Signs, Symptoms, Management and Complications Flashcards
How does CMV in pregnancy present in the mother?
- May only be mild symptoms
- Fever
- Lymphadenopathy
- Rash and sore throat
- N.B. A latent infection may reactivate in pregnancy, but this rarely affects the foetus
How would you test for CMV in pregnancy?
- Paired sera (look for IgG & IgM)
- Amniocentesis at >20/40 & viral shell culture can detect transmission
How would you manage CMV in pregnancy?
- Babies can be treated with ganciclovir to slow progression
- Wash surfaces that might have had young children’s saliva/urine/nasal secretions on them, as there is a risk of transmission
What are the complications of CMV in pregnancy?
- Congenital defects:
IUGR Microcephaly, encephalitis, seizures, CP Hepatosplenomegaly Thrombocytopenia Jaundice Chorioretinitis Purpuric skin lesions
- Later onset problems
Cognitive and motor delay
Sensorineural deafness
90% of infected neonates are normal at birth, but if they are symptomatic, there is a 33% mortality with the rest having chronic complications.
How does GBS in pregnancy present in the mother?
- It is asymptomatic, as it is a common bowel commensal that is carried vaginally.
How would you test for GBS in pregnancy?
- No screening in the UK, but may be found on routine high vaginal swabs or urine culture
- If previous GBS in pregnancy, test 3-5 weeks before the due date
How would you manage GBS in pregnancy?
- Treat bacturia at the time of diagnosis if found antenatally, but do not treat positive vaginal or rectal swabs until labour.
- Give all women benzylpenicillin (or clindamycin if allergic) in labour if:
GBS positive at any time in labour (urine or swab)
Previous foetal GBS infection
Labour at <37/40
Intrapartum fever
GBS positive with PROM (in this case, abx & IOL)
Membranes ruptured at term for >18 hours with unknown culture result
What are the complications of GBS infection in pregnancy?
- Severe foetal infection with 20% mortality, presenting as meningitis, pneumonia or sepsicaemia
How would you test for HIV in pregnancy?
- Offer HIV test at booking, along with other infections (Hep B/C, VZV, measles, toxoplasmosis)
- Test newborn babies of HIV positive mothers at 1, 6, 12 and 18 weeks of life
How would you manage HIV in pregnancy?
Antenatal
- Specialist involvement to check viral load, compliance and toxicity
- Continue HAART or if not on it, start by 24/40 and continue to delivery
Intrapartum
- Offer vaginal delivery to women with viral loads of <50 copies/mL or <400 copies/mL if on HAART
- Avoid foetal blood sampling/amniotomy
- Offer CS at 38/40, later if <50 copies/mL
Postpartum
- Cabergoline is recommended to suppress lactation
- Treat newborn with zidovudine (or HAART if mother not treated or high maternal viral load). If high risk, co-trimoxazole can be given for PCP prophylaxis
- Offer contraception
- Test newborn babies of HIV positive mothers at 1, 6, 12 and 18 weeks of life
What are the risks of HIV in pregnancy?
Vertical transmission
How does HSV in pregnancy present in the mother?
- Genital lesions
N.B. recurrence of HSV is usually not a problem due to maternal antibodies
How would you test for HSV in pregnancy?
- Type-specific diagnosis made by PCR
- Refer to GUM clinic and test her (+ partner) for other infections
How would you manage HSV in pregnancy?
Antenatally
- Offer oral acyclovir and valaciclovir in last trimester
- Recommend LSCS if active infection within 6 weeks of delivery
Intrapartum
- If vaginal delivery, give IV acyclovir to both mother and baby
What are the complications of HSV in pregnancy?
- Neonatal infection usually occurs at 5-21 days with grouped vesicles/pustules on a red base +/- perioccular and conjunctival lesions
Complications include
- Blindness
- Reduced IQ
- Epilepsy
- Jaundice
- ARDS
- DIC
- Death in 30% even if treated
How does listeria in pregnancy present?
- Fever, rigors
- Myalgia
- Headache
- Sore throat, cough
- D&V
- Vaginitis
Infections usually from food (milk, soft cheese, pâté)
How would you test for listeria infection in pregnancy?
- Perform cultures in any pregnant woman with unexplained fever for >48hrs
- Diagnose with blood, CSF, meconium and placenta culture
How would you treat listeria in pregnancy?
- Treat with ampicillin and gentamicin
- Isolate baby
What are the complications of listeria in pregnancy?
Maternal
- Miscarriage, premature labour and stillbirth
Foetal
- Distress in labour
- Pneumonia
- Convulsion, meningitis
- Hepatosplenomegaly
- Pustular/petechial rashes
- Conjunctivitis
- Fever, leukopenia
How would malaria in pregnancy present?
- Odd behavoiur
- Fever, sweating
- DIC, anaemia
- Jaundice
- Premature labour
- Seizures, LOC
- Hypoglycaemia
How would you test for malaria in pregnancy?
- Thick and thin blood films with sensitivities
How would you manage malaria in pregnancy?
- Seek expert help
- If falciparum, quinine & clindamycin for 7/7
- If severe falciparum:
Consider ITU
Artesunate & clindamycin
Packed cells if HCT <20%
Beware hyperpyrexia, renal failure, pulmonary oedema and sepsis. - If vivax, chloroquine over 3/7 then weekly in pregnancy
What are the complications of malaria in pregnancy?
- Miscarriage, stillbirth
- Low birthweight
- Prematurity, increased risk of PPH
- Congenital malaria (1%)
- Neonatal hypoglycaemia
- Increased risk of infection
How would parvovirus B19 present in pregnancy?
- May be asymptomatic
- “Slapped cheek” rash, maculopapular rash
- Fever, arthralgia
- If immunocompromised, sudden haemolysis
