Perinatal infections Flashcards
Parvovirus risk of infection in pregnancy by exposure location
20% if at home
8-12% at childcare
8% in community
Outcomes with proven maternal infection of Parvo
10% miscarriage
3% hydrops - 1/3 resolve, 1/3 IUT, 1/3 die without IUT
<1% congenital abnormalities
Monitoring in recent parvo infection
USS at 1-2 weekly intervals for 12 weeks
If no fetal abnormality noted after 30 weeks - stop scanning
anaemia - refer MFM for IUT
Positive Syphilis
VDRL +ve
RPR titre +ve
TPPA +ve
Latent infection/past treated Syphilis
VDRL -ve
RPR -ve
+ve TPPA
Possible false positive or early infection syphilis
VDRL +
RPR +
- TPPA
Repeat test in 4 weeks
Syphilis stage and risk of infection
Primary (chancre)-high
Secondary (systemic illness)-Moderate
Latent and tertiary - neglibile
Management of Syphilis
Treat with Benzathine Penicillin 1.8g
MDT with infectious diseases and paediatric team
Monthly RPR and VDRL until delivery
-if _ve or >4 fold drop in titre - successful tx
-retreat if rise in titre
CMV risk of fetal infection by primary or secondary infection
primary:30% chance of fetal infection
30% chance of fetus being affected
Non-primary: approx 1%
risk of sequelae with CMV symptomatic or asymptomatic infection
Primary: symptomatic 50%
asymptomatic 10-15%
Secondary: <10%
CMV testing - recent infection
+igG
+IgM
low avidity
if intermediate avidity - treat as recent infection
CMV management
Fetal USS (6 weeks after maternal infection) - CNS signs, hydrops, echogenic bowel, IUGR
Fetal MRI-microcephaly
Amnio-higher sensitivity if after 20 weeks
If woman immunocompromised can do valaciclovir
Fetal risks with CMV infection
CP
Sensorineural hearing loss
Visual impairment
Delayed psychomotor development
Secondary herpes infection risk of transmission
<1%if no active disease
1-3% if HSV in genital tract at time of delivery
(higher risk if recurrent HSV 1 (15%) than HSV 2 (<0.01%)
Primary herpes with no seroconversion before 34 weeks risk of transmission
25-50%
Primary herpes management (and secondary)
If diagnosis in 3rd trimester then need C/S
If vaginal delivery unavoidable avoid FBS, instrumental,
prophylaxis from 36 weeks (valcyclovir 500mg BD)
Swab baby eye, throat, and rectum at 24 hrs post delivery
Hepatitis B bloods and management based on viral load
HbsAg +ve
HBV >10^7 treat mum w tenofivir from 30 weeks; stop 4-12weeks PP
HBV <10^7 baby needs vaccination at birth and at 2,4 &6 months, HB immunoglobulin and bath at birth
Screen mum for Hep C and HIV
Hepatitis C management
RNA positive - perinatal transmission risk 5%
No evidence CS reduces risk of transmission
Avoid invasive procedure in labour
Can BF but caution with cracked nipples and bleeding
HIV management (pre preg)
MDT approach Identify partner status Aim viral load to be at a minimum cervical smears UTD (yearly screening) Screening for other STIs (bloods/swabs) Ensure vaccinations UTD Mother to child transmission counselling
HIV tran
smission risk with or without treatment
25-30% without
<1% with full treatment
HIV intrapartum management
avoid fetal invasive procedures
avoid PROM
Can consider vaginal birth if load undetectable
IV zivudine if viral copies 50 and above
C/S at 36 weeks (C/S if 400 or above, consider if 50 and above)
HIV antepartum management
Continue on HAART regime if effective Viral load CD4 count, viral resistance FBC, LFTs, U/Es other STI screen late presenting - commence HAART asap
HIV postpartum management
formula fed baby
Treat with AZT at birth
PJP prophylaxis if high risk of transmission
Baby needs viral PCR
acute listeriosis
gram stain and cultures of genital tract
amoxicillin for 14 days (oral if well, IV if unwell)
Can consider gent if mum unwell
Delivery depends on condition of mother and prematurity
Risk to baby - SB or sepsis (granulomas, pneumonitis, purulent conjunctivitis)
Food Safety advice in pregnancy
Avoid undercooked meats and soft cheeses Buy fresh produce and meats Cook meats and wash vegetables thoroughly Don't kiss baby on the mouth Exercise good hand hygiene Forego pre-prepared salads and foods Heat until piping hot
TB in pregnancy management
Tx - INH, rifamapin, ethambutol
CXR, sputum, urine sample
Neonate likely effected due to haematogenic spread so therefore needs close follow up
Positive rubella
positive IgM and IgG
Risk of fetal infection of Rubella
highest in first and third trimesters
lowest in 2nd trimester (30%)
Risk of congenital defects low after 16 weeks, otherwise risk 85% 1st trimester, 36% up to 16 weeks
Management rubella
consider TOP if first trimester
consider fetal testing if second trimester - 6 weeks after infection and after 20 weeks
low risk of CRS if after 20 weeks
Toxo infection blood results
IgG +
IgM +
IgA+
low IgG avidity
Toxo risk of fetal infection
lowest risk in first trimester, highest in third
highest risk if contracted in first trimester, lowest risk if contracted in third
CRS effects
Cardiac defects bone disease eye disease intellectual diability encephalitis
Congenital toxo
chorioretinitis microcephaly hydrocephalous intracranial calcifications mental retardation
Toxoplasmosis management
perform serology to confirm active infection
Refer MDM
Tertiary USS + MRI
consider fetal sampling
antibiotics - ?spiramycin; pyramethadine and sulfadiazine from 18 weeks
Consider TOP if confirmed infection
Confirm diagnosis infant with paediatric involvement
Varicella in pregnancy
ZIG if <96 hours exposure
acyclovir if >96 hrs since exposure and <24 hours since onset of rash
IV aciclovir if complications develop
C/S if fetal compromise or maternal status deterioration/ respiratory failure
1% risk of infection prior to 28 weeks, virtually no risk after this
Give ZIG to baby if mum has 7 days before delivery or 2 days after OR if mum has >2 days after and baby prem or <1000g
BFing ok
