infection?

A

If near term and hydrops or foetal anaemia are present

45
Q

What causes mumps?

A

RNA virus = low incidence due to MMR vaccine

46
Q

Does mumps tend to have an adverse effect on pregnancy?

A

No = non-teratogenic and has no ill effects on pregnancy

47
Q

Can the live MMR vaccine be taken during pregnancy?

A

No

48
Q

Does influenza infection affect the course of pregnancy?

A

No = course remains unaffected

49
Q

Is the influenza vaccine contraindicated during pregnancy?

A

No = also safe to take when breastfeeding

50
Q

What are some complications associated with influenza infection?

A

Virulent infection = miscarriage, preterm labour

1st trimester infection = no teratogenic effect

51
Q

How is influenza treated?

A

Antivirals and monitor for complications

52
Q

What is herpes simplex infection?

A

Genital tract infection due to HSV-2 = transmitted by sexual contact

53
Q

What type of herpes simplex infection is associated with high risk of foetal infection?

A

Primary genital HSV infection

54
Q

How is recurrent or primary HSV infection in 1st/2nd trimester treated?

A

Aciclovir 400mg 3x daily

Vaginal delivery

55
Q

How is primary HSV in the third trimester treated?

A

Treat infection with antivirals

Recommend C-section

56
Q

How common is vertical transmission of HIV?

A

About 14-25% = higher in premature birth and prolonged membrane rupture

57
Q

What are the foetal risks associated with HIV?

A

IUGR, miscarriage, perinatal mortality

58
Q

What other infections should be screened for if mother is HIV positive?

A

Other STIs, CMV, TB and toxoplasmosis

59
Q

What is the initial management for HIV?

A

Partner notification and assess viral load/CD4+

HAART treatment and prophylactic antibiotics

60
Q

What type of delivery is recommended for HIV positive mothers?

A

Elective C-section = reduces vertical transmission risk by 50%
Zidovudine infusion 4hrs prior to C-section

61
Q

When may a vaginal delivery be considered in an HIV positive woman?

A

If viral load <50 and on HAART

62
Q

How is Zika virus spread?

A

Primary infection happens through mosquito bite = no vaccine

63
Q

What can Zika virus cause in pregnant woman?

A

Serious foetal birth defects

64
Q

How does Zika virus present?

A

Majority have minimal symptoms

In those with significant symptoms, virus causes mild 2-7 days illness

65
Q

What are the birth defects associated with Zika virus?

A

Microcephaly, brain defects, hearing/vision problems, limited ROM at joints, seizure/too much tone restricting body movement, swallowing abnormalities, developmental delay

66
Q

What causes covid-19?

A

SARS-Cov-2 coronavirus

67
Q

Where does covid-19 tend to effect?

A

Mostly a respiratory disease = mouth, nose and eyes are routes of infection

68
Q

How is covid-19 transmitted?

A

Droplets = 5-10mcm size, spread about 1m
Aerosol = <5 mcm size, wide spread, can remain airborne for longer
Fomites (e.g mobile phones)

69
Q

How does covid-19 impact pregnancy?

A

Pregnant women don’t seem to be at higher risk

No evidence of increased risk of severe disease, ITU admission or death

70
Q

How common is vertical transmission of covid-19?

A

Rate of 2.5-4% = mode of birth doesn’t affect transmission risk

71
Q

What is sepsis?

A

Life threatening organ dysfunction caused by body’s response to infection

72
Q

What are the signs of sepsis?

A 
Respiratory rate >22 and heart rate >100
High or low temperature = >38c or <35C
Hypotension = systolic BP <90mmHg
Cap refill >2s and oxygen saturation <94% on air
Skin clamminess and rash/mottled skin
Confusion or agitation
73
Q

What may help the early recognition of sepsis?

A

Plotting clinical observations on a MOEWS chart

74
Q

What is a red flag for sepsis?

A

Reduced or altered consciousness in a pregnant/postpartum woman

75
Q

What is the treatment for sepsis?

A

Sepsis 6 = give high flow oxygen, measure hourly urine output, give IV antibiotics and fluids, take blood for cultures, check haemoglobin and lactate

76
Q

How quickly should the sepsis 6 be delivered?

A

Within 1 hour

77
Q

What causes toxoplasmosis?

A

Toxoplasmosis gondii = found in raw/uncooked meat or infected cat faeces

78
Q

How can toxoplasmosis spread to the foetus?

A

Via transplacental transmission

79
Q

What are the foetal complications of toxoplasmosis?

A

Hydrocephalus, chorioretinitis, cerebral calcifications, microcephaly, mental retardation

80
Q

What is the treatment of toxoplasmosis?

A

Self limiting and doesn’t usually require treatment

Acute infection can be treated with spiramycin

81
Q

What causes listeriosis?

A

Listeria monocytogenes = intracellular gram positive bacillus

82
Q

Where is listeria monocytogenes found?

A

In soil and vegetation = infection causes by eating infected foods or through contact with infected miscarried animal products

83
Q

What are the maternal symptoms the listeriosis?

A

Flu-like illness or like food poisoning = headache, diarrhoea, nausea, abdominal pain

84
Q

What is the outcome of liseriosis?

A

Neonatal death due to septicaemia occurs in 10%

Overall perinatal mortality is 50%

85
Q

What are the obstetric complications of listeriosis?

A

Late miscarriage, preterm labour, stillbirth

86
Q

What is the treatment for listeriosis?

A

Ampicillin and gentamicin

Trimethoprim and sulfamethoxazole if penicillin allergy

87
Q

How can listeriosis be prevented?

A

Pregnant women should avoid unpasteurised milk, soft cheese and refrigerated smoked seafood

88
Q

What are some features of group B strep infections?

A

Safe most of the time

Can rarely cause sepsis, pneumonia or meningitis

89
Q

When would you give penicillin for group B strep infection?

A

If positive swab or urine sample

Previous baby affected by group B strep

90
Q

When would you add broad spectrum antibiotics to penicillin when treating group B strep infection?

A

If chorioamnitis or risk factors for complications present

91
Q

What are the risk factors for complications from group B strep infection?

A

Preterm birth. prolonged rupture of membrane, raised temperature

92
Q

How are mild UTI symptoms treated?

A

7 days of oral antibiotics

Respond to microbiology results as required

93
Q

How are systemic UTI symptoms or sepsis treated?

A

Admit for IV antibiotics

Request microbiology and possibly US

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