Perinatal Infections

Question 1

Which infections are relevant?

Answer 1

Bacterial
-GUT CS
Gonnor/Clamyd, UTI, TB, Chorioaminionitis, Syphilus

Viral
CMV, Herpes, HepB, Rubella

Other
toxoplas

Question 2

Why do these infections matter?

Answer 2

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

Question 3

What is the commonest bacterial infection?

Answer 3

UTI

Question 4

What us commenest cause of PTL?

Answer 4

Chorioamnionitis

Question 5

What is perinatal?

Answer 5

Pregnancy + first week of life

Question 6

What are causes of Chorioaminionitis?

Answer 6

• low path anaerobic commensal vaginal/bowel bacteria
• bacterial vaginosis
• group b strep(rare in sa but occurs 1st world.

Question 7

Why is chorioamnionitis NB?

Answer 7

Comments cause of PTL AND PTL is commenest cause of fetal or neonatal death therefore…chorio commoemst cause of fetal/neonatal death

Question 8

How does chorioamnionitis cause PTL?

Answer 8

Mom is often asymptomatic

Infection will set up inflammation in baby which affects the PG pathway and causes PTL

Question 9

Effects of Choriomanionitis to mom

Answer 9

PPROM
PTL
endometritis
Septicaemia

Question 10

Effects of chorioamnionitis on baby?

Answer 10

Septic shock

Pneumonia

Question 11

How to manage chorioamnitis?

Answer 11

Mom and/or baby

• iv ampicillian (crosses placenta)
• genta/metronida if septicaemia

Question 12

What to do if group B strep detected?

Answer 12

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.

Question 13

What does Clamydia and Gonorrhoea cause in baby?

Answer 13

Clamydia- eye infevtion and pneumonia

Gon- eye inf

Treat mom + partner

Question 14

TB in babys?

Answer 14

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

Question 15

Effect of TB on pregnancy?

Answer 15

Impaired fetal growth if mum ill and wasted.

Previous tb with bad lungs and pulm hpt may cause maternal mortality

Question 16

How to identify primary syphilus?

Answer 16

Chancre

Painless Regional Lymphadenopathy

Question 17

What are signs of secondary syphilus?

Answer 17

Rash on palms and soles
Alopecia
Snail track ulcers in mouth
Generalised adenopathy 
Malaise

Latent Syph still affects fetus

Question 18

How to dx syphilus?

Answer 18

Primary screening

-VDRL(lab test, not on CSF, expresed at titre >1/16 treat for syph,

Question 19

Management of Syphilus

Answer 19

Primary
-benzathine penicil 2.4mu IMI x3 1 week apart. Crosses placenta.

Secondary l/early latent
-same treatment

Pen allergy

• doxy
• erythro

Question 20

What are the consequences of congenital syphilus?

Answer 20

LBW- preterm or UGA

Hepatosplenomeg
Blisters on palms and soles
Peeling skin
Oedema 
Osteitis in 70%
Jaundice
Purpura 
Anaemia
Rds

Question 21

What is Rx for neonatal syphilus?

Answer 21

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

Question 22

If mom has Acute hepatitis in preg?

Answer 22

Baby gets extra vaccine at birth +hep B IgG if avail.

Question 23

What does CMV look like under microscope?

Answer 23

Infected and swollen cells

Multinucleate giant cells.

Question 24

What are effects of CMV on baby?

Answer 24

Brain

• seizures
• microcephaly

Ears and Eyes

• late onset neural deafness
• micropthalmia
• chorioretinitis

Blueberrry muff
HSM

Question 25

Clinical features of Rubella in mother?

Answer 25

German Measles 
Flu like symptoms
Red maculopap rash face + extremeties 
Post auricular, sub occip and cervical lymphadenopathy 
No encephalitis 
Self limiting arthrits in young women

Question 26

Clinical features of rubella in baby?

Answer 26

Cataracts, glaucoma , PDA, VSD, microcephaly, deafness, extramedullary haematopoiesis (blueberry muf rash)

Question 27

How can infants contract herpes?

Answer 27

If mom haw active herpes baby is at high risk.
Infant exposed to infected maternal secretions at delivery or PROM.
If mum has 48hr acyclovir baby can safely delivered

Question 28

Why does recurrent herpes infection confer less risk to fetus?

Answer 28

Mother can transfer protective Ab across placenta.
- mum infected 1st time during preg means no Ab=higher risk.
Viral shedding can happen up to 6weeks post infection.
HIV Infection = more viral rep and shedding

Question 29

How to make Dx of herpes?

Answer 29

Pcr
Culture
Serology

Question 30

Clinical features in mom and baby?

Answer 30

Mother
- painful vesicles on vulva or vagina and persist for 2-3weeks.

Congenital Infection
-microcephaly HSM jaundice pneumonitis

Neonatal Infection

• local skin lesion eye mouth involvement
• cns involvement (encephalitis)

Question 31

How to dx hsv?

Answer 31

Viral pcr or culture from fluid in vesicles

Question 32

What clues in state sector can indicate possible infection antenatally?

Answer 32

Syphilis signs and symp
Rubella- rash and post auric/subocip nodes
Herpes- vesicles
Aids - suspect toxo and cmv

Question 33

What would raise suspicion in congen infection antenatally?

Answer 33

Ultrasound changes in baby such as:

• symm iugr
• big placenta
• hydrops fetalis
• big liver/spleen
• brain calcifications

Question 34

What will raise suspcion of congen infection post delivery?

Answer 34

SGA baby
Flat,unwell, poor feeding 
Mom rpr pos and untreated - always check rpr.
Heavy placenta >1/7 of baby weight 
Any specific signs or sympt