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HD 2 > Pregnancy and Infection > Flashcards

Pregnancy and Infection Flashcards

1
Q

What is different about infection in pregnancy?

A

Relative immunosuppression

Physiological changes in mother

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2
Q

Name an infection in pregnancy that is harmful to the mother only.

A

Influenza

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3
Q

Name infections in pregnancy that are harmful to the foetus. (6)

A 
Toxoplasmosis
HSV
Syphilis
Parvovirus B19
CMV
Rubella
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4
Q

Name infections in pregnancy that are harmful to both the mother and the foetus. (3)

A

Hepatitis
VZV
HIV

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5
Q

What does TORCH stand for?

A 
Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes simplex virus (and HIV, hepatitis)
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6
Q

What IgG mean about the timing of the infection?

A

This signifies past infection and is protective in many cases. It peaks about a month after infection.

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7
Q

How is infection diagnosed?

A

Serology

PCR

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8
Q

Cytomegalovirus - how many UK adults have evidence of past exposure?

A

50% ( i.e. they are CMV IgG positive)

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9
Q

How is CMV transmitted?

A

Saliva, blood, blood products, sexual intercourse, organ transplantation or via mother

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10
Q

What is significant about the primary of infection of CMV? (2)

A

Often subclinical

More likely to cause congenital CMV

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11
Q

When is congenital CMV more likely in pregnancy?

A

1st trimester

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12
Q

What is the prevalence of congenital CMV?

A

~ 7 per 1000 live births

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13
Q

How many % of babies with congenital CMV are symptomatic?

What are the symptoms/complications? (4)

A

13%

IUGR, hepatosplenomegaly, microcephaly, sensorineural deafness

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14
Q

How is congenital CMV diagnosed?

A

Maternal serology - CMV IgG and IgM

Neonatal urine/saliva (for PCR)

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15
Q

What is the commonest congenital cause of sensorineural hearing loss?
How many % of these children develop SNHL in the first 5 to 7 years of life?

A

CMV

10%

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16
Q

How many % of UK adults are immune to Varicella Zoster Virus?

A

80-90% (i.e. VZV IgG positive)

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17
Q

How is VZV transmitted?

A

Droplets/airborne

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18
Q

VZV is highly infectious - how many people can 1 infected person infect? What is the term for this?

A

10-12

R(0)

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19
Q 
Rank these diseases from most to least contagious:
Ebola
Hep C
HIV
Measles
Mumps
SARS
A 
Measles
Mumps
SARS
HIV
Ebola
Hep C
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20
Q

How is VZV diagnosed? (3)

A

Clinically
Swab of vesicle fluid (for viral PCR)
Maternal serology

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21
Q

How is VZV prevented?

A

Varicella Zoster ImmunoGlobulin (post exposure)

Vaccination (pre-exposure)

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22
Q

Within how many days of exposure is VZIG effective?

A

Within 10 days

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23
Q

Why can pregnant women not be given the VZV vaccine?

A

It is a live attenuated vaccine

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24
Q

What is the treatment for VZV?

A

Aciclovir

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25
Q

What lung condition can VZV cause?

A

Pneumonitis

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26
Q

What does congenital varicella cause? (8)

A

Skin lesions, limb hypoplasia, microcephaly, hydrocephaly, neurodevelopmental delay, cataracts, and also GI, genitourinary and cardiac abnormalities.

It may also lead to miscarriage of the pregnancy.

27
Q

Is the risk of congenital varicella higher in the first or second trimester?

A

Second

28
Q

When does neonatal varicella occur?

A

When the mother has VZV around the time of delivery (most severe if 5 days before to 2 days after delivery).

29
Q

How is neonatal varicella treated?

A

VZIG and acyclovir

30
Q

Herpes simplex virus - how many adults have HSV 1 antibodies by age 40?

A

> 90%

31
Q

What is HSV 2 seroprevalence related to?

A

Sexual activity

32
Q

How many % primary HSV infection is asymptomatic?

A

> 80%

33
Q

Neonatal HSV infection - how many % of neonates acquire infection perinatally?

A

90%

34
Q

70% of untreated cases of neonatal HSV infection leads to ______.

A

Disseminated HSV infection

35
Q

Does HSV 1 or HSV 2 cause 70% of neonatal HSV infections?

A

HSV 2

36
Q

What causes most cases of HSV 1 neonatal infection?

A

Maternal acquisition of genital HSV 1 late in pregnancy

37
Q

How is neonatal HSV treated?

A

Aciclovir

38
Q

What is the mortality of treated neonatal HSV?

A

25%

39
Q

What is another name for rubella?

A

German measles

40
Q

What are the symptoms of rubella?

A

Rash
Lymphadenopathy
Arthralgia

41
Q

When in the pregnancy is the risk of congenital rubella highest?

A

Before 11 weeks

42
Q

What may congenital rubella before 20 weeks cause?

A

Foetal loss

43
Q

What are the symptoms of congenital rubella? (4)

A

Microcephaly
Heart disease
Purpura
Cataracts/other eye problems

44
Q

MMR - what type of vaccine is this? What does it provide lifelong protection against (with two doses)?

A

Live attenuated vaccine

Measles, Mumps, Rubella

45
Q

How many % of adults have past exposure to Parvovirus B19?

A

~60%

46
Q

What is the cellular target for Parvovirus B19?

A

Erythrocytes

47
Q

When in the pregnancy is the risk of Parvovirus B19 highest?

A

0-20 weeks: 9% risk of fetal loss

9-20 weeks: 3% risk of hydrops fetalis

48
Q

What parasite causes toxoplasmosis? What is its natural host?

A

Toxoplasma gondii

Cats

49
Q

How do humans become intermediate hosts of toxoplasmosis?

A

Ingestion of oocysts (eating infected meat or via contact with cat faeces)

50
Q

What are the symptoms of toxoplasmosis?

A

Commonly asymptomatic
Lymphadenopathy
Fever

51
Q

How many % adults are T.gondii IgG positive?

A

40%

52
Q

When is pregnancy is toxoplasmosis most risky to the foetus?

A

1st trimester

53
Q

What are the clinical features of congenital toxoplasmosis?

A

IUGR, hydrocephalus, cerebral calcification, microcephaly, hepatosplenomegaly

54
Q

What are some potential treatments for congenital toxoplasmosis?

A

Spyramicin

Pyrimethamine/sulfadiazine/folinic acid

55
Q

Syphilis is an STI due to what organism?

A

Treponema pallidum

56
Q

When is the highest risk of transmission of syphilis from mother to child?

A

1st trimester or peripartum

57
Q

How is syphilis treated?

A

Penicillin

58
Q

What is syphilis in pregnancy associated with? (3)

A

Miscarriage
Still birth
Prematurity

59
Q

What is Hutchinson’s triad (syphilis signs)?

A

Deafness, teeth and interstitial keratitis

60
Q

What are the symptoms of early (0-2 years) congenital syphilis?

A 
Rash
Rhinorrhoea
Osteochondritis
Perioral fissures
Lymphadenopathy
GN
61
Q

What are the symptoms of late (>2 years) congenital syphilis?

A 
Hutchinson’s teeth
Clutton’s joints
High arched palate
Deafness
Saddle nose deformity
Frontal bossing
62
Q

When is the antenatal infection screen done?

A

At 12 weeks

63
Q

What does the antenatal infection screen test for?

A 
Hep B
HIV
Rubella
Syphilis
CMV/toxoplasma/VZV

HD 2 (25 decks)

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