Conditions arising in pregnancy

Question 1

Can alcohol affect the fetus?

Answer 1

Alcohol in pregnancy can cross the placenta and enter the fetus, where it disrupts fetal development.

Question 2

What are the effects of alcohol in early pregnancy?

Answer 2

The effects are greatest in the first 3 months of pregnancy, including miscarriage, small for dates, and preterm delivery.

Question 3

What is Fetal Alcohol Syndrome (FAS)?

Answer 3

FAS refers to certain effects found in children of mothers who consumed significant alcohol during pregnancy.

Question 4

What are the features of Fetal Alcohol Syndrome (FAS)?

Answer 4

1. microcephaly (small head)
2. thin upper lip
3. Smooth flat philtrum (the groove between the nose and upper lip)
4. short palpebral fissure (short horizontal distance from one side of the eye and the other)
5. learning disability
6. behavioural difficulties
7. hearing and vision problems
8. cerebral palsy

Question 5

What is Congenital Rubella Syndrome?

Answer 5

It is caused by maternal infection with the rubella virus during pregnancy, with the highest risk during the first 3 months.

Question 6

What is important for rubella immunity in women planning to become pregnant?

Answer 6

• women planning to become pregnant should have the MMR vaccine
• if in doubt they can be tested for rubella immunity
• if they don’t have antibodies to rubella they can be vaccinated with 2 doses of the MMR 3 months apart

Question 7

Can pregnant women have the MMR vaccine?

Answer 7

No, as it’s a live vaccine. Non-immune women should be offered the vaccine after giving birth.

Question 8

What are some features of Congenital Rubella Syndrome (CRS)?

Answer 8

• congenital cataracts
• congenital heart disease (PDA and pulmonary stenosis)
• learning disability
• hearing loss

Question 9

What does Varicella Zoster Virus (VZV) cause in pregnancy?

Answer 9

It causes chickenpox and can lead to severe cases in mothers, such as varicella pneumonitis, hepatitis, or encephalitis.

Question 10

How can a mother test for immunity against chickenpox?

Answer 10

Mothers who have previously had chickenpox are immune. If in doubt, IgG levels for VZV can be tested.

Question 11

What can a mother be treated with if not immune to chickenpox in pregnancy?

Answer 11

They can be treated with IV varicella immunoglobulins as prophylaxis against developing chickenpox within 10 days of exposure.

Question 12

What should be given if the chickenpox rash starts in pregnancy?

Answer 12

Oral aciclovir can be given if presented within 24 hours and more than 20 weeks gestation.

Question 13

When does Congenital Varicella Syndrome occur and what are its features?

Answer 13

• when there’s infection in the first 28 weeks of gestation
• fetal growth restriction
• microcephaly, hydrocephalus and learning disability
• scars and significant skin changes following the dermatomes
• limb hypoplasia (underdeveloped limbs)

Question 14

What is Congenital Cytomegalovirus (CMV)?

Answer 14

It is an infection due to maternal CMV infection during pregnancy.

Question 15

How is Congenital CMV spread?

Answer 15

It spreads via the infected saliva or urine of asymptomatic children.

Question 16

What are the features of Congenital CMV?

Answer 16

• most cases of CMV in pregnancy don’t cause congenital CMV
  1. fetal growth restriction
  2. microcephaly
  3. hearing loss
  4. vision loss
  5. learning disability
  6. seizures

Question 17

What is Congenital Toxoplasmosis?

Answer 17

It is an infection with the Toxoplasma gondii parasite, usually asymptomatic, but can lead to congenital toxoplasmosis if contracted during pregnancy.

Question 18

How is Congenital Toxoplasmosis spread?

Answer 18

It is spread by contamination with feces from a cat that is a host of the parasite.

Question 19

What is the triad of features for Congenital Toxoplasmosis?

Answer 19

1. intracranial calcification
2. hydrocephalus
3. chorioretinitis

Question 20

What is Congenital Zika Syndrome?

Answer 20

It is caused by the Zika virus, which is spread by Aedes mosquitos and can also spread through sexual contact.

Question 21

What are the symptoms of Zika virus in a normal person?

Answer 21

It can cause no symptoms, minimal symptoms, or mild flu-like illness.

Question 22

What does Congenital Zika Syndrome involve?

Answer 22

It can lead to microcephaly, fetal growth restriction, and other intracranial abnormalities eg. ventriculomegaly and cerebellar atrophy

Question 23

What investigations and management are needed for suspected Zika virus in pregnancy?

Answer 23

• pregnant women that may have contracted the virus, should be tested for the viral PCR and antibodies to the Zika virus
• women with a positive result should be referred to fetal medicine to monitor the pregnancy
• there’s no treatment for the virus