Obstetrics And Perinatal Infections Flashcards

0
Q

Infections in pregnancy-> neonate

A

May effect fetal development
Neonatal immune system not fully mature
Different spectrum of infectious agents
Congenital infections may cause long term lie threatening illness

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1
Q

Risk factors modifying outcomes of infection in pregnancy-> mother

A

Physiological/ immunological changes may increase susceptibility and alter clinical manifestations
Many drugs are contraindicated
Urinary tract infections may be asymptomatic or lead to pyelonephritis
Varicella->develop varicella pneumonia
Maternal rash
-> rubella
-> parvovirus B19-> no congenital risks but in increased risk on mis carriage

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2
Q

Maternal cytomegalovirus

A

May be primary or secondary-> both cause congenital infection and teal damage
Timing of infection doesn’t appear important
Maternal infection is almost always asymptomatic

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3
Q

Congenital cytomegalovirus

A

3-4 per 1000
Severe handicap-> 5-10%
minor -> 5%

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4
Q

Prevention of congenital cytomegalovirus

A

Screening is not advocated
-> no advice to give positive women
-> recurrent CMV may also cause congenital CMV
Development of a vaccine

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5
Q

Congenital rubella

A

Transplacental transmission
Outcome dependent on timing within pregnancy
-> first trimester-> multiple developmental defects-> congenital rubella syndrome-> CNS, eye, heart
12-18 weeks-> deafness
After 18-> no risk
Universal MMR vaccine
Antenatal screening and post partum vaccination
Investigation of maternal rash

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6
Q

Congenital toxoplasmosis

A

Toxoplasma Gondi, protozoon
Transplacental transmission
-> brain damage, chorodio retinitis-> may not present until later life
Risk of fetal damage is greatest in early pregnancy

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7
Q

Congenital syphilis

A

May be multi system
Range of clinical features which present at 5-15
Routine antenatal screening and treatment

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8
Q

Congenital varicella

A

Varicella embryopathy
Skin loss, scaring, usually unilateral
Impaired limb bud development
Many other less specific features-> microcephaly, cataracts, IUGR 1-2% risk following maternal varicella in first 20 weeks of pregnancy

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9
Q

Blood Bourne virus transmission

A

Antenataly-> transplacental
Perinataly-> infected birth canal, exposure to maturation blood
Postnatally-> breast milk-> only HIV

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10
Q

Mother to baby HIV

A
20% risk
Preventable by:
-> maternal antiretroviral therapy to reduce viral load
-> elective Caesarian 
-> no breast feeding 
Antenatal screening
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11
Q

Mother to baby HBV

A
5-90% transmission rate 
Neonatal infection leads to very high carriage rates
Preventable by vaccination 
-> active-> accelerate course
-> passive-> hep B immunoglobin 
Universal antenatal screening-> HBsAg
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12
Q

Mother to baby HCV

A

Rates very low compared to hep B

No intervention so no screening

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13
Q

Neonatal septicaemia/meningitis

A

Main causes-> group B streptococcus, E.coli
Acquired from maternal birth canal/early rupture of membranes leading to chorioamniotits
Known carriers of GBS given antibiotics during labour
Listeria monocytogenes less common

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14
Q

Group B streptococcus

A

Important causes of neonatal pneumonia, septicaemia and meningitis
Commonly found as normal gut flora
Colonise perineum/vagina in 1/4 of pregnant women
1/200 risk of neonatal infection
I.v antibiotics reduces risk to 1/4000

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15
Q

Varicella in pregnancy

A

In mother-> varicella pneumonia
-> in first 20 weeks-> risk of fetal damage
->late pregnancy-> neonatal infection
Delivery >7 days after maternal rash-> safe
VZIg to neonates
Prophylactic aciclovir

16
Q

Neonatal herpes

A

Most infections acquired from primary Venetian herpes at term
50% of cases have no external lesions but have internal dissemination
Prognosis is awful
1 in 50,000 live births

17
Q

Ophthalmia neonatorum

A

Acute Purulent conjunctivitis
Neisseria gonorrhoeae or chlamydia trachomatis
Acquired from infected maternal birth canal
Neonatal pneumonia