Pregnancy and infection

Question 1

Why is timing of infection by cytomegalovirus important in pregnant women? How is CMV diagnosed? What are signs of CMV in foetus/newborn?

Answer 1

If pregnant woman becomes infected by CMV in the 1st trimester it is much more likely to cause congenital CMV

Diagnosis:

• materal serology: CMV IgG and IgM
• neonatal urine/saliva for CMV DNA PCR

S+S in utero:

• IUGR
• hepatosplenomegaly
• microcephaly
• sensorineural deafness

Question 2

How can VZV be prevented and treated?

Answer 2

Prevention: VZV immunoglobulin (post-exposure)
vaccination (pre-exposure)

Treatment: valaciclovir

Question 3

What are the S+S of congenital varicella syndrome?

Answer 3

Skin lesions 
Limb hypoplasia 
Microcephaly, hydrocephaly, developmental delay 
Cataracts/other eye problems
GI, genitourinary, cardiac 
Miscarriage

Question 4

What are the S+S of congenital rubella virus?

Answer 4

eye anomalies, cataracts, glaucoma, strabismus (cross-eyed), nystagmus, microophthalmia, iris dysplasia

Question 5

What are the risks of contracting Parvovirus at:
0-20 weeks
9-20 weeks
>20 weeks

Answer 5

0-20 weeks: 9% risk of foetal loss
9-20 weeks: 3% risk of hydrops foetalis
>20 weeks: negligible risk

*erythrocytes/erythroblasts are the cellular target

Question 6

What is hydrops foetalis? How is it caused? How is it treated?

Answer 6

Accumulation of fluid in at least 2 foetal compartment
caused by heart failure secondary to poor RBC production/RBC dysplasia
can be treated by intrauterine cord blood transfusion

Question 7

When is the risk of congenital toxoplasmosis at its lowest? what are the clinical features? How is it diagnosed? how is it treated?

Answer 7

Risk lowest if it occurs in the 1st trimester
Clinical features:
- IUGR
- hydrocephalus 
- cerebral calcification 
- microcephaly 
- hepatosplenomegaly 

Diagnosis:

• maternal serology
• amniotic fluid PCR

Treatment:

• spyramicin
• pyrimethamine
• sulfadiazine
• folinic acid

Question 8

When is the highest risk of infection by syphilis in pregnancy? What is the difference between early and late congenital syphilis? What are the complications associated with syphilis during pregnancy? What is the treatment?

Answer 8

High risk of infection is during first trimester

Early:

• Rash
• Rhinorrhoea
• Osteochondritis
• Perioral fissures
• Lymphadenopathy

Late:

• Hutchinson’s teeth
• Clutton’s joints
• high arched palate
• deafness
• saddle nose deformity
• frontal bossing

Complications:
miscarriage/stillbirth/prematurity

Treatment:
penicillin

Question 9

What is Hutchinson’s triad?

Answer 9

• hutchinson’s teeth
• deafness
• hutchinson’s keratitis

Question 10

What is the most common cause of congenital sensorineural deafness?

Answer 10

CMV