Obs - infections in pregnancy Flashcards by RK Splendid

which is the most common vertically transmitted virus in pregnancy?

CMV

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what are signs of a CMV infection in pregnancy?

asymptomatic
sore throat, fever, fatigue,
swollen glands

outside pregnancy - usally harmless for mum

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what are the differnt phases of CMV infection and when can it spread?

CMV can only be passed on when it’s “active”. The virus is active when:

a. you get CMV for the first time – young children often get CMV for the first time at nursery
b. the virus has “re-activated” – because you have a weakened immune system
c. you’ve been re-infected – with a different type (strain) of CMV

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what impact can CMV have on neonates? in childhood?

 IUGR
 Pneumonia
 Thrombocytopenia
 Neurological sequelea: hearing,
visual and mental impairment
 Death

childhood: childhood disability and deafness

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what is risk of catching CMV from mum?

40% vertical transmission rate

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how would CMV be investigated/ diagnosed?

Ultrasound
 Intracranial and hepatic calcification
echogenic bowel
CMV IgM titres rise with low IgG avidity if recent infection
Amniocentesis 6 weeks after
maternal infection – CONFIRM vertical transmission

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how is CMV managed?

• Monitering
o Fetal ultrasound every 2-4 weeks from diagnosis
o +/- fetal MRI at 28-32 weeks gestation

• If fetus is asymptomatic
o Expectant management

• If fetus is symptomatic
o Vanciclovir, PO, 8g/day

• If fetus is severly symptomatic
o Vanciclovir, PO, 8g/day
o Discuss TOP - termination of pregnancy

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why is it important to ask about hepres in PMH?

can reactivate in pregnancy

ask about when they had their last episode

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what is the management of herpes simplex?

C-section if delivery within 6 weeks of primary attack or genital herpetic lesions at the time of delivery.

In early pregnancy; Treat with aciclovir till asymptomatic then stop then restart at 36 weeks?

If primary infection occurs earlier in the pregnancy, offer prophylactic ORAL ACICLOVIR daily from 36 weeks until delivery
Aciclovir or valaciclovir can be given prophylactically to the baby during the at-risk period (recently born - if exposed)

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what is the gold standard test for Herpes simiplex?

Pcr test of vesicular fluid

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what are the signs of rubella infection in mother?

asymptomatic

flu like sx; fever, sore throat, cold,

macular rash

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what are the consequences for fetus of rubella infection?

 Deafness
 Cardiac disease - only difference from cmv infection
 Eye problems
 Mental retardation

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what is the risk of herpes infection to baby?

rarely transmitted

but if so, mortality is high!

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what is the prognosis of rubella?

high likelihood of malformation in 1st trimester

likelihood greatly drops as months go on.

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how is rubella ivx and treated?

Routine screening at antenatal booking -> identify
those who need vaccination - only given after end of pregnancy because

Live vaccine is contraindicated during pregnancy

A. Offer TOP - high risk of neonatal infection if rubella <16 wks

B. Rubella Immunoglobulin IM - if doesnt want TOP.
reduce the likelihood of a clinical attack which may
possibly reduce the risk to the fetus

C. Notify the Health Protection Unit (HPU) and refer to high-risk perinatal specialist + paediatric
infectious disease specialist

D• Recommend rest, adequate fluid intake and paracetamol for symptomatic relief

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responsible organism in toxoplasmosis?

Toxoplasma Gondii

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how is toxoplasmosis transmitted?

Follows contact with cat faeces, soil or

eating infected meat

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how is toxoplasmosis ivx / diagnosed?

Ultrasound findings
- Hydrocephalus

Maternal IgM

Amniocentesis after 20 weeks to confirm vertical
transmission

what is the treatment of toxoplasmosis in utero and in the newborn?

Maternal infection:
Spiramycin during pregnancy

Fetal infection:
Pyrimethamine + Sulfadiazine + Folic acid

Newborn:
1st Line: Pyrimethamine + Sulfadiazine + Calcium Folinate
• Adjunct: Prednisolone

whiich infections are teratogenic in pregnancy?

Syphilis

Herpes zoster - 1-2% risk f early pregnancy

management of chicken pox?

