Perinatal Infections Flashcards
Rubella screening in pregnancy
Prevalence so low, not routinely offered
Women screening and Rb antibody not detected offer MMR after pregnancy
CI in pregnancy (live vaccine)
Clinical fx of congenital rubella syndrome
Sensorineural deafness PDA Blindness Encephalitis Endocrine problems
Timing of rubella infection a/w CRS
Risk decreases w/gestation
infection <11w has 100% CRS
>20w has no risk
Mx of Rubella infection in pregnancy
If confirmed calculate risk of CRS
Refer to FMU
If <16w offer TOP
Advice to Rubella IgG -ve women in pregnancy
Keep away from potential sources of infection
Offer MMR PN
Syphilis risks in pregnancy
FGR Hydrops Cong. syphilis and long term disability Stillbirth PTD Perinatal+neonatal mortality
Rx for syphilis in pregnancy
Benzathine penicllin (adequate Rx improves outcomes for foetus)
Screening for syphilis in pregnancy
Routine AN screening for ALL pregnant women
Test is: treponemal Ab in serum
Treponemal vs non-treponemal testing in syphilis in pregnancy
NT: VDRL, RPR
high false positive rate
T: EIA (v. sens+spec.), TPHA, FTA-abs
NB NONE will detect incubation phase syhphilis
Management of syphilis in pregnancy
Confirm Dx, STI screen
GUM clinic contract tracing
IM benathine penicillin 98% successful at preventing cong. syphilis
Admit to observe (Jarish-Herxheimer)
Jarish-Herxheimer reaction
- 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
If woman w/ syphilis in pregnancy not treated?
Treat baby immediately after delivery
Toxoplamosis caught from?
Raw/rare meat, handling cats + litter
Dx test for toxoplasmosis
Sabin Feldman Dye test
IgM tests available but igM may persist for years after infection
If USS raises suspicion of congenital toxoplasmosis?
Amniocentesis
PCR of fluid v. sens for T gondii
If confirmed and abnormalities, offer TOP
Mx of toxoplasmosis in pregnancy
Spiramycin 3wk course 2-3g/day
Reduces incidence of transplacental infection
CMV in pregnancy Dx
Serology IgM can persist for months so to be a confirmed Dx requires NEW finding of IgM during pregnancy
Can become reactivated
?foetal infection with CMV?
amnio and PCR
if confirmed and abormalities offer TOP
VZV in pregnancy
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
Infectious with VZV?
48hr prior to appearance of rash until vesicles crust (5d)
Nonimmune woman exposed to chickenpox in pregnancy
VZIG asap (effective <10d) See Dr if rash
Chickenpox in pregnancy
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
Aciclovir w/chickenpox in pregnancy
Aciclovir 800mg5/d for 7d (if they present within 24hrs of rash onset and >20wks gestation
also give IV if viraemic during delivery
Nonimmune pregnant women exposed to chickenpox contagious?
21d after exposure if no VZIG
28d if had VZIG
Risks of delivery during chickenpox viraemia
Bleeding TCP DIC Hepatitis Varicella of the newborn
Maternal infection with chickenpox at time of delivery
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
Contact with shingles in pregnancy
Low risk of non immune woman getting CP from someone with singles
Summary of VZVin pregnancy
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
PACES counselling for exposed women
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
Parvovirus B19
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
Listeria in pregnancy
Culture
Meconium staining may raise suspicion
IV amox.
Herpes Simplex Virus in pregnancy
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
Primary HSV infection in pregnancy
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
Recurrent episodes of HSV in pregnancy
NOT indication for C-sec
Daily supressive 400mg aciclovir from 36w considered
avoid invasive procedures if genital lesions
Group B strep in pregnancy
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
When to give IV benpen in GBS
asap after start of labour
clindamycin 900mg IV 8hrly if penicillin allergic
Indications for GBS proph.
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
Red flags for GBS
Parenteral Abx given to woman for suspected invasive bacterial infection (not inc. proph.)
Resp distress >4hrs after birth
seizure
need for mechanical ventilation
Summary of GBS
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)
HIV in pregnancy monitoring
- 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
Risk of HIV transmission controlled by
Obstetric factors, VL, infant feeding
Interventions to reduce vertical HIV trans.
ART (AN and intrapartum and for 4-6wks of life for baby)
C-sec if high VL
Avoid bf
Mx of Infants w/HIV+ mothers
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)
Summary HIV in pregnancy
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
PACES counselling of HIV in pregnancy
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
HBV in pregnancy
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
Hepatitis C in pregnancy
Detect anti-HCV
PCR
IFN, ribavirin CI in pregnancy
