Obstetric and Perinatal Infections Flashcards
What does the placenta act as?
Immunological barrier
What is the role of the placenta
Reduced expression of class 1 MHC antigen on placental cells
Syncytium blocks transit of immune cells
Inhibition of T cell
What T cells changes are there in the maternal immune system in pregnancy
TH1 decreases
NK increases
increases the liklihood of severe symptomatic poliovirus/Hep A
Rheumatoid arthritis often ameliorates
Systemic lupus erythenatosus can flare up
Features of the fetal immune system
fetal IgM and IgA produced in 2nd half of pregnancy
fetal IgG antibody synthesis lacking
fetal CMI absent
When does an intrauterine infection happen
During pregnancy
When does a perinatal transmission happen
During birth
Rubella features
Fever/malaise
3 days irregular maculopapular rash
athralgia
infection is commonly subclincal
Associated problems with congenital rubella syndrome
Cataracts, brain and heart problems
1/4 develop insulin- dependent DM in later life
infant sheds virus into throat and urine its very infectious
What is slapped cheek syndrome medically called
Erythrovirus/parovirus B19
What problems can erythrovirus cause
fetal anaemia
heart failure- hydrops foetalis - build up of fluids in the tissue around lung/heart/abdomen
Treatment for B19
Intrauterine blood tranfusion
Termination options
Diagnosis of CMV
Urine PCR key test for congenital CMV
Symptoms of mild CMV
Asymptomatic
Symptoms of severe CMV
Liver/spleen/blood/brain/eye
Maternal diagnosis of congenital CMV
Serology, seroconversion,
baby diagnosis of congenital CMV
PCR urine first week of life
What type of infection is syphilis
Maternal infection
What can syphilis lead to
Miscarriages, premature births, still births or death of newborn
Congenital syndrome problems of syphilis
Teeth/ brain / ears / bones
Hepatosplenomegaly jaundice anaemia
What to do if HBsAg is +ve
HBV vaccine for body
What to do if HIV +ve
antiretroviral drugs for mother + baby
elective CS
no breast feeding
Intervention if syphilis serology is +ve
treat mother with penicillin
Follow up baby - antibody levels should fall
What to do if rubella is non-immune
After MMR vaccines AFTER pregnancy as it protects the pregnancy
What type of infections can occur around the time of birth
Chorioamnionitis
Group B hemolytic streptococci
Bacterial meningitis
Neonatal Varicella
