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MIDW 305 > CBL 1 – Infections and TORCH > Flashcards

CBL 1 – Infections and TORCH Flashcards

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1
Q

Who should be screened for TORCH?

A

Everyone when taking antenatal history

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2
Q

Defn TORCH?

A

a group of infections that can cause serious birth defects or other conditions in a fetus if the mother contracts the infection during pregnancy

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3
Q

What are the TORCH infections? (6)

A

Toxoplasmosis
Other agents (HIV, syph, parvo B19, varicella, zika)
Rubella
Cytomegalovirus (CMV)
Herpes Simplex Virus (HSV)

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4
Q

Risk factors for toxoplasmosis ? (4)

A
  • Food (raw/undercooked)
  • Outdoor cats
  • Gardening (the soil)
  • Vertical transmission
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5
Q

Is there routine screening for toxoplasmosis?

A

No, except for immunocompromised people

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6
Q

Rate of vertical transmission of toxoplasmosis?

A

20-50%

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7
Q

Symptoms of toxoplasmosis?

A

Flu like illness

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8
Q

How is toxoplasmosis confirmed?

A

Serology

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9
Q

What do you do if a client has toxoplasmosis?

A

CONSULT

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10
Q

How to screen for HSV?

A

Always ask about genital herpes for client AND partner

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11
Q

If someone has a Hx of HSV what should you order?

A

Type specific serologies

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12
Q

When is the greatest risk of HSV for vertical transmission/transmission through vaginal birth?

A

Primary infection in T3

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13
Q

What is the chance of HSV vertical transmission for primary T3 infection?

A

30-50%

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14
Q

What are the recommendations for T3 for people with Hx of HSV in pregnancy?

A

Vacyclovir or Acyclovir starting at 36 weeks

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15
Q

What are the recommendations for HSV outbreak in labour/ROM ?

A

CS <4 hours + CONSULT obvi

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16
Q

Risk factors for Parvovirus? ) (4)

A

Teachers
Household contact
Early Childhood Educators
Caregivers

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17
Q

Is routine screening recommended for 5ths disease/Parvo?

A

No

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18
Q

How many people are immune to parvo?

A

Most, 50-75% people

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19
Q

Symptoms of parvo?

A

Flu like symptoms

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20
Q

Confirming parvo infection?

A

Serology

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21
Q

What to do with confirmed parvo infection?

A

Consult

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22
Q

How many people are immune to varicella?

A

> 90 %

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23
Q

Are you at risk for vertical transmission of varicella if immune?

A

No

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24
Q

If non immune with varicella infection what should you do? (3)

A

Consult OB for VZVIG within 96 hours of exposure
Consider immunization in newborn if exposed near time of birth
If client becomes symptomatic consult ASAP

