Pregnancy and infection Flashcards
Is hepatitis dangerous for mother, baby or both
Both
Is hepatitis dangerous for mother baby or both
MOther
Is syphilis more harmful to foetus or mother
Foetus
What 3 diseases are harmful to mother and foetus
Hepatitis
VZV
HIV
What diseases are more harmful to foetus than mother
HSV Syphilis CMV Toxoplasmosis rubella
What does the ToRCHeS anagram tell us?
Toxoplasmosis Other Rubella Cytomegalovvirus Herpes
3 categories that infections of foetus/ mother can be divided into
Parasite
Virus
Bacteria
What 2 things are immune systems responses based on
- Early IgM rise
- IgG rise
What does the early IgM rise represent
Early recognition of new pathogen in immune system
What does IgG signify
Past infection
What does PCR enable
Detection of the viral DNA or RNA
Can give diagnosis earlier than serology
What does CMV stand for
Cytomegalovirus
How can CMV be transmitted
Saliva, blood/ blood products, sexual intercourse, organ transplantation or via mother
Is primary or secondary CMV infection more likely to cause congenital CMV
Primary
In which trimester is congenital CMV more likely
first
What is the prevalence of CMV
7 per 1000 live births
What % of babies with CMV are systomatic
13
How do you diagnose congenital CMV
- Maternal serology (CMV IgG and IgM)
- Neonatal urine/ saliva for CMV DNA (PCR)
What are the severe symptoms of congenital CMV
Intrauterine growth retardation
Hepatosplenomegaly
Microcephaly
What is the commonest congenital cause of sensorineural hearing loss
CMV
What does VZV stand for
Varicella Zoster Virus
What % of UK adults are immune to VZV
80-90
How many people can 1 person infect with VZV
10-12 susceptible individuals
How does timing of infection affect risk of VZV
Mother: the later the infection the worse and the greater foetal complications
What CNS complications are associated with VZV
VZV ecephalitis and meningitis
What is Ro?
Number of people that one sick person will infection on average
How is VZV diagnosed
Swab of vesicle fluid
Maternal serology
What preventative mangement is available for VZV?
Varicellar Zoster ImmunoGlobulin (post exposure)
Vaccination (controversial)
Why should VZV vaccination not be offered during pregnancy
Because it is a live attenuated vaccine
What diseases does VZV lead to
Chicken pox
Shingles
Typical sign of shingles
Reactivation of chicken pox in one nerve root so NEVER crosses the midline
Affect on the skin of congenital varicellar syndrome
Skin lesions leading to limb hypoplesia
Affect on CNS of congenital varicella syndrome
Microcephaly
Hydrocephaly
Neurodevelopmental delay
Is HSV1 or HSV2 related to sexual activity
HSV2
What % of adults have HSV1 by age 40
90
What disease is herpes simple virus associated with
Cold sore
Genital lesion
CNS infection
How is the majority of HSV transmitted to neonate
Perinatally (as child passes through vaginal canal)
How is neonatal HSV infection diagnosed
Clinical
HSV DNA PCR neonate blood
vesicle swab
Maternal vesicle swab
What is the treatment for neonatal HSV infection
Aciclovir treatment
Is rubella common or rare in UK
Rare- been removed from UK antinatal screening
Why is rubella unworrying outside of pregnancy
Self limiting disease
How is rubella diagnosed
Serology
Oral fluid
Upon clinical suspicion (rash)
When is the risk greatest for congenital rubella
Early on in pregnancy (sometimes before she knew was pregnant)
MMR vaccinates against..
Measles, mumps and rubella
What is parvovirus B19 nicknamed
Slapped cheek disease due to ruddy appearance of cheek
What it the cellular target of parvovirus B19
Erythryocytes
How do you diagnose parvovirus B19
Maternal serology/ PCR
Foetal ultrasound
What is the biggest risk of parvovirus B19 contracted in 9-20 weeks gestation
Hydrops fetalis (heart failure)
What parasite causes toxoplasmosis
Toxoplasma gondii
How do humans contract toxoplasmosis
Cat is natural host
Humans are intermediate host with ingestion of oocysts via faeces or infected meat
What is the risk to the mother and baby of contracting toxoplasmosis in first trimester
Risk to mother lowest
Risk to foetus greatest
Clinical features of congenital toxoplasmosis
IUGR Hydrocephalis Cerebral calcification Microcephaly Hepatosplenomegaly
Diagnosis of congenital syphilis
Clinical syndrome (non painful genital ulcer) Serology
When is there highest risk of syphilis transmission
First trimester
Treatment of syphilis?
Penecilin
How does secondary syphilis present
Rash of palms of feet and hands
Signs of late congenital syphilis
Hutchinsons teeth Cluttons joints High arched palate Deafness Saddle nose deformity
What is tested for in antenatal screening
Hep B
HIV
Syphilis
CMV
In what way are UTI different in pregnancy
Higher risk to outflow obsutrction
What is the risk of group B strep in pregnant women
Neonatal sepsis
What ethical issues are involved in infection
Antenatal screening
Serology difficult to interpret
May lead to amniocentis
Often no treatment
