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MK SR INDEX CASES REPRODUCTIVE CARE > Reproductive Infections/Immunology > Flashcards

Reproductive Infections/Immunology Flashcards

1
Q

Special considerations for infections in pregnancy

A

• Pregnancy is an immunocompromised state
• Infections in pregnancy have implications not only for mother
but also unborn child
• Mother to child transmission can occur with certain infections in utero, during childbirth or post-partum
• Maternal antibodies provide protection against certain infections in the newborn child

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2
Q

national antenatal screening for infections

A
  • booking bloods: HIV Ab, Hepatitis B sAg and Syphilis. Positive require specialist care.
  • Urine: for asymptomatic bacteriuria
  • MRSA screening late in pregnancy
  • Chlamydia in < 25 yr olds
  • No routine screening for GBS
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3
Q

Suppressive antiviral therapy in pregnancy - give an example

A

Given to mothers with recurrent herpes to lower risk of mother having active lesions at the time of delivery

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4
Q

Mother to child transmission can occur with certain infections in utero, during childbirth or post-partum

Give an example of each

A

Utero: chickenpox

Childbirth: blood borne, contact GBS

Post-Partum:

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5
Q

Boosting maternal immunity

A

Pertussis booster
influenza vaccine

live vaccines contraindicated in pregnancy

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6
Q

Bacterial Infections in pregnancy

A
  • UTI / STI - Genital Tract Sepsis
  • Group A & Group B strep
  • MRSA
  • Listeria
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7
Q

What organisms cause Bacterial Sepsis in Pregnancy?

A

Mainly: Group A Streptococcus (chorioamnitis) and E.Coli (pyelonephritis)

Mixed infections with both Gram-positive and Gram-negative organisms are common, especially in chorioamnionitis.

Coliform infection is particularly associated with urinary sepsis, preterm premature rupture of membranes, and cerclage.

Anaerobes: Peptostreptococcus, Bacteroides spp. > Clostridium perfringens

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8
Q

Antimicrobial therapy for Bacterial Sepsis in Pregnancy

A
  • Source control if possible: for example, by delivery of the baby
  • IVIG is recommended for Toxic shock syndrome related to severe invasive streptococcal or staphylococcal infection if other therapies have failed.
  • IVIG neutralises the superantigen effect of exotoxins, and inhibits production of tumour necrosis factor (TNF) and interleukins.

Antibiotics that switch off protein synthesis (such as toxins) such as a macrolide clindamycin or a oxazolidinone such as linezolid

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9
Q

How are infections identified in pregnancy (give 3)

A
  • Routine screening in pregnancy
  • Symptomatic maternal presentation
  • Investigations triggered by foetal abnormalities on anomaly scan at 18-20 wks
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10
Q

Why do we only screen for Hepatitis B sAg in pregnancy?

A

Not interested in past infection, just want to know about current infection (surface antigen sAg)

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11
Q

Symptomatic Presentation of injections in pregnancy

A
  • Rash illness: Maculopapular / Vesicular
  • Genital / abdominal symptoms (chorioamnionitis)
  • Respiratory / urinary
  • Non-specific pyrexial illness
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12
Q

Maculopapular rash in pregnancy

A 
Rubella 
Measles
Mumps 
Enterovirus 
Parovirus 
May or may not have meningitis
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13
Q

Vesicular rash in pregnancy

A

Not a wide differential

Chicken pox
Herpes Simplex

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14
Q

Toxic shock syndrome in pregnancy is associated with which organisms?

A

Toxic shock syndrome caused by staphylococcal or streptococcal exotoxins can produce confusing symptoms.

Have to target bacteria and toxin with treatment

Bacterial Sepsis in Pregnancy

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15
Q

Viral Infections in pregnancy

A
  • CMV
  • Parvovirus
  • Chicken Pox / Zoster
  • Rubella
  • Measles
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16
Q

Non-bacterial, non-viral infections in pregnancy

A
  • Parasitic: Toxoplasmosis
  • Fungal infections: Thrush
  • Mycobacterial
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17
Q

Infection Treatment during pregnancy

Which infections are always treated?

A
  • Bacterial infections incl STIs
  • Chicken pox
  • Toxoplasma
  • HIV
  • TB
18
Q

Infection Treatment during pregnancy

Which infections are selectively treated?

A

Hepatitis B

19
Q

Prevention of maternal infection

A
  • Exposure to rash illness : Primary prevention
  • Recurrent genital herpes : Secondary prevention
  • Prophylactic antibiotics for preterm prelabour rupture of membranes
  • Vaccination during pregnancy : Flu & Pertussis
20
Q

Methods of preventing of mother to child transmission

A
  • Treatment of maternal infections
  • Intra-partum antibiotic/antiviral prophylaxis
  • Neonatal prophylaxis
  • Neonatal vaccination
  • Neonatal immunoglobulins
  • Restriction of breast feeding (e.g. HIV)
21
Q

What is “Intrapartum prophylaxis”?

A

Treatment during labour

  • Chorioamnionitis
  • Group B Streptococcus
  • MRSA
  • ESBL producers
  • HIV
22
Q

Which viral infections are treated with “Intrapartum prophylaxis”?

A

HIV

23
Q

Which bacterial infections are treated with “Intrapartum prophylaxis”?

