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Y5 Gynae & Obstetrics > Perinatal Infections > Flashcards

Perinatal Infections Flashcards

1
Q

How likely is Rubella in the UK

A

VERY UNCOMMON

Thanks to MMR

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2
Q

What is the screening of rubella in the UK like?

A

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

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3
Q

When would you give MMR in a pregnant lady without rubella antibodies

A

Give MMR AFTER pregnancy

Because it is a live vaccine

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4
Q

How does Rubella manifest in a foetus?

A

Congenital Rubella Syndrome

  • sensorineural deafness
  • cataracts, blindness
  • encephalitis
  • endocrine procress
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5
Q

How does the risk of congenital rubella syndrome change during pregnancy?

A

Risk of CRS DECREASES with gestation

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6
Q

At what stage of pregnancy does a rubella infection have no risk of CRS?

A

> 20 weeks

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7
Q

What should you do if rubella infection occurs <16 weeks?

A

Offer termination

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8
Q

What bacterium causes syphilis?

A

Triponema palidum

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9
Q

What are consequences of syphilis in pregnancy?

A 
FGR 
Foetal hydros 
Congenital syphilis
Stillbirth 
Preterm birth 
Neonatal death
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10
Q

How do you screen for syphilis run pregnancy=

A

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

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11
Q

What stage of syphilis with serological tests not detecxt=

A

incubation stage syphilis

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12
Q

What is the management of syphilis?

A

Benzathine penicillin

+ Contact GUM clinic for appropriate contact tracing

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13
Q

What is a side effect of treating syphilis with penicillin?

A

A Jarish-Herzheimer reaction

Duer to release of inflammatory cytokines in response to dying organism

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14
Q

What does a Jarish-Herzheimer reaction present as?

A

Worsening of symptoms + fever 12-24h after start of treatment

Uterine contractions, foetal distress

ADMIT dDURING TREATMENT

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15
Q

What do you do to the baby is mother with syphilis is not treated during pregnancy?

A

Treat baby immediately after delilbery

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16
Q

What is toxoplasmosis caused by?

A

Toxoplasma gondiii

Protozoan in cat faeces, soil, uncooked meat

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17
Q

What type of screening for toxoplasmosis is done?

A

No routine screening

It is rate for babies to be affected

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18
Q

What is important advice for prevention of toxoplasmosis

A

Avoid rare/raw meat
Avoid handling cats and cat litter
Wear gloves and wash hands when gardening

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19
Q

What are symptoms of maternal toxoplasmosis?

A

Asymptomatic / flu like illness (headache, fever, muscle pains)

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20
Q

What is transmission of toxoplasmosis like in pregnanvy=

A

First trimester: severe foetal damage, but transmission risk is low

Third trimester: no foetal damage, transmission risk high

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21
Q

What are features of infants affected with toxoplasmosis

A

Most infants are asymptomatic at birth and develop it later on

ventriculomegaly
Microcephaly
Chorioretinitis
Cerebral calcification

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22
Q

What is used to make diagnosis of toxoplasmosis=

A

Sabin Feldman dye test

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23
Q

What do you do if abnormal US raises suspicion of congenital toxoplasmosis?

A

Amniocentesis performed

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24
Q

What do you offer is toxoplasmosis is found to be the cause of abnormalities on ultrasound?

A

Offer TOP

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25
Q

How many infants in the UK are infected with congenital CMV?

A

1 in 200

26
Q

What Are clinical features of CMV in the mother?

A

No symptoms / flu like symptoms

27
Q

What are clinical features of CMV in the foetus?

A 
Growth restriction 
Microcephally 
IC calcification 
Ventriculomegaly 
Ascites 
Hydrops
28
Q

How do you diagnose CMV in the mother?

A

Serological diagnosis via IgM - but has to be + in a mother who was - at time of booking (as IgM can persist for months)

29
Q

How do you diagnose CMV in foetus if suspected?

