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Microbiology Part 2 > Lec49 Intrauterine and Perinatal > Flashcards

Lec49 Intrauterine and Perinatal Flashcards

1
Q

What is relationship time of exposure in pregnancy and severity of infection / risk of infection?

A
  • decreasing severity of infection over time of pregnancy

- increasing risk of infection over time [as placental barrier breaks down]

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2
Q

What routes of transmission for CMV – placental, intrapartum, or breast milk?

A
  • placental or breast milk
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3
Q

What routes of transmission for HIV – placental, intrapartum, or breast milk?

A
  • intrapartum or breast milk
  • can also cross placenta but only if really serious disease [high VL, bad immune system]
  • normally its intrapartum
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4
Q

What routes of transmission for rubella – placental, intrapartum, or breast milk?

A

placental

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5
Q

What routes of transmission for VZV – placental, intrapartum, or breast milk?

A

placental

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6
Q

What routes of transmission for toxoplasma – placental, intrapartum, or breast milk?

A

placental

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7
Q

What routes of transmission for syphilis – placental, intrapartum, or breast milk?

A

placental

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8
Q

What routes of transmission for listeria – placental, intrapartum, or breast milk?

A

placental

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9
Q

What are potential effects maternal infection on pregnancy?

A
  • pregnancy loss
  • teratogenicity
  • in utero infection
  • chronic infection of fetus
  • acute infection of newborn
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10
Q

What are the torch infection?

A
  • in utero infections that present with ocular findings and rash
    T: toxoplasma gondii
    O: syphilis, parvo B19, varicella, HIV, Hep B, chlamydia
    R:Rubella
    C: CMV
    H: HSV
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11
Q

What are risk factors of perinatal HIV transmission?

A
  • advanced maternal disease
  • high maternal viral load
  • ruptured membrane for > 4 hrs [long labor]
  • breast feeding
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12
Q

What is current treatment for pregnant HIV+ to prevent transmission?

A
  • multi drug ARV regimen
  • cesarean delivery
  • ARV prophylaxis
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13
Q

What are signs of group B strep in pregnant woman?

A
  • asymptomatic, UTI, amnionitis, sepsis
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14
Q

How do you prevent baby with strep B?

A
  • screen at 35 wks

- treat during labor or 4 hrs before cesarean

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15
Q

What is risk of mother-infant transmission GBS?

A
  • 50% of infected mothers pass it on, only 2% have symptoms
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16
Q

What are symptoms of infant group B strep?

A

within first week of life:

  • early onset sepsis
  • pneumonia
  • meningitis
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17
Q

What are indications for giving GBS prophylaxis?

A
  • infant with invasive GBS during previous pregnancy
  • pos GBS screening during current pregnancy
  • unknown GBS AND deliver < 37 wks
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18
Q

What is treatment for GBS prophylaxis?

A

first choice: penicillin or ampicillin

2nd: clindamycin
3rd: vancomycin

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19
Q

When is maternal morbidity from pregnant influenza greatest?

A

highest maternal morbidity later in pregnancy

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20
Q

What are recommendations of influenza vaccine in pregnancy?

A
  • give vaccine in any/all trimesters in pregnancy –> may passively transfer antibodies
  • fetus never in danger of picking up virus but itll help protect fetus early in life
21
Q

What is the most common congenital infection?

A

CMV

22
Q

What is effect of congenital CMV?

A
  • congenital hearing loss
  • range moderate hepato-splenomegaly to fatal illness
  • 80-90% have complications in 1st year of life –> vision impairment, mental retardation, hearing loss
  • in 1st trimester –> pregnancy loss
  • 2nd or 3rd trimester –> congenital disease
23
Q

What is risk of vertical transmission of CMV?

A

30-40%

24
Q

How do you screen for maternal CMV?

A
  • sometimes do CMV serologic screening
  • CMV IgM = not reliable, high false pos rate
  • paired serum test
25
Q

How do you screen for CMV in neonate?

A
  • culture/PCR amniotic fluid but does not predict severity

- ultrasound to assess severity

26
Q

Is there a vaccine for CMV?

A

NO

27
Q

Where does listeria infection come from?

A
  • processed food [deli meats]
28
Q

When do most listeria infections occur in pregnancy?

A
  • in 3rd trimester usually

- if 1st trimester = worse prognosis

29
Q

How does vertical listeria transmission occur?

A

listeria infects placenta = reservoir

30
Q

How can you get rid of listeria in pregnant woman?

A

only way is to remove placenta

31
Q

What is effect of listeria infeciton in mom?

A
  • 20-30% mortality in neonates
  • infection in early gestation –> sponatenous abortion
  • in late gestation –> risk of preterm birth
32
Q

How do you prevent pregnant listeria infection?

A
  • no deli meats
  • no soft cheeses
  • no unpasteurized milk
33
Q

What is treatment for listeria?

A

antibiotic [penicillin, ampicillin, amoxicillin] that can cross placenta and penetrate cell wall

34
Q

Is there higher risk for vertical transmission in early or late pregnancy of toxoplasmosis?

A
  • later in gestation more likely to be transmitted

- early infections more likely to be severe

35
Q

How do you dx congenital toxoplasmosis?

A

during pregnancy: serology, amniocentesis, toxoplasmosis test
after birth: serology, CT, neuro exam, toxoplasmosis

36
Q

classic in utero triad of toxoplasmosis

A

Chorioretinitis, intracranial calcifications, hydrocephalus

37
Q

effects of toxoplasmosis?

A
  • most infants asymptomatic but 85% have visual impairment later in life
38
Q

What is treatment for toxoplasmosis?

A

in utero: spiramycin then pyrimethamine + sulfadiazine

post natal: pyrimethamine + sulfadiazine for up to yrs

39
Q

What is preventive measure of HSV in pregnant women and at birth?

A
  • neg women avoid intercourse with pos partner in 3rd trimester
  • at 1st episode genital herpes or frequent recurrences –> treat with acyclovir
  • C section recommended with active disease
  • maybe intrapartum IV acyclovir also
40
Q

What is risk of vertical transmission HSV?

A
  • 30-50% risk when primary infection near term

- low risk when recurrent infection

41
Q

How do you prevent neonatal herpes?

A
  • prevent maternal acquition HSV

- avoid exposure to herpetic lesions during delivery

42
Q

What are effects of congenital rubella syndrome?

A
  • deafness
  • blindness
  • mental retardation
  • fetal death up to 20%, premature delivery
  • defects rare after 20 wks gestation
43
Q

When is highest risk of CRS? highest risk of transmission?

A
  • highest risk of CRS early in pregnancy
44
Q

What is treatment for congenital rubella?

A

supportive

45
Q

What are effects of varicella in maternal?

A
  • increased risk of varicella pneumonia, <1% of maternal infections transmitted vertically
46
Q

What are signs of congenital varicella syndrome?

A
  • chorioretinitis, congenital cataracts, cerebral cortical atrophy, variable degress of limb atrophy, skin scarring, GI reflux
47
Q

What does neonatal congenital varicella transmission occur?

A

less than 5 days before birth

48
Q

What is treatment of congenital varicella in mom? neonate?

A
  • don’t give vaccine [its life]
  • immediately give VZ Ig at exposure
  • mother –> hospitalize, acyclovir or valacyclovir
  • neonate: VZ Ig
49
Q

What are signs of neonatal HSV? treatment?

A
  • may be limited to skin/mucous membranes
  • may be systemic [including CNS]
  • treat: IV acyclovir if sero+ or if maternal infection was primary HSV

Microbiology Part 2 (30 decks)

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