Viral infections in pregnancy

Question 1

What is the incubation period of CMV?

Answer 1

20 to 60 days.

Question 2

For CMV at what gestation is amniocentesis recommended?

Answer 2

17 weeks and 8 weeks after suspected maternal infection.

Question 3

What percentage of babies born with asymptomatic for CMV will have hearing loss?

Answer 3

15%

Question 4

Should CMV screening be offered in Canada?

Answer 4

Only screen in provinces where IgG avidity testing is available, especially in patients at high risk - children under 3 years old at home.

Question 5

What is the classical triad of congenital Rubella syndrome?

Answer 5

• Hearing impairment
• Cardiac abnormalities (PDA,
  pulmonary artery stenosis)
• Eye anomalies (cataracts,
  retinopathy, microphthalmia,
  glaucoma)

Question 6

What are the criteria for diagnosis Rubella infection in pregnancy?

Answer 6

1. A 4-fold rise in rubella IgG antibody titres between
   acute and convalescent serum specimens OR
2. Rubella-specific IgG seroconversion OR
3. A positive serological test result for rubella-specific IgM antibody and low-avidity IgG OR
4. A positive rubella culture or viral detection via reverse transcription PCR

Question 7

At what gestation is amniocentesis recommended to confirm Rubella infection?

Answer 7

After 20 weeks and 6 weeks after initial infection.

Send amniotic fluid for:
1. PCR.
2. Rubella culture.
3. Fetal IgM.

Question 8

What is the prognosis for Rubella infection in pregnancy?

Answer 8

Prognosis:
* 50% attend school for hearing impaired
* 25% attend some schooling for hearing impaired
* 25% attend mainstream school

Question 9

How long after Rubella vaccination should pregnancy be delayed?

Answer 9

One month after vaccination.

Question 10

How long after acquiring Toxoplasmosis infection should a patient wait to become pregnant?

Answer 10

6 months

Question 11

Which high risk population should be considered for Toxoplasmosis screening?

Answer 11

1. Immunocompromised.
2. HIV patients.
3. Living in high prevalence areas such as Nunavik and Northern Quebec.

Question 12

What does classic Toxoplasmosis syndrome include?

Answer 12

Classic toxoplasmosis syndrome
include:
* Chorioretinitis
* Hydrocephalus
* Intracranial calcification
* Convulsion

Question 13

At what gestation is amniocentesis recommended to confirm Toxoplasmosis infection?

Answer 13

After 18 weeks and 4 weeks after the infection.

Question 14

What are the indications for pharmacological management of Varicella infection?

Answer 14

If infected with varicella, supportive management is recommended EXCEPT in:
* > 100 lesions
* Respiratory co-factors (such as smoking)
* Varicella pneumonitis
* CXR can be considered to assess for pneumonia in confirmed VZV patients

Question 15

What are the indications for CXR in Varicella infection?

Answer 15

CXR can be considered to assess for pneumonia in confirmed VZV patients