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Obestetrics > Perinatal Infections > Flashcards

Perinatal Infections Flashcards

1
Q

Rubella screening in pregnancy

A

Prevalence so low, not routinely offered
Women screening and Rb antibody not detected offer MMR after pregnancy
CI in pregnancy (live vaccine)

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2
Q

Clinical fx of congenital rubella syndrome

A 
Sensorineural deafness
PDA
Blindness 
Encephalitis
Endocrine problems
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3
Q

Timing of rubella infection a/w CRS

A

Risk decreases w/gestation
infection <11w has 100% CRS
>20w has no risk

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4
Q

Mx of Rubella infection in pregnancy

A

If confirmed calculate risk of CRS
Refer to FMU
If <16w offer TOP

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5
Q

Advice to Rubella IgG -ve women in pregnancy

A

Keep away from potential sources of infection

Offer MMR PN

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6
Q

Syphilis risks in pregnancy

A 
FGR
Hydrops
Cong. syphilis and long term disability
Stillbirth
PTD
Perinatal+neonatal mortality
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7
Q

Rx for syphilis in pregnancy

A

Benzathine penicllin (adequate Rx improves outcomes for foetus)

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8
Q

Screening for syphilis in pregnancy

A

Routine AN screening for ALL pregnant women

Test is: treponemal Ab in serum

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9
Q

Treponemal vs non-treponemal testing in syphilis in pregnancy

A

NT: VDRL, RPR
high false positive rate
T: EIA (v. sens+spec.), TPHA, FTA-abs
NB NONE will detect incubation phase syhphilis

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10
Q

Management of syphilis in pregnancy

A

Confirm Dx, STI screen
GUM clinic contract tracing
IM benathine penicillin 98% successful at preventing cong. syphilis
Admit to observe (Jarish-Herxheimer)

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11
Q

Jarish-Herxheimer reaction

A
  • Occurs w/treatment of syphilis in pregnancy as a result of pro-inf. cytokines as response to dying organisms
  • Presents as worsening of Sx and fever for 12-24hrs after starting Rx
  • may a/w uterine contractions and foetal distress
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12
Q

If woman w/ syphilis in pregnancy not treated?

A

Treat baby immediately after delivery

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13
Q

Toxoplamosis caught from?

A

Raw/rare meat, handling cats + litter

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14
Q

Dx test for toxoplasmosis

A

Sabin Feldman Dye test

IgM tests available but igM may persist for years after infection

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15
Q

If USS raises suspicion of congenital toxoplasmosis?

A

Amniocentesis
PCR of fluid v. sens for T gondii
If confirmed and abnormalities, offer TOP

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16
Q

Mx of toxoplasmosis in pregnancy

A

Spiramycin 3wk course 2-3g/day

Reduces incidence of transplacental infection

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17
Q

CMV in pregnancy Dx

A

Serology IgM can persist for months so to be a confirmed Dx requires NEW finding of IgM during pregnancy
Can become reactivated

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18
Q

?foetal infection with CMV?

A

amnio and PCR

if confirmed and abormalities offer TOP

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19
Q

VZV in pregnancy

A

Ask at booking if had chickenpox (if no avoid during preg.)
If come into contact seek medical help asap
Significant contact =15 in face to face
IgG can confirm immunity

20
Q

Infectious with VZV?

A

48hr prior to appearance of rash until vesicles crust (5d)

21
Q

Nonimmune woman exposed to chickenpox in pregnancy

A 
VZIG asap (effective <10d)
See Dr if rash
22
Q

Chickenpox in pregnancy

A

Avoid contact w/other pregnant women and neonates until crust
?Aciclovir
VZIG no benefit once pox
?Admit if:smoking, lung dx, steroids, latter half of preg.
Isolation if admitted
Delivery during viramia dangerous
Refer to foetal medicine unit (wk16-20 of 5wks after infection) - detailed USS

23
Q

Aciclovir w/chickenpox in pregnancy

A

Aciclovir 800mg5/d for 7d (if they present within 24hrs of rash onset and >20wks gestation
also give IV if viraemic during delivery

24
Q

Nonimmune pregnant women exposed to chickenpox contagious?

