Infection in pregnancy

Question 1

What causes chicken pox?

Answer 1

The varicella zoster virus

Question 2

What can occur in mothers with chicken pox?

Answer 2

Varicella Pneumonitis (viral pneumonia)
Hepatitis
Encephalitis

Question 3

What are the symptoms of chicken pox?

Answer 3

Fever
Malaise
vesicular rash

Question 4

What can occur in children who’s mothers had chicken pox?

Answer 4

Foetal varicella syndrome

Severe neonatal varicella syndrome

Question 5

What are the signs and symptoms of foetal varicella syndrome?

Answer 5

skin scarring
eye abnormalities
hyperplasia of limbs
neurological abnormalities

Question 6

How do you know if a mother is immune to chicken pox?

Answer 6

previous chicken pox = immune.

Can test - IgG levels for VZV (positive = immune)

Question 7

What can be done for mothers who aren’t immune to chicken pox?

Answer 7

They can be given the vaccine before or after pregnancy.

Question 8

What should be done to women who have been exposed to chicken pox within pregnancy?

Answer 8

Previous infection - safe.
Positive IgG for VZV - safe.
Not sure - give IV varicella immunoglobulins (within 10 days of exposure).

Question 9

What is the treatment for a women who develops a rash (infection) during pregnancy?

Answer 9

Within 24hrs and 20wks - oral acyclovir.
Severe - IV acyclovir and hospital admission
After 24hrs - just hygiene.

Question 10

When does chicken pox infectivity begin and end?

Answer 10

48hrs before the rash presents - until 5-7 days after the rash starts (when they crust over)

Question 10

When does chicken pox infectivity begin and end?

Answer 10

48hrs before the rash presents - until 5-7 days after the rash starts (when they crust over)

Question 11

What is shingles?

Answer 11

Reactivation of chicken pox virus which has remained dormant in the sensory nerve root ganglion since primary infection.

Question 12

What is ‘slapped cheek’ caused by?

Answer 12

The Parovirus B19 virus.

Question 13

What are the signs and symptoms of parvovirus B19?

Answer 13

Non - specific viral symptoms
Fever
2-5 days after - erythematous of cheeks, few days later - rash on trunk

Most adults are asymptomatic

Question 14

When is parvovirus B19 infectious and when does it end?

Answer 14

Begins 7-10 days before the rash appears. Once the rash appears, it’s not infectious.

Question 15

What are the outcomes of getting parvovirus B19 during pregnancy?

Answer 15

Miscarriage or foetal death
severe foetal anaemia
hydros foetalis
Maternal-pre-eclampsia like syndrome.

Question 15

What are the outcomes of getting parvovirus B19 during pregnancy?

Answer 15

Miscarriage or foetal death
severe foetal anaemia
hydros foetalis
Maternal-pre-eclampsia like syndrome.

Question 16

Which tests should be done for pregnant women with suspected parvovirus B19?

Answer 16

IgM to parvovirus (acute infection)
IgG to parvovirus (previous exposure)
Rubella antibodies (as alternative)

Question 17

What is the treatment for parvovirus B19 infection?

Answer 17

Treatment is conservative.

If pregnant - referral to foetal medicine.

Question 18

What causes congenital toxoplasmosis?

Answer 18

The toxoplasma Gondii parasite.

Question 19

How is toxoplasmosis spread?

Answer 19

By contamination of faeces from a cat who is the host

Question 20

When is the highest risk of congenital toxoplasmosis?

Answer 20

The risk increases the further on in pregnancy the infection is acquired
(Highest risk = 3rd trimester)

Question 21

What are the outcomes of developing toxoplasmosis infection when pregnant?

Answer 21

Increased risk of:
Miscarriage
Intrauterine death

Question 22

What is the triad of symptoms that come with congenital toxoplasmosis?

Answer 22

Intracranial calcification
Hydrocephalus
Chorioretinitis

Question 23

Which infections are screened for during a pregnancy booking appointment?

Answer 23

Hepatitis B
Syphilis
HIV

Question 24

What are the risks associated with HIV during pregnancy?

Answer 24

NO increased risk of congenital abnormalities.

Pre-eclampsia
Misscarriage
Preterm delivery
Low birth weight

Question 25

What are the viral load levels for vaginal birth and C section for HIV?

Answer 25

<50 - vaginal birth should be supported
50-399 - pre labour CS should be considered between 38 and 29 weeks
>400 - pre labour CS is recommended between 38 and 39 weeks.

Question 26

Can you breast feed if you have HIV?

Answer 26

It gives an increased risk of transmission.

Question 27

How is hepatitis B spread?

Answer 27

Through blood and bodily fluids

Vertical transmission

Question 28

What is the risk of infection to babies who have mothers with acute Hep B infection?

Answer 28

9 in 10 babies will develop the infection.

Question 29

What is the risk of infection to babies who’s mothers have chronic hepatitis B infection?

Answer 29

1/2 in 10.

Question 30

What can Hepatitis B contracted at birth cause?

Answer 30

Hepatocellular cancer and serosis

Question 31

How is chronic hepatitis B treated during pregnancy?

Answer 31

Tenofovir mono therapy in the 3rd trimester.

Question 32

What can be given to babies of infected Hepatitis B mothers?

Answer 32

Hepatitis B immunoglobulin

Question 33

Can Hepatitis C be treated in pregnancy?

Answer 33

NO - the medications are teratogenic.

They can be used during breast feeding.

Question 34

What are the complications of syphilis?

Answer 34

Misscarriage
Still birth
Hydrops Fetalis
Growth restriction

Question 35

What is congenital syphilis?

Answer 35

Hutchinson’s triad:
Teeth
keratitis
deafness

Treated with penicillin.