Non-immune women exposed to chickenpox
o Should be given VZIG - within 10 days

Chickenpox in pregnancy - active rash

Oral Aciclovir 5/day for 7 days
Iv if resp symptoms/ complications

Neonatal infection
- IV Acyclovir

Given birth within 7 days of rash
VZIG to baby

Mum gets chicken pox wiithin 7 days of delivery
VZIG to baby

what are the risks associated with chicken pox infection at diifferent tiimepoinrts?

1st trimester - teratogeniiciity eg Limb defects

Significant risk of neonatal varicella of the newborn if within 4 weeks of delivery

Erythema infectiosum = “slap-cheek”

appearance is pathognomic of?

parvovirus b19

what iis the effect of pavoviirus b19 on fetus?

Virus suppressed fetal erythropoiesis -> anaemia and
variable thrombocytopenia

causes hydrops fetalis - Infection in the first 20 weeks
neurological damage
death

management of parvovirus infection?

Conservative o Rest, fluids, paracetamol • Medical § In utero transfusions - if hydrops - may allow complete recovery

how is parvovirius ivx?

50% spontaneous resolution maternal IgM fetal surveillance Anaemia detectable on ultrasound (increased blood flow in MCA and then oedema from cardiac failure)

list risk facotrs for GBS infection?

```  Positive urine culture for GBS  Previous infant with GBS  Intrapartum fever >38c  PTL  ROM >18h  Previous hx ```

what is the management of GBS?

IV abx for vaginal deliveries (after rupture of membranes, ideally 4 hours before delivery). o No penicillin allergy: IV benzylpenicillin o Mild penicillin allergy: cephalosporin o Severe penicillin allergy: vancomycin • Neonate with signs of early-onset GBS infection o IV Penicillin and gentamicin 2 strategy: can decide to screen and give abx if present or can decide to not screen but give abx if risk factors

hwo do you test for hep b in pregnancy?

maternal bloods - booking appointment

how is hep B treated?

Tenofovir - if high viral load in 3rd trimester

what are complications of baby inheriting hep B?

liver cirrhosis hepatocellular carcinoma in later life

how is HIV manged in pregnancy?

Antenatal: Mum start / continue `HAART. aim viral load <50 copies/ml (zidovudine preferred) - manage patient with Infect dis specialist Intrapartum: < 50 copies/mL, vaginal delivery is appropriate o >50 copies/mL: pre-labour C-section should be considered Postpartum: infants - zidovudine for 2-4 weeks after birth. start by 4hours!

how does group A strep present? which agent? impact on fetus?

strep pyogenes Chorioamnionitis + abdominal pain, diarrhoea and severe sepsis notorious for puerperal sepsis fetus dies in utero

How is syphilis managed?

Benzylpenicilin / Benzathine penicillin 2.4 million units IM once o If penicillin allergy, erythromycin oral - 14 days LATE syphilis IM Benzylpenicilin - 3 weeks Erythromycni 30 days

how would you test for syphilis?

iideally - serology VDRL (veneral dsiease research lab) Dark ground microscopy. Serology (specific and non specific treponema test - eg vdrl)- blood test

how is hep C treated in pregnancy?

The usual treatments for HCV, interferon and ribavirin, are contraindicated in pregnancy and should be deferred to the postpartum period. No specific precautions are recommended: there is a low risk of vertical or blood transmission from mother to fetus.

what are the risk factors of listeria infection?

pate, soft cheese, pre-packed meals

how is listeria managed?

If mother is symptomatic, IV amoxicillin should be used, 6g/day for 14 day

how would you manage group A strep infection?

Sepsis - sepsis 6 protocol monitor fetus with CTG

how would you manage antepartum TB?

RIPE: PE for 2, RI for 6 Viitamin B6 - pyriidoxine

which durg is contraindiicated in chlamydia rx in pregnancy? why?

doxyxycline - grey discoulration of bones and teeth

what is the risk of congenital rubella syndrome ?

before 10 weeks - 80% chance of congenital rubella syndrome, advise termination after 20 weeks - low chance

how does congenital rubella syndrome present?

sensorineural deafness eye abnormalities - eg cataracts congenital heart disease eg pateent ductus arteriosus