Obs - infections in pregnancy Flashcards
which is the most common vertically transmitted virus in pregnancy?
CMV
what are signs of a CMV infection in pregnancy?
- asymptomatic
- sore throat, fever, fatigue,
- swollen glands
outside pregnancy - usally harmless for mum
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
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
what is risk of catching CMV from mum?
40% vertical transmission rate
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
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
why is it important to ask about hepres in PMH?
can reactivate in pregnancy
ask about when they had their last episode
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)
what is the gold standard test for Herpes simiplex?
Pcr test of vesicular fluid
what are the signs of rubella infection in mother?
asymptomatic
flu like sx; fever, sore throat, cold,
macular rash
what are the consequences for fetus of rubella infection?
Deafness
Cardiac disease - only difference from cmv infection
Eye problems
Mental retardation
what is the risk of herpes infection to baby?
rarely transmitted
but if so, mortality is high!
what is the prognosis of rubella?
high likelihood of malformation in 1st trimester
likelihood greatly drops as months go on.
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
responsible organism in toxoplasmosis?
Toxoplasma Gondii
how is toxoplasmosis transmitted?
Follows contact with cat faeces, soil or
eating infected meat
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
