Maternal infections Flashcards
What is rubella caused by?
Rubella is also known as German measles.
Congenital rubella syndrome is caused by maternal infection with the rubella virus during the first 20 weeks of pregnancy.
When is risk of rubella highest in pregnancy?
Before 10 weeks gestation
Before becoming pregnant, what vaccination should be given for prevention of rubella?
MMR vaccine
Women thinking of becoming pregnant should ensure they have had MMR vaccine.
When in doubt, women considering pregnancy can be tested for rubella immunity. If they do not have antibodies to rubella, they can be vaccinated with two doses of the MMR, three months apart.
True/false?
True
MMR vaccine if requires should be given before pregnancy and not after becoming pregnant
Pregnant women should receive the MMR vaccination. True/false?
False
Should not be given as it is a live vaccine. Non-immune women should be offered the vaccine after giving birth.
What is the conditions caused by rubella in foetus (congenital rubella syndrome)?
Cataracts
Cardiac abnormalities - PDA (patent ductus arteriosus)
Microcephaly (abnormally small head)
Deafness
Remember: 3C’s = cataracts, congenital hearing loss and cardiac problems
What virus is chickenpox caused by?
Varicella zoster virus (VZV)
Chickenpox is serious in pregnancy, what can it lead to?
More severe cases in the mother, such as varicella pneumonitis, hepatitis or encephalitis
Fetal varicella syndrome
Severe neonatal varicella infection (if infected around delivery)
Mothers that have previously had chickenpox are immune and safe. True/false?
True
If in doubt regarding immune status for VZV in woman, what test can be conducted?
IgG levels
Positive IgG levels indicates immunity against VZV
When the pregnant woman has previously had chickenpox, they are safe. true/false?
true
When patient not sure about their immunity against chickenpox, test the VZV IgG levels. If negative, they are safe. true/false?
False
Positive IgG levels indicate safe against VZV (varicella zoster virus)
What is treatment of non-immune pregnant women for exposure to chickenpox?
Can be treated with IV varicella immunoglobulins as prophylaxis against developing chickenpox.
This should be given within ten days of exposure.
Congenital varicella syndrome occurs in what % of chickenpox cases in pregnancy?
1% of cases
When does congenital varicella syndrome usually occur in pregnancy?
First 28 weeks gestation
Typical features of congenital varicella syndrome?
- Foetal growth restriction
- Microcephaly, hydrocephalus and learning disability
- Scars and significant skin changes located in specific dermatomes
- Limb hypoplasia (underdeveloped limbs)
- Cataracts and inflammation in the eye (chorioretinitis)
What is congenital varicella syndrome?
Congenital Varicella Syndrome is an extremely rare disorder in which affected infants have distinctive abnormalities at birth (congenital).
This is in response to the mother’s infection with chickenpox (maternal varicella zoster) early during pregnancy (i.e., up to 28 weeks gestation).
What bacteria type is listeria monocytogenes?
Gram-positive bacteria that causes listeriosis
Listeriosis is much more common in non-pregnant women than pregnant women. true/false?
false
Listeriosis is many times more likely in pregnant women compared with non-pregnant individuals.
Listeriosis in pregnant women has a high rate of causing what issues?
high rate of miscarriage or foetal death. It can also cause severe neonatal infection.
How is listeria usually transmitted and as a result of this, what foods are typically avoided in pregnancy?
Typically transmitted by unpasteurised dairy products, processed meats and contaminated foods.
Pregnant women are advised to avoid high-risk foods (e.g. blue cheese) and practice good food hygiene.
Cause of congenital cytomegalovirus infection?
Occurs due to a cytomegalovirus (CMV) infection in the mother during pregnancy.
How is CMV typically transmitted?
The virus is mostly spread via the infected saliva or urine of asymptomatic children. Most cases of CMV in pregnancy do not cause congenital CMV.
Typical features of congenital cytomegalovirus infection?
-Foetal growth restriction
-Microcephaly
-Hearing loss
-Vision loss
-Learning disability
-Seizures
Remember vision loss: sightomegalovirus
Infection with toxoplasma gondii bacteria is usually symptomatic. True/false?
false
Usually asymptomatic
Common route of transmission for toxoplasma gondii?
Primarily spread by contamination with faeces from a cat that is a host of the parasite.
Classic triad of features in congenital toxoplasma infection?
Intracranial calcification
Hydrocephalus
Chorioretinitis (inflammation of the choroid and retina in the eye)
Parvovirus B19 infection typically affects adults. True/false?
False
Typically affects kids
Other names for parvovirus B19 infection?
Also known as fifth disease, slapped cheek syndrome and erythema infectiosum.
Parvovirus B19 infection is self-limiting, and the rash and symptoms usually fade over 1 – 2 weeks. True/false?
True
Why is parvovirus B19 infection also called “slapped cheek” syndrome?
After 2 – 5 days, the rash appears quite rapidly as a diffuse bright red rash on both cheeks, as though they have “slapped cheeks”
For parvovirus B19 infection healthy children and adults have a low risk of any complications, and management is supportive. True/false?
True
For people with parvovirus B19 infection, they are infectious once the rash has appeared. True/false?
False
They are infectious 7 – 10 days before the rash appears. They are not infectious once the rash has appeared.
What is significant exposure to parvovirus is classed as?
15 minutes in the same room, or face-to-face contact, with someone that has the virus.
Infections with parvovirus B19 in pregnancy can lead to several complications, particularly in the first and second trimesters. What are these complications?
- Miscarriage or foetal death
- Severe foetal anaemia
- Hydrops fetalis (foetal heart failure)
- Maternal pre-eclampsia-like syndrome
Pregnant women suspected of having parvovirus infection must have what tests done?
IgM to parvovirus, which tests for acute infection within the past four weeks
IgG to parvovirus, which tests for long term immunity to the virus after a previous infection
Rubella antibodies (as a differential diagnosis)
Treatment of parvovirus for pregnant woman?
Treatment is supportive. Women with parvovirus B19 infection need a referral to fetal medicine to monitor for complications and malformations.
How is zika virus transmitted?
Spread by host Aedes mosquitos in areas of the world where the virus is prevalent.
Apart from host Aedes mosquito, how else can zika virus be transmitted?
Can also be spread by sex with someone infected with the virus.
Zika virus can cause no symptoms, minimal symptoms, or a mild flu-like illness. True/false?
True
In pregnancy infection with the zika virus can lead to congenital Zika syndrome, what the features of this?
Microcephaly
Foetal growth restriction
Other intracranial abnormalities, such as ventriculomegaly and cerebellar atrophy
Management of pregnant women with zika virus?
Pregnant women that may have contracted the Zika virus should be tested with viral PCR and antibodies to the Zika virus.
Women with a positive result should be referred to foetal medicine for close monitoring of the pregnancy. There is no treatment for the virus.
