Perinatal Infections Flashcards
Which infections are relevant?
Bacterial
-GUT CS
Gonnor/Clamyd, UTI, TB, Chorioaminionitis, Syphilus
Viral
CMV, Herpes, HepB, Rubella
Other
toxoplas
Why do these infections matter?
Sustained maternal pyrexia (38.8) can cause problems.
- 1st trimester (ntd, miscarriage)
- 2/3rd trimester(preterm labour, fetal death)
PTL is commonest cause of fetal/neonatal death
What is the commonest bacterial infection?
UTI
What us commenest cause of PTL?
Chorioamnionitis
What is perinatal?
Pregnancy + first week of life
What are causes of Chorioaminionitis?
- low path anaerobic commensal vaginal/bowel bacteria
- bacterial vaginosis
- group b strep(rare in sa but occurs 1st world.
Why is chorioamnionitis NB?
Comments cause of PTL AND PTL is commenest cause of fetal or neonatal death therefore…chorio commoemst cause of fetal/neonatal death
How does chorioamnionitis cause PTL?
Mom is often asymptomatic
Infection will set up inflammation in baby which affects the PG pathway and causes PTL
Effects of Choriomanionitis to mom
PPROM
PTL
endometritis
Septicaemia
Effects of chorioamnionitis on baby?
Septic shock
Pneumonia
How to manage chorioamnitis?
Mom and/or baby
- iv ampicillian (crosses placenta)
- genta/metronida if septicaemia
What to do if group B strep detected?
Common cause of puerpural sepsis.
If mom is well and baby is sick and proved to have GBS then mom is carrier.
Mom must be given prohylactic Ab next preg and notify obstetrician.
What does Clamydia and Gonorrhoea cause in baby?
Clamydia- eye infevtion and pneumonia
Gon- eye inf
Treat mom + partner
TB in babys?
No diff in presentation/management for 1st TB epsiode.
The main challenge is to avoid extrapulmonary TB.
Mom is not infectiius after 2weeks therapy.
INH prohkyaxis given to baby if mum less than 2 weeks treatment or active TB
Cant use streptomycin in treatment
Effect of TB on pregnancy?
Impaired fetal growth if mum ill and wasted.
Previous tb with bad lungs and pulm hpt may cause maternal mortality
How to identify primary syphilus?
Chancre
Painless Regional Lymphadenopathy
What are signs of secondary syphilus?
Rash on palms and soles Alopecia Snail track ulcers in mouth Generalised adenopathy Malaise
Latent Syph still affects fetus
How to dx syphilus?
Primary screening
-VDRL(lab test, not on CSF, expresed at titre >1/16 treat for syph,
Management of Syphilus
Primary
-benzathine penicil 2.4mu IMI x3 1 week apart. Crosses placenta.
Secondary l/early latent
-same treatment
Pen allergy
- doxy
- erythro
What are the consequences of congenital syphilus?
LBW- preterm or UGA
Hepatosplenomeg Blisters on palms and soles Peeling skin Oedema Osteitis in 70% Jaundice Purpura Anaemia Rds
What is Rx for neonatal syphilus?
Procaine penicill 50 000 iU/kg IMI for 10days if baby symptomatic or xray sign.
Baby asympto but mother has
- asymtp but untreated (latent)
- partial rx
- rx completed in last 4 weeks preg
- treated with erythromycin
Baby will get benzathine penicill 50 000iU/kg IMI STAT
If mom has Acute hepatitis in preg?
Baby gets extra vaccine at birth +hep B IgG if avail.
What does CMV look like under microscope?
Infected and swollen cells
Multinucleate giant cells.
What are effects of CMV on baby?
Brain
- seizures
- microcephaly
Ears and Eyes
- late onset neural deafness
- micropthalmia
- chorioretinitis
Blueberrry muff
HSM
