Pregnancy and infections

Question 1

When in pregnancy is the highest risk of congenital varicella?

Answer 1

First 20 weeks
Highest in weeks 12-20

Management: Green top guidelines (2015): Oral aciclovir should be prescribed for pregnant women with chickenpox if they present within 24
hours of the onset of the rash
Also state that women who develop CP in pregnancy should have a scan 5 weeks after infection

Question 2

Consequences for baby/child in maternal varicella infection, chicken pox
1) In first 20 weeks
2) In 7 days prior to or after birth
3) Late pregnancy (in general)

Answer 2

1) Congenital varicella syndrome: limb deformities, skin scaring,
2) purpura fulminans
(highest risk if 4 days before and two days after)
3) Shingles of infancy

Question 3

15 minutes face to face is considered a significant ezposure for a rash illness? T/F

Answer 3

FALSE

Face to face contact
or Same room for 15 minutes (ie 4 bedded bay)

From measles guidelines

Contact tracing should focus primarily on:
* close contacts including household contact
* face to face contact of any length
* more than 15 minutes in a small, confined area, for example room in a house,
classroom, 4-bed hospital bay (including healthcare workers)

Question 4

A baby has an exposure to chicken pox from their sibling. The mother has had Varicella vaccination. What should you do?

Answer 4

Test VZV IgG in mother (or baby)

If <150mIU offer VZIG

Question 5

Screening for baby if

Mother who is HCV Ab positive and no ongoing risk factors

Answer 5

Test RNA in mum, is stably not detected
= do nothing

Question 6

Mother has HCV Rna detected (or has an acute Hep C in pregnancy which then clears)

Answer 6

RNA test on baby at 2-3 MONTHS

If positive: repeat at 6 months= current HCV infection, advise referral to hepatologist

If negative: Do serology at 12-18 months

Recommend HAV vaccination (add this to any comment)

Question 7

HEV in pregnancy- when are the worst outcomes

Answer 7

Third trimester
25% mortality
Mainly genotype 1

Question 8

T/F 50% of neonatal HSV infections during peripartum period

Answer 8

False
85% during delivery
5% in utero
10% after birth (almost always HSV-1)

50% is the risk of MTCT is primary infection in last trimester and seroconversion not complete
20 percent if non-primary in last trimester and seroconversion not complete
<2 percent in recurrent HSV1 or 2

Question 9

Neonatal HSV risk factors

Answer 9

Prematurity
Mode of delivery (vaginal vs C section)
- Shedding often occurs for 6 weeks so if delivery starts 6 weeks within this time C section is recommended

Prolongued ROM

Skin damage to baby (eg skin electrodes)

Question 10

Dose of aciclovir for prophylaxis in pregnancy

Answer 10

In last trimester 500mg TDS
(valacivlovir 500mg BD)

Question 11

Indications for long term supressive therapy for HSV in neonate

Answer 11

CNS disease
Disseminated disease

Should have regular neutrophil checked

Disseminated disease has 30% mortality

Question 12

TAT suggested for IDPS

Answer 12

8 days

Accept for late bookers

to expedite testing the maternity service must liaise directly with the laboratory, usually by telephone, to ensure the laboratory has the necessary clinical information to inform prompt analyses. Maternity services must not rely only on writing ‘urgent’ or similar on the request form or flagging ‘urgent’ on an electronic request

Question 13

Negative now comment

Answer 13

Negative at time of testing. Please offer testing at anytime in pregnancy if new risk factor or relevant symptoms

Question 14

Women has recurrence of HSV in labour. What is the managment?

Answer 14

Confirm recurrence
If term baby- vaginal delivery OK, but advise maintaining skin competency in baby
Screen baby at 24 hours: Eyes, bum, mouth, skin (surface swab +/- lesions)
Send blood for PCR
Do ALT of baby

Question 15

How long after returning from Zika endemic country should you not have a baby

Answer 15

2 months women
3 months men