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HD2 > Effects of Infections in Early Pregnacy > Flashcards

Effects of Infections in Early Pregnacy Flashcards

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1
Q

What are the 2 ways to think of pregnancy in terms of infections?

A
  • relative immuno-suppression

- physiological changes in mother

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2
Q

Which infections are harmful to the mother?

A

Influenza

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3
Q

Which infections are harmful to the fetus?

A 
Toxoplasmosis
HSV
Syphilis
Parovirus B19
CMV
Rubella
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4
Q

Which infections are harmful to the mother and foetus?

A

Hepatitis (A, E, B, C)
VZV
HIV

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5
Q

How should you remember the main infections?

A 
TORCHES
Toxoplasmosis
Other (influenza, parovirus B19)
Rubella
Cytomegalovirus (CMV)
Herpes Simplex Virus, HIV, Hepatitis
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6
Q

How do you diagnose infection in pregnancy?

A
  • look for pathogen itself (PCR to detect viral DNA or RNA, very sensitive)
  • look for immune response to it (early IgM rise followed by IgG rise)
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7
Q

What is the footprint of infection?

A

IgG signifies part infection and is protective in many cases

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8
Q

What is cytomegalovirus?

A

CMV

  • very common (50% adults have past exposure)
  • primary infection subclinical
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9
Q

How is CMV transmitted?

A

Saliva
Blood/blood products
Sexual intercourse
Organ transplantation

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10
Q

When can CMV occur?

A

Any time during pregnancy

- primary infection more likely to cause congenital CM and will be most likely in 1st trimester of pregnancy

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11
Q

How to diagnose CMV?

A

Maternal serology - CM IgG and IgM

Neonatal urine/saliva - CMV DNA PCR

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12
Q

What are the wide range symptoms of CMV?

A

Severe - intra uterine growth retardation (non specific)
Hepatosplenomegaly
Microcephaly
Sensorineural deafness

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13
Q

What is the significance of deafness and CMV?

A
  • commonest congenital cause of sensorineural hearing loss
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14
Q

What is Varicella Zoster Virus?

A

Chicken Pox

  • Most adults immune
  • Lower % in tropical climates
  • extremely infectious via droplet/airborne
  • 1 person infects 10-12 susceptible individuals
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15
Q

What does the risk association of Varicella Zoster Virus depend on?

A
  • mother: worse the later

- foetus: more complicated

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16
Q

How is Varicella Zoster virus diagnosed?

A

Clinical syndrome
Swab of vesicle fluid
Maternal serology

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17
Q

How is Varicella Zoster virus prevented?

A

if known mother is IgG negative:

  • VZ immunoglobulin (post exposure)
  • Vaccination (pre-exposure)
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18
Q

How is Varicella Zoster virus treated?

A
  • valaciclovir

- safe during pregnancy

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19
Q

What is shingles?

Study These Flashcards
A

Reactivation of chicken pox in a nerve root

- doesn’t cross midline

20
Q

When is there high risk of congenital varicella syndrome?

Study These Flashcards
A
  • higher in second trimester
21
Q

What are the symptoms of congenital varicella syndrome?

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A
  • skin lesions (limb hypoplasia)
  • CNS (microcephaly, hydrocephaly, neurodevelopmental delay)
  • cataracts/eye problems
  • GI, genitourinary and cardiac abnormalities
22
Q

What is the risk of neonatal varicella?

Study These Flashcards
A
  • much higher than congenital

- during birth/just after deliver

23
Q

What is herpes simplex virus?

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A
  • extremely common
  • HSV2 related to sexual activity
  • associated with wide spectrum of disease (genital/oral ulceration, CNS infection)
24
Q

How does neonatal HSV infection arise?

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A
  • while passing through birth canal
  • if adults kiss child
  • if not treated = infection
25
How is neonatal HSV infection diagnosed?
- clinical - HSV DNA PCR neonate blood - vesicle swab - maternal vesicle swab
26
How is neonatal HSV managed?
Aciclovir treatment | - reduces mortality
27
What is rubella?
- uncommon - most of population have antibodies to rubella - self limiting outside of pregnancy = rash, lymphadenopathy - in pregnancy dangerous - no treatment
28
How is rubella diagnosed?
- serology | - oral fluid PCR
29
What are the risks of congenital rubella?
``` - greater earlier there is contraction RISK OF - microcephaly - heart disease - petechiae and purpura ```
30
What is Parovirus B19?
- slapped cheek disease - erythrocytes are cellular target - most adults have past exposure
31
How is parovirus diagnosed?
- maternal serology/PCR | - fetal ultrasound
32
At 0-20 weeks what is the risk of fetal loss?
9%
33
At 9-20 weeks what is the risk to the fetus?
3% risk of hydrops fetalis (heart failure) as has to work harder to produce Hb
34
At >20 weeks what is the risk to the fetus?
Negligible
35
What is toxoplasmosis?
- due to parasite toxoplasma gondii - natural host is cat - humans intermediate host through ingestion of oocyst (contact with cat feaces or eating infected meat)
36
What is the risk of congenital toxoplasmosis?
- lowest if maternal infection occurs in 1st trimester | - risk to foetus greatest during 1st trimester
37
What are the clinical features of congenital toxoplasmosis?
``` IUGR Hydrocephalus Cerebral calcification Microcephaly Hepatosplenomegaly ```
38
How is congenital toxoplasmosis diagnosed?
Maternal serology Amniotic fluid PCR
39
How is congenital toxoplasmosis prevented?
- no vaccine | - avoidance behaviour only (no gardening, don't handle cat little, avoid uncooked meats)
40
What is syphilis?
- STI - due to spirochete Treponema pallidum - common - highest risk during 1st trimester or peripartum - associated with miscarriage/still birth/prematurity
41
How is syphilis diagnosed?
Clinical syndrome and serology
42
How is syphilis treated?
Penicillin
43
What are the clinical features of early congenital syphilis?
early 0 to 2 years: - rash - rhinorrhoea - osteochondritis - perioral fissures - lymphadenopathy
44
What are the clinical features of late congenital syphilis?
Late >2 years - Hutchinson's teeth - Clutton's joints - high arched palate - deafness - saddle nose deformity - frontal bossing
45
What is looked for during antenatal screening?
Week 12 HBV, HIV, Syphilis, CMV/toxoplasmosa, VZV - regular US to monitor foetal development
46
When can termination of pregnancy be offered?
Before 24 weeks

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