Obstetrics and perinatal infections Flashcards

1
Q

How are UTIs different in pregnant women

A

May be asymptomatic

May lead to pyelonephritis (may ascend to kidneys)

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2
Q

How does varicella differ in pregnant women

A

May be much more severe. More likely to die of varicella pneumonia

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3
Q

Most important causes of congenital infections

A
Cytomegalovirus (most common)
Rubella
Toxoplasmosis 
Syphilis 
Varicella 
Zika
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4
Q

Consequence of cytomegalovirus

A

Only a small minority have severe consequences (cataracts, sensory neural deafness and cataracts)

minor consequences- unilateral deafness

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5
Q

How does baby get cytomegalovirus infection

A

From mother. May be primary or secondary. CMV is a herpesvirus so exhibits latency

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6
Q

When is risk of damage to baby greater when mother is infected with CMV

A

IF this is her very first infection as she doesn’t have antibodies

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7
Q

What is maternal infection of CMV like

A

Mostly always asymptomatic

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8
Q

IF a pregnant woman develops a rash, what do you need to do and why

A

Must exclude maternal rubella- because there is a risk of congenital rubella syndrome

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9
Q

How do foetuses get congenital rubella

A

Transplacental trasmissione to fetus

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10
Q

What is the outcome of congenital rubella dependent on

A

Timing within pregnancy. Whether it is in:

  • First trimester
  • 12-18 weeks
  • After 18 weeks
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11
Q

What is the risk of congenital rubella if acquired in first trimester

A

Multiple developmental defects including CNS, cataracts, heart

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12
Q

What is the risk of congenital rubella if acquire in 12-18 weeks

What is the risk of congenital rubella if acquired after 18 weeks

A

Most likely

Deafness

-NO risk

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13
Q

How is congenital rubella preventable

A

Universal MMR vaccination

Antenatal screening and postpartum vaccination

Investigation of all maternal rash and maternal contact with rash

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14
Q

What is a maternal rash more likely to be and what is the consequence of this

A

Parvovirus B19 infection

  • Increased risk of spontaneous miscarriage
  • Can cause fatal hydrops
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15
Q

Transmission of congenital toxoplasmosis and when does the risk increase

A

transmission during maternal infection- risk increases with duration of pregnancy

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16
Q

What does congenital toxoplasmosis lead to

A

Brain damage, chloroido-retinitis

17
Q

How do we check for syphilis to stop congenital syphilis

A

Routine antenatal screening and treatment

18
Q

What can congenital varicella lead to

A

Skin loss, scarring, usually unilateral, segmented

Impaired limb bud development

Many other, less specific features e.g. microcephaly, cataracts, IUGR

19
Q

What is Zika virus reported with a rise in

A

Microcephaly (where baby’s head is much smaller than expected)

20
Q

Blood-borne virus infections

A

HIV
Hep B virus
Hep C virus

21
Q

How can blood-borne virus transmission occur to baby

A

Antenatally- Transplacental
Perinatally-INfected birth canal, exposure to maternal blood
Postnatally- In breast milk (HIV only

22
Q

How to prevent mother to baby HIV

A

Maternal antiretroviral therapy to reduce viral load

Elective (planned) caesarian section

No breast feeding

23
Q

How to prevent mother to baby hep b

A

Preventable by vaccination

24
Q

Difference in management between Hep b and Hep c management

A

Hep b can be treated so is screened for however there is no intervention for hep c so there is no rationale for screening

25
What are some other neonatal infection
Neonatal septicaemia/meningitis Neonatal varicella Neonatal herpes Opthalmia neonatorum
26
Principal causes of neonatal septicaemia/meningitis
Streptococcus E.Coli (less common: listeria monocytogenes)
27
How is neonatal septicaemia acquired
From maternal birth canal/ early rupture of membranes leading to chorioamnionitis [for listeria monocytogenes, maternal infection is food borne (e.g. soft cheese) , organism resides in GI tract]
28
What does Group B streptococcus cause in pregnant women and how is it acquired
Neonatal pneumonia, septicaemia, meningitis Colonises perineum/vagina in around 1/4 pregnant women. IT is commonly found as normal GI flora
29
How can a Group B streptococcus infection be managed
IV antibiotics during delivery reduces risk of neonatal infection
30
Risk of maternal varicella in late pregnancy
Baby can be born with chicken pox and mortality rate is high
31
Maternal chicken-pox in late pregnancy management What drugs can you use
- How long does it take for maternal antibodies to develop and cross the placenta? - If she goes into labour for at least 7 days after her rash appears, then it will not get life threatening varicella If tha baby is born within 7 days of onset of maternal rash, then you would give the baby passive immunity through varicella immunoglobulin Can use prophylactic aciclovir when baby is born
32
How are most neonatal herpes infections acquired
Primary maternal genital herpes
33
Why is neonatal herpes difficult to diagnose What is the prognosis for neonatal herpes
50% cases have internally disseminated infection without external lesions -Prognosis is bad. Need to treat as soon as possible
34
Organisms that cause ophthalmia neonatorum (conjunctivitis) and how is it acquired
Gonorrhoea or chlamydia Infected maternal birth canal