CP6-3 clinical infections in childhood and pregnancy Flashcards
(58 cards)
What are potential consequences of infection in pregnancy?
miscarriage
Congenital abnormalities
Fetal death
Preterm delivery
Preterm rupture of the membranes
How do babies get passive immunity?
By maternal antibodies crossing the placenta to the foetus encouraging vaccination
What is an infection dangerous in pregnancy especially in 3rd trimester?
Chicken pox aka VSV
When is vertical transmission of HIV from mother to baby most likely to occur?
During birth
Breastfeeding
How is transmission of hepatitis B from mother to baby prevented?
Immunoglobulins for passive immunisation are given to the baby after birth
What is torch screening?
Screening mother’s blood for infections that can be vertically transmitted
T = toxoplasmosis
O = others - HIV, syphilis, hep B, VSV, coxsackie virus
R = rubella
C = cytomegalovirus disease
H = herpes simplex complex
How are the TORCH infections transmitted from mother to baby?
Haematogenously
What are common perinatal infections not screened for by TORCH screening?
Group B strep
Listeriosis
Gonorrhoea
Chlamydia
Influenza
What can group B strep infection in the genital tract lead to?
Neonatal sepsis
Why is group B strep not widely screened for in pregnancy in the UK?
As risk of false positives/negatives and often infection cleared before giving birth so causes more worry than benefit
What treatment is offered if a pregnant women is diagnosed with having group B strep?
Intra-partum antibiotics if wanted +/- screening at 35-37 weeks and offer antibiotics again at this time
What is chorioamnionitis?
Inflammation of umbilical cord, amniotic membranes/fluid and placenta
What are risk factors for chorioamnionitis?
rupture of membranes (e.g. water breaks early)
Amniocentesis (a test for genetic and chromosomal conditions using a sample of amniotic fluid)
Cordocentesis (a test which uses a sample of blood from the umbilical cord to detect abnormalities)
Cervical cell age
Multiple vaginal exam
What is the pathogenesis of intra-amniotic infections?
bacteria present in the vagina cause infection by ascending through the cervix
or rarely haematogenously e.g. listeria moncytogenes
What are the main organisms that can a cause intra-amniotic infection?
strep B
E. coli
genital mycoplasma species
How are intra-amniotic infections treated?
intra-partum antimicrobials and delivery to the foetus at the time of diagnosis - not after delivery
What is puerperal endometritis and its risk factors ?
Infection of the uterus lining during puerperium (postpartum period) which can lead to puerperal sepsis.
Risk factors include:
C-section
prolonged labour
prolonged rupture of membranes
multiple vaginal examinations
What are clinical features of peurperal endometritis?
fever after delivery (>/= 38.5 in first 24 hours, >/=38 for 4+ hours, 24+ hours after delivery)
uterine tenderness
abdo pain
purulent, foul-smelling lochia (discharge after birth)
general malaise
What organisms commonly causes puerperal endometritis?
E. coli
Group A and B strep aka beta-haemolytic strep
anaerobes
How is puerperal endometritis treated?
broad spectrum IV antimicrobials until patient is apyrexial (normal temp) for 48 hours
What is early onset neonatal sepsis?
sepsis in newborn babies within 72 hours of birth
What is the most common cause of early onset neonatal sepsis?
Group B strep
E. coli
What babies are most at risk of early onset neonatal sepsis?
premature and low birth weight babies
What is late onset neonatal sepsis?
sepsis in neonates >72 hours after birth
