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Reproduction & Sexual Health > Maternal Infections > Flashcards

Maternal Infections Flashcards

1
Q

How does rubella present?

A

Fever, rash, lymphadenopathy, polyarthritis

Transmitted by direct contact/respiratory droplet exposure

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2
Q

What is the rubella triad?

A

Cataracts
Patent ductus arteriosus
Deafness (due to microcephaly)

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3
Q

Describe the likelihood of rubella complications depending on gestation

A

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

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4
Q

How is rubella in pregnancy managed?

A

If <12 weeks consider TOP
Specific IgG can be detected after natural infection/vaccination and blood IgM within 10 days of exposure
Supportive treatment - rest, fluids, paracetamol, postnatal vaccination

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5
Q

What causes measles?

A

Paramyxovirus

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6
Q

How does measles present?

A

Fever, runny nose, cough, red eyed, rash, Kopek white spots inside mouth, rash appears on forehead first

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7
Q

Is measles teratogenic?

A

No but the high fever can cause IUGR, microcephaly, miscarriage, stillbirth or preterm labour

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8
Q

What maternal complications can measles cause?

A

Pneumonia and encephalitis

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9
Q

How is measles managed?

A

Supportive care to reduce fever

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10
Q

What causes chicken pox and how is it transmitted?

A

VZV DNA virus of herpes family - transmission is mainly via droplets

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11
Q

How does chicken pox present?

A

Fever, malaise followed by itch vesicular rash starts on trunk and moves to peripheries

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12
Q

What proportion of people are seropositive for chickenpox by age 10?

A

9/10

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13
Q

Describe the chicken pox risk depending on gestation

A

7-28 weeks - fetal varicella syndrome
4 weeks before delivery - neonatal chicken pox
7 days before delivery - neonatal chicken pox with septicaemia

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14
Q

Describe fetal varicella syndrome

A

Trans-placental infection during pregnancy causes;

  • hypoplasia
  • psychomotor retardation
  • IUGR
  • cataracts
  • microcephaly
  • cutaneous scarring
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15
Q

If a mother has been exposed to chicken pox how can immunity be check and what is done if she is not immune?

A

IgG antibodies to VZV

VZVIg given within 10 days of exposure

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16
Q

How long is the patient infective with VZV for?

A

2 days before the symptoms until the lesions crust over

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17
Q

What is classed as significant exposure?

A

> 15 minutes face to face contact

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18
Q

When should acyclovir be given?

A

If >20 weeks or <24 hours within rash developing

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19
Q

Name the maternal complications of chicken pox

A

Hepatitis, encephalitis, pneumonia

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20
Q

What should be done to assess complications post infection?

A

5 week post infection scan

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21
Q

What type of virus is cyclomegalovirus?

A

Herpes virus

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22
Q

What are the risks of CMV to the foetus?

A

Miscarriage, stillbirth, IUGR, microcephaly, intracranial calcifications, hepatosplenomegaly, chorioretinitis, deafness

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23
Q

Is primary or reactivation of CMV more likely to cause congenital infection?

A

Primary - 30-40%

Reactivation - 1-2%

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24
Q

Which trimester carries higher risk of congenital CMV infection?

A

3rd trimester

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25
Q

How is CMV diagnosed?

A

Amniocentesis
IgG in reactivation
IgM with low avidity index

26
Q

What percentage of asymptomatic CMV babies will go on to have hearing loss?

A

8-23%

27
Q

How will CMV present in a baby?

A

Jaundice, petechial rash, hepatosplenomegaly, microcephaly

28
Q

What screening is done on babies who’s mums have had CMV?

A

Ultrasound every 2-4 weeks
Fetal MRI
Fetal blood sample
Post natal examination of placenta

29
Q

If CMV causes severe cerebral ultrasound abnormalities what may be required?

A

TOP

30
Q

How is CMV treated?

A

Valacyclovir

Hyper immune globulin

31
Q

What percentage of parvovirus does fetal infection occur?

A

30%

32
Q

What is the incubation period of parvovirus?

A

4-20 days

33
Q

How long is a person infectious with parvovirus for?

A

7-10 days prior to rash and 1 day following

34
Q

When is there a higher risk of fetal loss with parvovirus?

A

<10 weeks gestation

35
Q

What does parvovirus do to the foetus?

A

Affects erythroid precursors - aplastic anaemia, congenital heart failure, hydros and death

36
Q

How is parvovirus diagnosed?

A

IgM - serial USS and fetal MCA doppler

37
Q

Describe mumps in pregnancy

A

RNA virus no effect on pregnancy, low incidence but MMR vaccine is contraindicated in pregnancy

38
Q

Is influenza teratogenic?

A

No but if the infection is virulent there is a risk of miscarriage/preterm labour

39
Q

What can prevent influenza in pregnancy?

A

Vaccine - safe in pregnancy and breast feeding

40
Q

How can influenza in pregnancy be treated?

A

Antivirals to prevent complications e.g pneumonia

41
Q

What is zika virus?

A

Primary infection though mosquito bite can cause serous birth defects

42
Q

How long does zika virus remain active?

A

2-7 days most have minimal symptoms

43
Q

What are the fetal risks of zika virus?

A

Microcephaly, brain defects, vision and hearing issues, limited joint movement, seizures, swallowing abnormalities, developmental delay

44
Q

What is the percentage of verticle transmission of HIV?

A

14-25%

45
Q

What increases the risk of HIV transmission?

A

Preterm birth and prolonged rupture of membranes

46
Q

What are the risks of HIV in pregnancy?

A

IUGR, miscarriage, perinatal mortality

47
Q

How are HIV positive pregnant women managed?

A

Routine screening for HIV, STIs, CMV, TB, toxoplasmosis
Partner screening
Viral load and CD4 count
HAART and prophylactic antibiotics

48
Q

What can be done to reduce risk of transmission?

A

Elective c-section (reduces risk by 50%)
Avoidance of breastfeeding (reduces risk by <1%)
ZIidovudine infusion 1 hour before c -section

49
Q

At what viral load can vaginal delivery be considered?

A

<50 copies/ml

50
Q

Define sepsis

A

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

51
Q

What are the signs of sepsis in pregnancy?

A

RR>22, HR >100bpm, temp>38 or <35, hypotension with systolic <90mmHg, low oxygen and poor peripheral perfusion, clamminess, confusion, rash and mottled skin

52
Q

How is sepsis managed?

A

Sepsis 6

Lactate is raised in normal active labour

53
Q

Where is toxoplasmosis gondii found?

A

Raw or uncooked meat and infected cat faeces

54
Q

What are the risks of toxoplasmosis gondii?

A

Hydrocephalus, choriorentitis, cerebral calcification, microcephaly, mental retardation

55
Q

How is toxoplasmosis gondii managed?

A

Spiramycin

56
Q

What is listeriosis?

A

Gram positive bacteria found in soil and vegetation - caused by eating infected food or contact with infected miscarried products of animals

57
Q

How will listeriosis present?

A

Flu like or food poisoning

58
Q

What are the complications of listeria?

A

Neonatal death due to septicaemia, late miscarriage and preterm labour, stillbirth

59
Q

How is listeriosis treated?

A

Ampicillin and gentamicin

Trimethoprim and sulfamethoxazole

60
Q

How can group B strep be treated?

A

Penicillin

61
Q

What are the risk factors for GBS?

A

Preterm birth, prolonged ROM, raised temperature

62
Q

What is the treatment of UTI in pregnancy?

A

Nitrofurantoin

Trimethoprim is teratogenic in the first trimester as it inhibits folic acid

Reproduction & Sexual Health (36 decks)

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