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25
Can RMs Rx and admin Varicella vaccine pp?
Yes
26
How often should you screen for syphilis?
Twice in pregnancy (once at initial appointment and once in T3 (planning HB) or in labour)
27
What is the most common intrauterine infection?
CMV
28
Symptoms for CMV?
Flu like, but largely asymptomatic
29
Most common nb sequelae for CMV transmission?
Hearing Loss
30
Who should be screened for Rubella?
Everyone
31
When should rubella vaccine be offered if not immune?
PP
32
When would you not re-immunize with low levels for rubella?
Equivocal/Low dose after 2 MMR vaccines
33
What should you do if rubella infection in pregnancy?
Consult
34
What are the risks of COVID for pregnant people?
>risks of hospitalization in pregnancy
35
Risks for fetus pregnant person with COVID 19?
- Higher rates of PTB - Higher rates of NICU admission
36
Management of COVID hospitalization in pregnancy?
3rd trimester growth ultrasound EMF in labour Send placenta to pathology
37
What is Toxoplasmosis?
Part of TORCH, parasite
38
What should you order for suspected toxoplasmosis infection?
IgG and IgM, repeat 2 weeks later
39
What should you order for confirmed Toxoplasmosis infection?
Amnio after 18 weeks GA and within 4 wks of exposure U/S if amnio unclear (IUGR, microcephaly, etc)
40
What is the Tx to reduce chance of toxoplasmosis vertical transmission?
Spiramycin
41
What should you do if confirmed case of vertically transmitted Toxoplasmosis infection?
Refer to MFM
42
What are the types of HSV?
Type 1 – usually lip Type 2 – usually genitals Both can be found in genitals, and both cause viral shedding
43
Why are we concerned with HSV in pregnancy? (3)
- Part of TORCH – vertical transmission (rare) - Intrapartum (through contact with vaginal secretions in birth) - Postpartum (through direct skin contact)
44
What is the most risky HSV situation in pregnancy?
Primary exposure in 3rd trimester (30-50% chance of transmission to babe)
45
What are the possible clinical scenarios with HSV in pregnancy ? (3)
Primary (HSV 1 or HSV 2 IgM with no IgG and breakout) Non-primary – first recognized episode but has antibodies (IgG) Recurrent – clinical episode with someone with antibodies (IgG)
46
Management of HSV? (4)
- Offer type specific HSV testing to client in early pregnancy and repeat at 32-34 wks - Offer acyclovir/valacyclovir to partner or client at 36 wks - C/S if active lesions (consult not transfer) AND C/S if primary outbreak in T3 (transfer?) - Reduce FSE, ARM, instrumental delivery
47
What is fifth’s disease AKA parvovirus?
Part of TORCH, spread by resp secretions
48
Risks of parvo?
Most have no adverse outcomes >20 wks Risks of miscarriage <20 wks 13 %
49
Symptoms of parvo?
Flu, rash, joint pain, most asymptomatic
50
Is routine screening for parvo rec?
No, most people are immune
51
Who is more likely to get parvo?
Parents, people working with kids
52
What to do if parvo infection diagnosed?
Refer to MFM or OB for regular US/Dopplers to rule out anemia and hydrops
53
What to do if someone is exposed to varicella and not immune in preg?
Serum testing Immunoglobulin administered in 96 hrs of exposure Cannot be Rx by midwives for some reason
54
What to do if someone is symptomatic of varicella and not immune? (3)
Oral acyclovir Detailed US Hospital admission
55
What should you consider if varicella outbreak close to birth?
Newborn immunization
56
Recommendation for CMV exposure with no previous immunity?
Amnio at least 7 weeks after onset after 21 wks GA Serial US (IUGR, microcephaly, liver calcifications)
57
Incidence of fetal transmission with primary infection of CMV?
Primary infection 30-40 % vertical transmission, 25 % sequelae to fetus if infected
58
CMV fetal sequalae? (3)
* Hearing loss * visual impairment * delay of motor development
59
Fetal risks of Rubella?
Severe <16 wks Miscarriage, congenital rubella syndrome
60
Tx of rubella in pregnancy?
- Post exposure prophylaxis immunoglobulin - Risk of VT – offer termination >16 wks
61
What level of IgG non immune rubella?
<10 iu/ml
62
Reading serologies?
IGG - good (there forever) – immune? IGM - Mal (iMmediate) – active infection
62
Who is recommended to have CS with HSV?
Primary outbreak in T3 Legions at time of delivery (controversial)
63
Vaccines to be avoided in pregnancy?
MMR and Varicella
64
What are the T1 lab reqs?
● Blood group and antibody screen ● CBC ● HIV serology ● STS serology (Syph, chlamyd, Hep B) ● HBsAg ● anti-HCV (for clients with risk factors) ● Rubella antibody titre ● CT/GC ● Urine C&S (1)
65
How is toxo diagnosed?
Can be identified with serologic testing or amniocentesis, or by the presence of abnormal ultrasound findings. Amnio is more diagnostic.
66
What could fetal effects of syphilis be?
○ skeletal deformities ○ severe anemia ○ Hepatomegaly ○ Spleenomegaly ○ Jaundice ○ CNS issues including blindness and loss of hearing ○ skin rashes ○ Meningitis ○ Prematurity ○ Low birth weight ○ Miscarriage, stillbirth, neonatal death - fetal / neonatal demise occurs in 40% of affected pregnancies
67
What is the OTHER in TORCH (5)?
syphilis, varicella, parvovirus, HIV, hep B
68
Which parts of TORCH do we routinely test for?
Syphillis Rubella Varicella (if not immune) HIV Hep B
69
What is the transmission rate from parvo B19 infection to fetus?
17-33%
70
What could childhood effects of syphilis be?
○ <2 years from birth ■ asymptomatic ■ Preterm birth ■ Low birthweight ■ Stillbirth ■ Disseminated infection ■ Skin or mucous membrane lesions ■ Bone deformities ■ Anemia ■ Hepatosplenomegaly ■ Neurologic complications as above, deafness ○ >2 years from birth ■ Scarring of cornea ■ Lymphadenopathy ■ Dental abnormalities
71
What does parvo look like in children?
Red cheeks, flu
72
Does Varicella testing need to happen routinely?
No, screening first if they have had it (prior to 2004) or had routine vaccines
73
What can happen if parvo crosses placenta?
Miscarriage Hydrops Fetal anemia Hypoxia Impaired hepatic function
74
What is the chance of nb transmission with active recurrent HSV lesions at time of birth for vag birth?
2-5 %
75
What are the potential abn findings on US for toxo? (6)
○ Hydrocephalus ○ Intracranial calcifications ○ Microcephaly ○ Fetal growth restriction ○ Ascites ○ Hepatosplenomegaly
76
Risks of toxo for the fetus?
Vertical transmission can lead to blindness, cerebral/cardiac anomalies
77
Serology for toxo?
IgG/IgM both negative = absence of infection or extremely recent acute infection Positive IgG + negative IgM = old infection (infection greater than 1 year ago) Both IgG/IgM both positive = recent infection OR false-positive test result
78
Serology for 5ths disease/parvo
+ IgG, - IgM = immune - IgG, + IgM = recent infection/false positive + IgG, + IgM = recent infection, repeat bloodwork should show increasing parvovirus B19 IgG titre. If IgG titre does not increase, then it indicates an older infection - IgG, - IgM = non-immune susceptible to infection
79
What is OTHER in Torch ? (5)
syphilis varicella parvovirus HIV hep B
80
Tx for syph?
Benzathine Pen G (different than Pen G we give in labour) 2.4 million units IM weely 1-2 x
81
Tx for chalmydia?
Amox 500 mg PO TID 7 days
82
Potential U/S findings that can relate to TORCH congenital infections ? (9)
-Big heart -Big spleen/lover -Big plaenta -Big brain -Hydrops IUGR -Oligo/Poly -Brain calcifications -Abdominal calcifications - - Cerebral ventriculomegaly -Intracranial calcifications -Cardiomegaly - Hepatosplenomegaly -Intra-abdominal calcifications -Hyrdops Fetalis -Placentomegaly -Hydroamnio/Oligo -IUGR

MIDW 305 (13 decks)

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