Perinatal Infections Flashcards
How likely is Rubella in the UK
VERY UNCOMMON
Thanks to MMR
What is the screening of rubella in the UK like?
Prevalence of Rubella in UK is so low that routine screening is not offered
But if screening is done and rubella antibody is not detected, give MMR AFTER pregnancy
When would you give MMR in a pregnant lady without rubella antibodies
Give MMR AFTER pregnancy
Because it is a live vaccine
How does Rubella manifest in a foetus?
Congenital Rubella Syndrome
- sensorineural deafness
- cataracts, blindness
- encephalitis
- endocrine procress
How does the risk of congenital rubella syndrome change during pregnancy?
Risk of CRS DECREASES with gestation
At what stage of pregnancy does a rubella infection have no risk of CRS?
> 20 weeks
What should you do if rubella infection occurs <16 weeks?
Offer termination
What bacterium causes syphilis?
Triponema palidum
What are consequences of syphilis in pregnancy?
FGR Foetal hydros Congenital syphilis Stillbirth Preterm birth Neonatal death
How do you screen for syphilis run pregnancy=
Routine screen for all pregnant women
Done by detection of treponemal antibodies in serological tests:
- EIA (very sensitive and specific)
- Treponema pallidum haemagglutination assay
- Fluorescent treponemal antibody-absorbed test
What stage of syphilis with serological tests not detecxt=
incubation stage syphilis
What is the management of syphilis?
Benzathine penicillin
+ Contact GUM clinic for appropriate contact tracing
What is a side effect of treating syphilis with penicillin?
A Jarish-Herzheimer reaction
Duer to release of inflammatory cytokines in response to dying organism
What does a Jarish-Herzheimer reaction present as?
Worsening of symptoms + fever 12-24h after start of treatment
Uterine contractions, foetal distress
ADMIT dDURING TREATMENT
What do you do to the baby is mother with syphilis is not treated during pregnancy?
Treat baby immediately after delilbery
What is toxoplasmosis caused by?
Toxoplasma gondiii
Protozoan in cat faeces, soil, uncooked meat
What type of screening for toxoplasmosis is done?
No routine screening
It is rate for babies to be affected
What is important advice for prevention of toxoplasmosis
Avoid rare/raw meat
Avoid handling cats and cat litter
Wear gloves and wash hands when gardening
What are symptoms of maternal toxoplasmosis?
Asymptomatic / flu like illness (headache, fever, muscle pains)
What is transmission of toxoplasmosis like in pregnanvy=
First trimester: severe foetal damage, but transmission risk is low
Third trimester: no foetal damage, transmission risk high
What are features of infants affected with toxoplasmosis
Most infants are asymptomatic at birth and develop it later on
ventriculomegaly
Microcephaly
Chorioretinitis
Cerebral calcification
What is used to make diagnosis of toxoplasmosis=
Sabin Feldman dye test
What do you do if abnormal US raises suspicion of congenital toxoplasmosis?
Amniocentesis performed
What do you offer is toxoplasmosis is found to be the cause of abnormalities on ultrasound?
Offer TOP
How many infants in the UK are infected with congenital CMV?
1 in 200
What Are clinical features of CMV in the mother?
No symptoms / flu like symptoms
What are clinical features of CMV in the foetus?
Growth restriction Microcephally IC calcification Ventriculomegaly Ascites Hydrops
How do you diagnose CMV in the mother?
Serological diagnosis via IgM - but has to be + in a mother who was - at time of booking (as IgM can persist for months)
How do you diagnose CMV in foetus if suspected?
test amniotic fluid with PCR
What do you do with foetus with abnormalities due to CMV
Offer termination
When do you vaccinate seronegative women to VZV?
Either pre pregnancy or post natal period
What are complications if a pregnant woman gets chicken pox?
Pneumonia, hepatitis, encephalitis
Foetal varicella syndrome
How do you manage chicken pox at the booking visit?
Ask if she has had chicken pox
If not, advise to avoid contact
If exposed, seek medical advice as soon as possible
How long is someone infectious with chicken pox for?
48h from rash appearance to until vesicles crust over (5 days)
How do you manage non-immune women exposed to chicken pox?
Give VZ Ig ASAP - only beneficial before symptoms develop
What do you prescribe is pregnant woman has chicken pox
Acyclovir 800mg 5/ day for 7 days if >28 week gestation
Consider referral to foetal medicine
What advice do you give to pregnant woman has chicken pox
Avoid contact with the pregnant women / neonates until lesions crust
What does congenital varicella syndrome present as?
Skin scarring in dermatome
Eye defects
Hypoplasia of limbs
Neuro abnormalities
What do you do if maternal infection is around time of delivery=
Significant risk of varicella in newborn
Consider giving VZIG (if birth occurs within 7 days of onset or rash)
Monitor infant for signs of infection
Organise neonatal ophthalmic exam
How do you treat neonatal VZV infection
Acyclovir
What are complications for a foetus in mother weigh parvovirus
Aplastic anaemia
Hydrops foetalis
Intrauterine death
How do you treat foetal anaemia due to parvovirus=
In utero transfusion
How can a mother contract listeria?
Unpausterised milk
Ripened soft cheese
Pate
Why are pregnant women more at risk of listeria?
Because they had reduced cell mediated immunity
What settings does listeria die / survive in=?
Die: cooked / frozen food
Survives in refrigerated food
What is the risk of listeria to the foetus?
Miscarriage / stillbirth (20%)
Premature delivery (50%)
Neonatal morality
How do you treat listeria?
IV antibiotics
When is HSV dangerous to the foetus?
If contracted at time of delivery (6 weeks prior)
What are the clinical presentations of neonatal HSV?
- Localised to skin, eyes, mouth
- Localised to CNS (encephalitis)
- Multiple organ involvement
What is the recommended mode of delivery if a woman develops primary genital. HSV during first trimester?
C section
What do you do if a woman has recurrent episodes of HSV during pregnancy
Vaginal delivery is okay
Give suppressive acyclovir 400mg tds
What is the role of strep B normallly
Vaginal commensal (in 20% of women)=
What does strep B do in noenate
Can cause sepsis > neonatal death
Transmitted between ROM to delivery
What do you give if a foetus has commensal strep B infection=
itrapartum antibiotic prophylaxis (penicillin/clindamycin)
What does chlamydia transmitted to foetus causxe
Confjunctivitis
Pneumonia infant
What are risks of chlamydia and gonorrhoe to the pregnancy
PPROM
Preterm delivery
WHEN does vertical transmission of HIV occur=
Late third trimester, during labour, delivery, breast feeding
How do you manage HIV in pregnancy
Antiretroviral therapy
Delivery by elective C S if high viral load
Avoid breastfeeding
How do you manage infants born to HIV+ mothers
Clamp cord as soon as possible
bathe baby immediately
Give azidothymidine for 4-6 wks post birth
What will be noenate result to HIV antibodies
Positive, because of transfer from mother
How do you diagnose HIV in neonate
Direct viral amplification by PCR