A

test amniotic fluid with PCR

30
Q

What do you do with foetus with abnormalities due to CMV

A

Offer termination

31
Q

When do you vaccinate seronegative women to VZV?

A

Either pre pregnancy or post natal period

32
Q

What are complications if a pregnant woman gets chicken pox?

A

Pneumonia, hepatitis, encephalitis

Foetal varicella syndrome

33
Q

How do you manage chicken pox at the booking visit?

A

Ask if she has had chicken pox
If not, advise to avoid contact
If exposed, seek medical advice as soon as possible

34
Q

How long is someone infectious with chicken pox for?

A

48h from rash appearance to until vesicles crust over (5 days)

35
Q

How do you manage non-immune women exposed to chicken pox?

A

Give VZ Ig ASAP - only beneficial before symptoms develop

36
Q

What do you prescribe is pregnant woman has chicken pox

A

Acyclovir 800mg 5/ day for 7 days if >28 week gestation

Consider referral to foetal medicine

37
Q

What advice do you give to pregnant woman has chicken pox

A

Avoid contact with the pregnant women / neonates until lesions crust

38
Q

What does congenital varicella syndrome present as?

A

Skin scarring in dermatome
Eye defects
Hypoplasia of limbs
Neuro abnormalities

39
Q

What do you do if maternal infection is around time of delivery=

A

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

40
Q

How do you treat neonatal VZV infection

A

Acyclovir

41
Q

What are complications for a foetus in mother weigh parvovirus

A

Aplastic anaemia
Hydrops foetalis
Intrauterine death

42
Q

How do you treat foetal anaemia due to parvovirus=

A

In utero transfusion

43
Q

How can a mother contract listeria?

A

Unpausterised milk
Ripened soft cheese
Pate

44
Q

Why are pregnant women more at risk of listeria?

A

Because they had reduced cell mediated immunity

45
Q

What settings does listeria die / survive in=?

A

Die: cooked / frozen food

Survives in refrigerated food

46
Q

What is the risk of listeria to the foetus?

A

Miscarriage / stillbirth (20%)
Premature delivery (50%)
Neonatal morality

47
Q

How do you treat listeria?

A

IV antibiotics

48
Q

When is HSV dangerous to the foetus?

A

If contracted at time of delivery (6 weeks prior)

49
Q

What are the clinical presentations of neonatal HSV?

A
  • Localised to skin, eyes, mouth
  • Localised to CNS (encephalitis)
  • Multiple organ involvement
50
Q

What is the recommended mode of delivery if a woman develops primary genital. HSV during first trimester?

A

C section

51
Q

What do you do if a woman has recurrent episodes of HSV during pregnancy

A

Vaginal delivery is okay

Give suppressive acyclovir 400mg tds

52
Q

What is the role of strep B normallly

A

Vaginal commensal (in 20% of women)=

53
Q

What does strep B do in noenate

A

Can cause sepsis > neonatal death

Transmitted between ROM to delivery

54
Q

What do you give if a foetus has commensal strep B infection=

A

itrapartum antibiotic prophylaxis (penicillin/clindamycin)

55
Q

What does chlamydia transmitted to foetus causxe

A

Confjunctivitis

Pneumonia infant

56
Q

What are risks of chlamydia and gonorrhoe to the pregnancy

A

PPROM

Preterm delivery

57
Q

WHEN does vertical transmission of HIV occur=

A

Late third trimester, during labour, delivery, breast feeding

58
Q

How do you manage HIV in pregnancy

A

Antiretroviral therapy
Delivery by elective C S if high viral load
Avoid breastfeeding

59
Q

How do you manage infants born to HIV+ mothers

A

Clamp cord as soon as possible
bathe baby immediately
Give azidothymidine for 4-6 wks post birth

60
Q

What will be noenate result to HIV antibodies

A

Positive, because of transfer from mother

61
Q

How do you diagnose HIV in neonate

A

Direct viral amplification by PCR

Y5 Gynae & Obstetrics (34 decks)

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