Perinatal Infections

Question 1

How likely is Rubella in the UK

Answer 1

VERY UNCOMMON

Thanks to MMR

Question 2

What is the screening of rubella in the UK like?

Answer 2

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

Question 3

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

Answer 3

Give MMR AFTER pregnancy

Because it is a live vaccine

Question 4

How does Rubella manifest in a foetus?

Answer 4

Congenital Rubella Syndrome

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

Question 5

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

Answer 5

Risk of CRS DECREASES with gestation

Question 6

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

Answer 6

> 20 weeks

Question 7

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

Answer 7

Offer termination

Question 8

What bacterium causes syphilis?

Answer 8

Triponema palidum

Question 9

What are consequences of syphilis in pregnancy?

Answer 9

FGR 
Foetal hydros 
Congenital syphilis
Stillbirth 
Preterm birth 
Neonatal death

Question 10

How do you screen for syphilis run pregnancy=

Answer 10

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

Question 11

What stage of syphilis with serological tests not detecxt=

Answer 11

incubation stage syphilis

Question 12

What is the management of syphilis?

Answer 12

Benzathine penicillin

+ Contact GUM clinic for appropriate contact tracing

Question 13

What is a side effect of treating syphilis with penicillin?

Answer 13

A Jarish-Herzheimer reaction

Duer to release of inflammatory cytokines in response to dying organism

Question 14

What does a Jarish-Herzheimer reaction present as?

Answer 14

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

Uterine contractions, foetal distress

ADMIT dDURING TREATMENT

Question 15

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

Answer 15

Treat baby immediately after delilbery

Question 16

What is toxoplasmosis caused by?

Answer 16

Toxoplasma gondiii

Protozoan in cat faeces, soil, uncooked meat

Question 17

What type of screening for toxoplasmosis is done?

Answer 17

No routine screening

It is rate for babies to be affected

Question 18

What is important advice for prevention of toxoplasmosis

Answer 18

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

Question 19

What are symptoms of maternal toxoplasmosis?

Answer 19

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

Question 20

What is transmission of toxoplasmosis like in pregnanvy=

Answer 20

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

Third trimester: no foetal damage, transmission risk high

Question 21

What are features of infants affected with toxoplasmosis

Answer 21

Most infants are asymptomatic at birth and develop it later on

ventriculomegaly
Microcephaly
Chorioretinitis
Cerebral calcification

Question 22

What is used to make diagnosis of toxoplasmosis=

Answer 22

Sabin Feldman dye test

Question 23

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

Answer 23

Amniocentesis performed

Question 24

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

Answer 24

Offer TOP

Question 25

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

Answer 25

1 in 200

Question 26

What Are clinical features of CMV in the mother?

Answer 26

No symptoms / flu like symptoms

Question 27

What are clinical features of CMV in the foetus?

Answer 27

``` Growth restriction Microcephally IC calcification Ventriculomegaly Ascites Hydrops ```

Question 28

How do you diagnose CMV in the mother?

Answer 28

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

Question 29

How do you diagnose CMV in foetus if suspected?

Answer 29

test amniotic fluid with PCR

Question 30

What do you do with foetus with abnormalities due to CMV

Answer 30

Offer termination

Question 31

When do you vaccinate seronegative women to VZV?

Answer 31

Either pre pregnancy or post natal period

Question 32

What are complications if a pregnant woman gets chicken pox?

Answer 32

Pneumonia, hepatitis, encephalitis | Foetal varicella syndrome

Question 33

How do you manage chicken pox at the booking visit?

Answer 33

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

Question 34

How long is someone infectious with chicken pox for?

Answer 34

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

Question 35

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

Answer 35

Give VZ Ig ASAP - only beneficial before symptoms develop

Question 36

What do you prescribe is pregnant woman has chicken pox

Answer 36

Acyclovir 800mg 5/ day for 7 days if >28 week gestation | Consider referral to foetal medicine

Question 37

What advice do you give to pregnant woman has chicken pox

Answer 37

Avoid contact with the pregnant women / neonates until lesions crust

Question 38

What does congenital varicella syndrome present as?

Answer 38

Skin scarring in dermatome Eye defects Hypoplasia of limbs Neuro abnormalities

Question 39

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

Answer 39

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

Question 40

How do you treat neonatal VZV infection

Answer 40

Acyclovir

Question 41

What are complications for a foetus in mother weigh parvovirus

Answer 41

Aplastic anaemia Hydrops foetalis Intrauterine death

Question 42

How do you treat foetal anaemia due to parvovirus=

Answer 42

In utero transfusion

Question 43

How can a mother contract listeria?

Answer 43

Unpausterised milk Ripened soft cheese Pate

Question 44

Why are pregnant women more at risk of listeria?

Answer 44

Because they had reduced cell mediated immunity

Question 45

What settings does listeria die / survive in=?

Answer 45

Die: cooked / frozen food | Survives in refrigerated food

Question 46

What is the risk of listeria to the foetus?

Answer 46

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

Question 47

How do you treat listeria?

Answer 47

IV antibiotics

Question 48

When is HSV dangerous to the foetus?

Answer 48

If contracted at time of delivery (6 weeks prior)

Question 49

What are the clinical presentations of neonatal HSV?

Answer 49

- Localised to skin, eyes, mouth - Localised to CNS (encephalitis) - Multiple organ involvement

Question 50

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

Answer 50

C section

Question 51

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

Answer 51

Vaginal delivery is okay | Give suppressive acyclovir 400mg tds

Question 52

What is the role of strep B normallly

Answer 52

Vaginal commensal (in 20% of women)=

Question 53

What does strep B do in noenate

Answer 53

Can cause sepsis > neonatal death | Transmitted between ROM to delivery

Question 54

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

Answer 54

itrapartum antibiotic prophylaxis (penicillin/clindamycin)

Question 55

What does chlamydia transmitted to foetus causxe

Answer 55

Confjunctivitis | Pneumonia infant

Question 56

What are risks of chlamydia and gonorrhoe to the pregnancy

Answer 56

PPROM | Preterm delivery

Question 57

WHEN does vertical transmission of HIV occur=

Answer 57

Late third trimester, during labour, delivery, breast feeding

Question 58

How do you manage HIV in pregnancy

Answer 58

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

Question 59

How do you manage infants born to HIV+ mothers

Answer 59

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

Question 60

What will be noenate result to HIV antibodies

Answer 60

Positive, because of transfer from mother

Question 61

How do you diagnose HIV in neonate

Answer 61

Direct viral amplification by PCR