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GERR > Obstetric, perinatal and sexually transmitted infections > Flashcards

Obstetric, perinatal and sexually transmitted infections Flashcards

1
Q

Why does the immune system change during pregnancy?

A
  • Foetus are non-self, if immune system didn’t change then may reject foetus
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2
Q

What are the immune system changes during pregnancy?

A
  • Placenta acts as immunological barrier
  • reduce expression of class 1 MHC antigens on placental cells
  • placental syncytium blocks transit of immune system
  • T cells inhibited, specifically natural killer cells and T helper one cells
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3
Q

What is the function of T helper one cells?

A

Respond to intracellular pathogens e.g. viruses and bacteria

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4
Q

What are the consequences for the mother of the lowered immune system?

A
  • increased likelihood of severe symptomatic poliovirus or Hep A
  • Rheumatoid arthritis often ameliorates (less painful)
  • systemic lupus erythematous can flare up
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5
Q

Describe immune system off foetus

A
  • Few foetal IgM and IgA antibodies produced until second half pregnancy
  • No foetal CMI (cell mediated immunity)
  • Few foetal IgG antibody produced throughout pregnancy
  • Maternal IgG does help protect baby
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6
Q

What infections are more severe in pregnancy?

A
  • Malaria (RBCs infected by malaria can accumulate at placenta)
  • Influenza
  • UTI (get urinary incontinence due to obstruction, often get pyelonephritis)
  • Candidiasis
  • Listeriosis
  • Varicella
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7
Q

What are the methods of mother to baby transmission?

A
  • Intrauterine infection (during pregnancy) through placenta
  • Perinatal transmission (during birth, blood and body fluid mixing)
  • Post natal through breast milk e.g. HTLV (human T-lymphotropic virus)
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8
Q

What congenital infections can be transferred through intrauterine transmission?

A
  • Rubella
  • Parovirus B19
  • CMV (cytomegalla virtu)
  • syphilis
  • Toxoplasma gondii
  • Varicella zoster virus
    TORCH synonym o=others
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9
Q

What congenital infections can be transferred through perinatal transmission?

A
  • HIV
  • HBV
  • Group B streptococci
  • Listeria monocytogenes
  • Chlamydia trachomatis
  • Neisseria gonorrhoea
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10
Q

What is the incubation period of rubella?

A

14-21 days

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11
Q

What are the symptoms of rubella?

A
  • Fever
  • Malaise
  • irregular maculopapular rash
  • Not very serious
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12
Q

When does rubella become a serious problem?

A
  • Maternal infection of rubella
  • particularly in first 16 weeks
  • causes sensorineural deafness, diabetes mellitus later in life and can cause cataracts, brain and heart problems
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13
Q

What is rubella infection transmitted by the mother called?

A

Congenital rubella syndrome

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14
Q

What are the symptoms of erythrovirus (pathovirus B19)?

A
  • Febrile Illness in children and maculopapular rash on face (slapped cheek syndrome)
  • or can get symptomless infection, commonly in pregnancy
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15
Q

What happens with B19 in pregnancy?

A
  • very dangerous if infected between weeks 10-20 of pregnancy
  • get foetal anaemia due to high number of erythrocytes being made at this time which are targeted by virus
  • this causes heart failure and then hydrops foetalis (swelling of baby) can be fatal
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16
Q

How do you try to prevent B19 in pregnant women?

A
  • Tell pregnant women to look out for any children with raises and inform doctor if do come in contact
  • Ask children who come to practice and have B19 or rubella if they have had contact with any pregnant women
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17
Q

What should be done if a pregnant women has been in contact with someone with a rash?

A
  • take blood sample to check for presence of immunity or current infections of rubella
  • If non-immune another blood sample will be taken 4 weeks after contact to check again
  • if positive for infection or immunity B19 given intrauterine blood transfusion rubella termination options
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18
Q

Cytomegalovirus diagnostic test?

A
  • Urine PCR for baby as more virus present in urine than blood
  • For women can use blood given when initially booked in to check
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19
Q

is Cytomegalovirus rare?

A

not very rare 1 in 100 babies, wide range of severity

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20
Q

What factors affect the severity of cytomegalovirus in pregnant women?

A
  • Primary infection (first time) far greater risk of severe disease than if infection has just been reactivated
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21
Q

What type of virus if CMV?

A

Herpes

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22
Q

What is the severest CMV?

A
  • CMV inclusion disease where affects liver, spleen, blood, brain and eyes
  • CMV can also be asymptotic or cause unilateral deafness
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23
Q

What are the symptoms of syphilis in pregnant women and babies?

A

Maternal - miscarriage, premature births, stillbirths or death of newborn
Congenital - Teeth, brain, ears, bones, hepatosplenomegally, jaundice or anaemia

24
Q

How is syphilis treated?

A

Give mother high dose penicillin

25
Q

what pathogen causes toxoplasma gondii and where may the women come into contact with it?

