Pregnancy/ neonatal Flashcards
32 year old teacher presents to GP after being told child in class has slapped cheek - not yet confirmed parvo B19
She is 15 weeks pregnant
What further history should be taken?
immunisation history - MMR
VZV history
dates on contact with child - infectious from 10 days prior to rash onset, until 1 day after rash appears
significant contact - face to face, or 15mins in same room, or household contact
patient symptoms - fever, rash, arthralgia, headache, conjunctivitis
What is risk to pregnant women if has primary parvo B19 infection in pregnancy?
greater risk if <20 weeks gestation
9% risk foetal loss
3% risk hydrops foetalis
32 year old teacher presents to GP after being told child in class has slapped cheek - not yet confirmed parvo B19
She is 15 weeks pregnant
What testing is required?
Test booking bloods - if IgG positive, then no further work required.
If IgG negative on booking, send bloods for IgM/ IgG
If IgM/ IgG negative after exposure, send repeat bloods 1 month after exposure to see if late antibody development
If IgM positive, consider testing blood for ParvoB19 DNA if confirmation required
patient should avoid contact with other pregnant women until known to be non-infectious e.g either via blood tests, or 10 days after exposure
32 year old teacher presents to GP after being told child in class has slapped cheek - not yet confirmed parvo B19
She is 15 weeks pregnant
Should teacher be excluded from work?
If shown to be previously immune, then can return to work
If developed infection in this episode, can return to work, as already got infection
If not previously infected, and managed to avoid infection on this exposure, then should remain off work until 20 weeks gestation. This is only if school outbreak, as risk of infection same in community/ school
Women with previous genital herpes
How many develop recurrence during pregnancy?
75% will have recurrence during pregnancy
What increases risk of HSV transmission to neonate?
primary infection during pregnancy
low maternal antibody levels - i.e because infected late in pregnancy, and not enough time for maturation of immune response
premature rupture of membranes
vaginal delivery
What are three main presentations of neonatal HSV?
Skin/ eyes/ mouth - vesicles on skin/ mouth and conjunctivitis
CNS - skin lesions, fever, seizures, abnormal MRI
Disseminated - skin lesions, hepatitis, encephalitis
What is treatment duration for HSV infection neonate?
14 days if skin/ eyes/ mouth only
21 days if encephalitis/ disseminated. Requires repeat LP prior to discontinuing treatment
Post-HSV encephalitis, aciclovir suppression is recommended.
What is the dose/ duration?
300mg/m2 TDS
for 6-12 months
monitor FBC monthly, as aciclovir can cause neutropaenia
What are morphological/ biochemical features of listeria species?
gram positive
cocci/ bacilli or coccobacilli
beta-haemolytic
anaerobic
Which foods have been associated with listeria outbreaks?
soft cheese pate smoked seafood cantaloupe cold deli meats
What is treatment for pregnant patient with suspected listeriosis?
Amoxicillin + Gent
macrolides/ co-trimoxazole are options
Treat for 14 days
