MI: Viral Infections in Pregnancy Pt.3 Flashcards
Describe the symptoms of measles.
- Prodrome (2-4 days): fever, malaise, coryza,
- Conjunctivitis
- Kopolik spots
- Maculopapular rash starting at hairline and spreading to trunk/limbs within 3 days
List some maternal complications of measles infection.
- Secondary bacterial infection (otitis media, pneumonia, bronchitis)
- Encephalitis
- Subacute sclerosing panencephalitis
What are the risks of measles in pregnancy?
- Foetal loss (miscarriage, intrauterine death)
- Preterm delivery
- Increased maternal morbidity
IMPORTANT: NO congenital abnormalities to the foetus
How should pregnant women who have been in contact with suspected/confirmed measles be treated?
Measles immunoglobulin attenuates the illness if given within 6 days of exposure
What type of virus is parvovirus B19?
- DNA virus
- Parvoviridae family
Describe the clinical presentation of parvovirus B19 infection.
Mostly asymptomatic
- Erythema infectiosum (fifth disease, slapped cheeck syndrome)
- Transient aplastic crisis
- Polyarthropathy
Outline the pathophysiology of parvovirus B19 infection.
- Tropism for rapidly-dividing erythrocyte precursors
- Causes suppression of erythrogenesis
- NO reticulocytes are available to replace egeing or damaged arythrocytes as they are cleared by the reticuloendothelial system
At what stage in pregnancy is parvovirus B19 infection most concerning?
<20 weeks gestation
- 33% risk of tranmission to foetus
- 9% infection risk
- 50% of foetal infections result in intrauterine death
Infection >20 weeks has no documented risks
What is the main complication to the foetus from parvovirus B19 infection?
- Viral destruction of erthrocyte precursors causes severe anaemia
- This leads to high-output heart failure and hydrops fetalis
How is parvovirus B19 infection <20 weeks managed?
- Referral to fetal medicine for monitoring
- May require intrauterine blood transfusion
- Some will resolve spontaenously
- If the foetus survives the hydropic state, they have a good prognosis
Describe how maternal parvovirus B19 infection can be diagnosed.
- Viral detection (PCR)
- Serology
Name some human pathogenic enteroviruses?
How can they be transmitted?
Transmitted via respiratory droplets +/- faecal
What are the symptoms of enterovirus infection?
- Hand, foot, mouth disease
- Rash
- Encephalitis
- Myocarditis
Which enterovirus presents the biggest risk to the neonate?
Coxsakie virus
- Perinatal infection can occur in the last week of pregnancy
- Neonates are at risk of myocarditis, fulminant hepatitis, bleeding, and multi-organ failure
Outline the symptoms of Zika virus.
- 80% asymptomatic
- May cause fever, rash, myalgia and arthralgia
What are some consequences of Zika virus infection in pregnancy.
- Miscarriage
- Stillbirth
- Congenital Zika syndrome
- Severe microcephaly
- Decreased brain tissue
- Seizures
- Retinopathy/deafness
- Talipes
- Hypertonia
What advice can be given to pregnant women who are concerned about Zika virus?
- Bite avoidance
- Avoid travelling to Zika endemic countries if pregnant
- Avoid conception 2-6 months after travel to Zika endemic country (6 months for men, 2 months for women)
- Test only if symptomatic or abnormalities seen on USS
What questions to ask pregnant women presenting with rashes in history?
What is the general investigations to conduct in pregnant women with rashes?
What is subacute sclerosing panencephalitis?
- Fatal progressive degenerative disease
- Tends to occur 7-10 years after measles infection
- Present with delays motor skills and behavioural problems