A
  • Chorioamnionitis
  • Group B Streptococcus
  • MRSA
  • ESBL producers
24
Q

Types of neonatal interventions for infections

A
  • Septic screen + antibiotics • Vaccination
  • Immunoglobulins
  • Antivirals : HIV
  • Restriction of breast feeding
25
Q

Definition of Puerperal sepsis

A

Sepsis developing after birth until 6 weeks postnatally

• Most common site is the genital tract and in particular the uterus,
resulting in endometritis
• Others include Mastitis, urinary tract infection, pneumonia, skin and soft-tissue infection, gastroenteritis and pharyngitis

26
Q

Puerperal sepsis : pathogens

A

Sepsis developing after birth until 6 weeks postnatally

  • GAS, also known as Streptococcus pyogenes
  • Escherichia coli
  • Staphylococcus aureus
  • Streptococcus pneumoniae
  • meticillin-resistant S. aureus (MRSA),
  • Clostridium septicum
  • Morganellamorganii
27
Q

Management of HIV in pregnancy

A
  • Already on cART – continue unless contraindicated in pregnancy
  • Women not on cART- commence ART in the first trimester if VL high and/or CD4 cell count low - otherwise start in second trimester
  • All women should have commenced ART by week 24 of pregnancy
28
Q

Management of HIV in pregnancy presenting late

A

Women presenting in labour/ROM/requiring delivery without a documented HIV result must be recommended to have an urgent HIV test.
• Intrapartum intravenous zidovudine infusion is recommended in the following circumstances:
• - For women with a viral load of >1000 HIV RNA copies/mL plasma who present in labour, or with ruptured membranes or who are admitted for planned CS.
• - For untreated women presenting in labour or with ruptured membranes in whom the current viral load is not known.

29
Q

Management of HIV Untreated woman presenting in labour at term

A
  • All women should be given a stat dose of nevirapine 200 mg and commence fixed-dose zidovudine with lamivudine and raltegravir and receive IV zidovudine for the duration of labour
  • If presenting in preterm labour, if the infant is unlikely to be able to absorb oral medications consider adding double-dose tenofovir
  • Combination PEP for infant within 4 hours
30
Q

Mode of Delivery for women with HIV

A
  • Viral load <50 HIV at 36 weeks, no obstetric contraindications - planned vaginal delivery
  • Viral load of 50–399 HIV RNA copies/mL at 36 weeks, PLCS should be considered, taking into account the actual viral load, the trajectory of the viral load, length of time on treatment, adherence issues, obstetric factors and the woman’s views.
  • Viral load is ≥ 400 HIV RNA copies/mL at 36 weeks, PLCS is recommended between 38 and 39 weeks
  • Vaginal birth after Caesarean section (VBAC) should be offered to women with a viral load <50
31
Q

Breastfeeding in HIV

A
  • UK recommendation is to avoid breastfeeding with support for formula milk
  • Women who are virologically suppressed on cART with good adherence and who choose to breastfeed may be supported to do so, but should be informed about the low risk of transmission of HIV through breastfeeding in this situation.
  • Breast fed infants need regular HIV tests
32
Q

Infant testing for HIV

A

• During the first 48 hours and prior to hospital discharge
• If HIGH RISK, at 2 weeks of age
• at 6 weeks (at least 2 weeks post cessation of infant prophylaxis*)
• at 12 weeks (at least 8 weeks post cessation of infant prophylaxis *)
• On other occasions if additional risk
• HIV antibody testing for seroreversion should be checked at age 18–24 months
*In very low risk neonatal PEP is for 2 weeks

33
Q

Recommendations for Hepatitis B in pregnancy

A
  • Specialist review recommended within 6 weeks of antenatal diagnosis for assessment
  • Treatment for Hepatitis B recommended for prevention of MTCT only if HBV Viral load > 107 IU/ml
  • All babies need an accelerated course of hepatitis B vaccination starting at birth
  • Specific indications for Hepatitis B immunoglobulins depending on HB eAg/Ab status, Viral Load and birthweight ( Green Book )
  • PLCS not necessary
  • Breast feeding allowed
34
Q

What is the name of Group A Streptococcus?

A

Streptococcus pyogenes

35
Q

Group A Strep in pregnancy can present as

A

Chorioamnionitis/abdominal pain/diarrhoea/severe sepsis

36
Q

Source of Group A Strep in pregnancy

A
  • Carried by 5-30% of people
  • Sore throat
  • Infection is usually from children
37
Q

What is the name of Group B Streptococcus?

A

Streptococcus agalatiae

38
Q

What maternal conditions should we consider Group B Streptococcus in?

A
  • preterm labour
  • Labour is prolonged
  • Maternal fever
39
Q

Management of Group B Streptococcus in pregnancy

A
  • Vertical transmission to baby is prevented by giving intrapartum intravenous Penicillin or clindamycin
  • Clindamycin in penicillin allergy

Women with the following risk factors are treated with intrapartum antibiotics-
•Previous baby with GBS
•Preterm labour
•Rupture of membranes >18hrs
•Maternal pyrexia in labour
•Maternal GBS in swab or urine in pregnancy

40
Q

When should GBS in pregnancy be treated immediately (not intrapartum)

A

if found in urine needs to be treated immediately

MK SR INDEX CASES REPRODUCTIVE CARE (23 decks)

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