Infections in Pregnancy

Question 1

What is the organism in ‘Group B Streptococcus’?

Answer 1

Streptococcus agalactiae

Question 2

True / False: All pregnant women are screened for Group B Streptococcal infection

Answer 2

False: Screening and treatment is reserved for high risk women e.g. those with PROM, premature labour, previous infected baby, etc.

Question 3

Which organism is found in unpasturised cheese, processed meat, etc?

Answer 3

Listeria monocytogenes

Question 4

Give 2 ways in which a listeria infection can be transmitted from mother to baby

Answer 4

Transplacentally

Vertically (i.e. via birth canal in labour)

Question 5

True / False: Women found to be negative for rubella antibodies at booking bloods will immediately receive vaccination against rubella

Answer 5

False - There is no antenatal intervention given to women found to be rubella antibody negative. The screening is done to identify high risk women and to offer them rubella vaccination AFTER the pregnancy to prevent infection in future pregnancies

Question 6

How does congenital rubella infection affect the fetus?

Answer 6

Sensorineual deafness
Congenital cataracts
Blindness
Cardiac disease
Encephalitis

Question 7

Which virus gives a ‘slapped-cheek’ appearance?

Answer 7

Parvovirus B19

Question 8

Which virus causes chickenpox?

Answer 8

Varicella zoster virus (VZV)

Question 9

How can you test to see if a woman is immune to VZV?

Answer 9

Test VZV IgG antibodies

Question 10

How should a non-immune woman who has been exposed to chickenpox be managed?

Answer 10

Check immune status (by checking VZV antibody levels)…if immune, give VZV immunoglobulin, administered immediately (effective if given up to 10 days after exposure)

Question 11

How should chickenpox be treated in pregnancy?

Answer 11

Oral aciclovir

Question 12

Is rubella infection more dangerous to the foetus if it is acquired at the beginning or the end of a pregnancy?

Answer 12

More dangerous at the beginning - 100% of foetuses will suffer abnormalities if the infection is acquired within the first 11/40

Question 13

What are the symptoms of Group B streptococcal infection in pregnant women?

Answer 13

No symptoms - Group B strep is normal flora of the GI tract and vagina so the mother does not experience symptoms. It is dangerous if it is transferred to the baby.

Question 14

List some risk factors for Group B streptococcal infection being passed onto the baby?

Answer 14

Maternal pyrexia
PROM
Previous affected baby
Prematurity

Question 15

What steps are taken to prevent the baby from acquiring Group B strep. infection at birth?

Answer 15

IV penicillin given to all high risk women or those known to be infected. The neonate is monitored closely for signs of the infection.

Question 16

What are the maternal symptoms of listeria infection in pregnancy?

Answer 16

Flu-like symptoms
Fever
Shivers
Myalgia
Headache
Nausea + vomiting

Question 17

How is listeria in pregnancy diagnosed?

Answer 17

Relies on clinical suspicion - do blood cultures in any unexplained maternal pyrexia lasting more than 48hrs

Question 18

What is the treatment for antenatal listeria infection?

Answer 18

IV amoxicillin

Question 19

What are the maternal symptoms of toxoplasmosis infection?

Answer 19

Flu-like symptoms
Rash
Fever
Eosinophilia

Question 20

What is the treatment for antenatal toxoplasmosis infection?

Answer 20

Sulphadiazine

Pyrimethamine

Question 21

Which infectious conditions are screened for at the booking bloods?

Answer 21

HIV
Syphilis
Hepatitis B

Question 22

True / False: All pregnant women are screened for syphilis at booking?

Answer 22

True

Question 23

What is the management of a pregnant woman who acquires a herpes simplex virus in the 3rd trimester of pregnancy?

Answer 23

Acyclovir 400mg TDS until delivery

Caesarian section preferable

Question 24

What are the symptoms of antenatal CMV infection for the mother?

Answer 24

Usually mild, flu-like symptoms
Fever
Lymphadenopathy
Rash
Sore throat