A

protozoan parasite found in undercooked meat and cat faeces

26
Q

What problems can occur in the baby if mother affected by toxoplasma gondii?

A
  • encephalitis, learning difficulties, hepatosplenomegaly and cardiac pulmonary disease
  • can also be very mild or asymptomatic
27
Q

What are the adverse outcomes of chicken pox (varicella virus) in pregnant women?

A

Congenital varicella syndrome - limb deformities and serious brain and eye abnormalities
Maternal - Pneumonitis (especially if primary infection)

28
Q

What is the test for women who has come into contact with chickenpox?

A
  • Test immunity, lots have no remembered history of immunity but will be immune (no further action taken if immune)
  • If non-immune give VZIG (varicella zoster immunoglobulin) via injection
29
Q

What is the best treatment for any congenital infections?

A

Prevention - warning the mother of signs of infection in other and not waiting for infection to present in the women

30
Q

What conditions are tested for in UK antenatal screening?

A

HBV, HIV, Syphilis and rubella (only in NI)

31
Q

What conditions are tested for in UK antenatal screening?

A

HBV, HIV, Syphilis and rubella (rubella only in NI)

32
Q

What analyte is checked for in HBV (Hep B)?

A

HBaAg (checking for current infection)

33
Q

What analyte is checked for in HIV?

A

HIV Ag/Ab (checking for current infection)

34
Q

What analyte is checked for in syphilis?

A

T palidum total Ab (checking for current or past infection)

35
Q

What analyte is checked for in rubella?

A

IgG (checking for immunity)

36
Q

When is a antenatal screening taken?

A

13 weeks of gestation

37
Q

What other tests are necessary and what is the treatment for HBV if positive on screen?

A
  • check for DNA markers, if present more likely to transmit to foetus
  • treat by giving baby HBV vaccine and specific immunoglobulins (very effective)
38
Q

What other tests are necessary and what is the treatment for HIV positive screen?

A
  • HIV viral load, if high load then more likely transmission
  • More likely to transmit perinatally so at birth
  • Treat with antiretroviral drugs and elective Caesarean section to minimise blood sharing and no breast feeding
39
Q

What other tests are necessary and what is the treatment for syphilis positive screen?

A
  • Confirm positive using other serological tests
  • Treat with penicillin and possibly treat baby also
  • follow up baby check antibody presence
40
Q

What other tests are necessary and what is the treatment for rubella positive screen?

A

treat with MMR vaccination after pregnancy to protect next pregnancy

41
Q

What infections can occur around the time of birth?

A
  • Chorioamnionitis (infections of uterine membranes)
  • Group B streptococci
  • bacterial meningitis (can cause sepsis)
  • Neonatal varicella (different from congenital mother gets infection around time of delivery so immune system immature and get varicella)
  • HSV infections
42
Q

What can Chorioamnionitis cause?

A
  • Maternal fever
  • premature delivery
  • still birth
43
Q

What are the common symptoms of perinatal infection with STIs?

A
  • Neonatal conjunctivitis (caused by gonorrhoea and chlamydia)
  • Pneumonia (caused by chlamydia)
44
Q

What infections can cause sepsis and/or meningitis in neonates?

A
  • Group B streptococcus (part of normal flora of GI and genital tract in women)
  • Listeria monocytogenes
  • E.coli
  • Enterovirus and parechoviruses
45
Q

Where can listeria monocytogenes be contracted from?

A

Unpasteurised milk or cheese or vegetables

transmitted transplacentally

46
Q

What are the effects of listeria monocytogenes infection?

A
  • Maternal flu and in foetal infection get premature delivery, neonatal septicaemia or pneumonia
  • can get early onset neonatal meningitis
47
Q

What is the treatment for listeria monocytogenes?

A

Amoxicillin and possible in combination with gentamicin

48
Q

What does puerperal mean?

A

time period around six weeks after childbirth

- during this period mother reproductive organs are returning to original condition

49
Q

What is the major cause of maternal death?

A

puerperal sepsis mainly Group A streptococcus but can be Clostridium perfringens, E.coli or Group B strep

50
Q

How is puerperal sepsis prevented?

A
  • Ensure mothers maintain very good hygiene (hand hygiene alone v important)
  • avoid anyone with a sore throat
51
Q

How ar puerperal sepsis diagnosed?

A

High vaginal swab and blood cultures

52
Q

Symptoms of puerperal sepsis?

A

These symptoms if between labour and 42 day postpartum:

  • Pelvic pain
  • Fever
  • Abnormal vaginal discharge
  • Delay in rat oef reduction fo size of uterus
53
Q

What is the first step in any microbiology investigation?

A
  • Take sample of inflamed organ

- Take good culture

54
Q

How are viral infections checked for in a bay?

A
  • blood sample take clotted blood and EDTA sample
  • clotted blood for antibody tests
  • EDTA for PCR
  • Urine sample to check for CMV
55
Q

Give example of cultures taken for bacterial infections?

A
  • Throat swab
  • HVS
  • Blood culture
  • CSF

GERR (49 decks)

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