A

21d after exposure if no VZIG

28d if had VZIG

25
Q

Risks of delivery during chickenpox viraemia

A 
Bleeding
TCP
DIC
Hepatitis
Varicella of the newborn
26
Q

Maternal infection with chickenpox at time of delivery

A

Sig. risk of neonatal varicella if within 4wks of delivery
Elective delivery avoided until 7d after rash onset (passive Ig transfer)
Neonatal opthalmix exam.
VZIG to baby if born within 7d of rash onset or mother dev. CP 7d PP
Monitor for 28d
Neonatal infection = aciclovir

27
Q

Contact with shingles in pregnancy

A

Low risk of non immune woman getting CP from someone with singles

28
Q

Summary of VZVin pregnancy

A

Any doubt if mother immune check blood for VZV antibodies
Non-immune: VZIG asap up to 10d post exposure
Oral aciclovir if <24 hrs rash >20wks

29
Q

PACES counselling for exposed women

A 
Risks: limb hypoplasia, cutaneous scar, IUGR
Stay away from pregnant women
IVIG
If rash come back
Referral to fetal medicine in 5wks time
amniocentesis can be done
30
Q

Parvovirus B19

A

Dx: seroconversion (IgM development)
PCR of mother/foetus best
Hydropic foetus may recover or need in utero transfusion
Infection <20w can lead to hydrops and IUD
Higher rate of foetal loss
If anaemia is treatd by intrauterine transfusions then complete recovery possible
No neurodamage so should be normal

31
Q

Listeria in pregnancy

A

Culture
Meconium staining may raise suspicion
IV amox.

32
Q

Herpes Simplex Virus in pregnancy

A

Ix: culture, PCR
Mx: aciclovir 400mg tds (if infection during T1-2 Rx from 36w-del., if T3 cont. until del.)
If <6w until del. type-speciic HSV Ab testing available

33
Q

Primary HSV infection in pregnancy

A

If >6wks prior to expected del. manage expectantly and anticipate vaginal del.
C-sec first line for genital herpes in T3
If chooses vaginal:
- avoid ROM and invasive procedures
- IV aciclovir to M+F

34
Q

Recurrent episodes of HSV in pregnancy

A

NOT indication for C-sec
Daily supressive 400mg aciclovir from 36w considered
avoid invasive procedures if genital lesions

35
Q

Group B strep in pregnancy

A

AN: if detected Abx not recommended, doesnt reduce GBS at time of del
?Intra-partum Abx proph.: benpen/clindamycin
PP: newborn w/risk factor stay in hosp. 24hr 2+ RFs get IV penicillin and gent. and full septic screen

36
Q

When to give IV benpen in GBS

A

asap after start of labour

clindamycin 900mg IV 8hrly if penicillin allergic

37
Q

Indications for GBS proph.

A 
Intrapartum fever
PROM >18 hours
Prematurity <37wks
Previous GBS infant
Incidental finding during current preg
GBS bacteruria
If c-sec in absence of labour or ROM NOT indicated
38
Q

Red flags for GBS

A

Parenteral Abx given to woman for suspected invasive bacterial infection (not inc. proph.)
Resp distress >4hrs after birth
seizure
need for mechanical ventilation

39
Q

Summary of GBS

A

Risk of GBS carriage in future pregnancy is 50% (offer testing)
If going to have swabs do this 3-5wks before delivey
?IV proph. (Hx, fever, PTL, PROM)

40
Q

HIV in pregnancy monitoring

A
  • CD4 at booking, VL every 2-4wk and 36wk and after del.
  • VL <50 aim for vaginal del. 36wks
  • C-sec if HCV co-inf.
  • High VL receive IV AZT if C-sec or SROM
41
Q

Risk of HIV transmission controlled by

A

Obstetric factors, VL, infant feeding

42
Q

Interventions to reduce vertical HIV trans.

A

ART (AN and intrapartum and for 4-6wks of life for baby)
C-sec if high VL
Avoid bf

43
Q

Mx of Infants w/HIV+ mothers

A 
Cord clamped ASAP
wash baby ASAP
no bf
AZT for 4-6wks (start within 4hr)
Will test +ve bc of maternal transfer so do direct viral amplification by PCR (birth, 6w, 12w, 18m)
44
Q

Summary HIV in pregnancy

A

All offered ART
Del: vaginal if undetectable VL at 36w otherwise c-sec
zidovudine infusion4hr before beginning c-sec
Neonatal art: AZT if <50/mL otherwise triple ART. Mx for 4-6wk
Avoid bf

45
Q

PACES counselling of HIV in pregnancy

A 
Risk of vertical trans.
Importance of adherence
VL measured every 2-4wk and at 36w
<50 vaginal, >50 c-sec
Explain need for AZT 6wks for neonate and HIV testing
46
Q

HBV in pregnancy

A

Screening in ALL
Babies born to infected mothers receive vaccination and HBV Ig within 12h birth
Vaccine: birth, 1m, 6m
C-sec does not reduce transmission (indicated if HIV+HBV)
Not trans by bf
Serological HBV test at 12m

47
Q

Hepatitis C in pregnancy

A

Detect anti-HCV
PCR
IFN, ribavirin CI in pregnancy

Obestetrics (21 decks)

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