Effects of infections in pregnancy Flashcards Preview

HD CC > Effects of infections in pregnancy > Flashcards

Flashcards in Effects of infections in pregnancy Deck (46)
Loading flashcards...
1
Q

Infections harmful to mother

A

Influenza

2
Q

Infections harmful to foetus

A
Toxoplasmosis
HSV
Syphilis
Parvovirus B19
CMV
Rubella
3
Q

Infections harmful to both mother and foetus

A

Hep A/E/B/C
VZV
HIV

4
Q

Acronym for harmful to foetus

A
ToRCHeS
Toxoplasmosis
Other
Rubella
Cytomegalovirus (CMV)
Herpes simplex virus (HIV , hep)
Syphilis
5
Q

Diagnosing infection in pregnancy

A

Serology
IgG signifies past infection
PCR- detection of viral or bacterial DNA or RNA

6
Q

Cytomegalovirus (CMV)

A

Very common- 50% adults past exposure

Transmission can be via saliva, blood, sex, organ transplant or mother- anytime during pregnancy

7
Q

Congenital CMV Cause

A
Primary infection more likely to cause it
Most likely in 1st trimester
Intrauterine- 1st, 2nd or 3rd trimester
Intra-partum
Post partum e.g. breast milk
8
Q

Congenital CMV facts

A

7 per 1000 births

9
Q

Congenital CMV diagnosis

A

Maternal serology- CMV IgG and IgM

Neonatal urine/saliva for CMV DNA PCR

10
Q

Congenital CMV symptoms

A

Intra uterine growth retardation
Hepatosplenomegaly
Microcephaly
Sensorineural deafness

11
Q

CMV + deafness

A

Commonest congenital cause of sensorineural hearing loss

12
Q

Varicella Zoster Virus (VZV)

A

80-90% adults immune
V infectious- droplet/airborne
Mother- worse the later
Foetus- complicated

13
Q

VZV CNS complications

A

VSV encephalitis/meningitis

14
Q

Least contagious to most contagious R0

A

Hep C –> ebola –> HIV –> SARS –> Mumps –> measles

15
Q

VZV diagnosis

A

Swab of vesicle fluid- viral PCR

Maternal serology

16
Q

VZV Management

A

Varicella Zoster ImmunoGlobulin
Vaccination
TREATMENT- (val)acyclovir (safe during pregnancy)

17
Q

VZV treatment

A

(val)acyclovir

Safe during pregnancy

18
Q

VZV in children

A

Chicken pox

19
Q

VZV in adults

A

Shingles

20
Q

Congenital Varicella syndrome

A

Higher risk in 2nd trimester
Skin lesions (73%)- leading to limb hypoplasia
CNS (62%)- microcephaly, hydrocephaly, neurodevelopmental delay
Cataracts/other eye problems
GI, genitourinary + cardiac abnormalities
Miscarriage

21
Q

Neonatal varicella

A

Mother has VZV around time delivery
–> most severe if 5-2 days before delivery
V severe/fatal
Neonate should receive VZIG and acyclovir

22
Q

Herpes Simplex Virus

A

V common

>90% adults HSV 1 antibodies by 40

23
Q

Neonatal HSV Infection

A

Most acquire infection perinatally
Nearly all infants manifest disease
Mortality 65% untreated
Mortality 25% if treated with acyclovir

24
Q

Rubella

A
German measles
>95% population have antibodies
Uncommon
Outside of pregnancy- self-limiting, rash, lymphadenopathy, arthralgia
Diagnosis- serology/oral fluid PCR
25
Q

Congenital rubella

A
Risk to pregnancy dependant on gestational age- highest when below 11/40 weeks- 90%
20% risk if below 20 weeks
Microcephaly
Heart disease
Petechiae and purpura
Eye anomalies
26
Q

MMR

A

Measles Mumps Rubella

27
Q

Parvovirus B19

A
Cellular target is RBCs
Diagnosis- maternal serology/PCR, foetal ultrasound
0-20 weeks- 9% risk of foetal loss
9-20 weeks- 3% risk of hydrops fetalis
>20 weeks- negligible
28
Q

Hydrops fetalis

A

Caused by heart failure secondary to poor RBC production or aplasia
Due to parvovirus B19
Treated by intrauterine cord blood transfusion

29
Q

Toxoplasmosis

A

Infection due to Toxoplasma gondii
Natural host is cat
Humans are intermediate host through ingestion of oocyst- cat faeces or infected meat
Infection is lifelong

30
Q

Toxoplasmosis MOA

A

Evades immune detection as intracellular pathogen
Cysts in different tissues- favours muscle, brain etc.
Reactivation causes problems in immunocompromised e.g. HIV

31
Q

Toxoplasmosis risk acquirement odds ratio

A

Cat ownership- 0.7
Gardening- 2
Eating raw meat- 2.6
Eating cured meat- 2.9

32
Q

Congenital toxoplasmosis

A

Risk to foetus highest during first trimester
IUGR, hydrocephalus, cerebral calcification, microcephaly, hepatosplenomegaly
Diagnosis- maternal serology/amniotic fluid PCR

33
Q

Congenital toxoplasmosis

A

Spyramicin

Pyrimethamine/sulfadiazine/folinic acid

34
Q

Congenital toxoplasmosis

A

No vaccine

Avoid gardening, don’t handle cat litter, avoid uncooked or cured meats

35
Q

Syphilis

A

Spirochete Treponema pallidum
STI
Diagnosis- clinical syndrome + serology- treponemal and non treponemal specific
Highest risk of transmission during 2st trimester or peripartum
Can be associated with miscarriage/still birth/prematurity

36
Q

Syphilis treatment

A

Penicillin

37
Q

Congenital syphilis- Early, 0-2 years

A
Rash
Rhinorrhoea
Osteochondritis
Perioral fissures
Lymphadenopathy
GN
38
Q

Congenital syphilis- Late, >2 years

A
Hutchinson's teeth
Clutton's joints
High arched palate
Deafness
Saddle nose deformity
Frontal bossing 
Desquamations
Snuffles- syphilitic rhinitis, mucus which is full of T.pallidum
39
Q

Hutchinson’s Triad

A

Due to congenital syphilis
Deafness
Hutchinson’s teeth
Interstitial keratitis- inflamed cornea

40
Q

Antenatal infection screening

A
At 12/40 weeks
HBV
HIV
Syphilis
CMV/toxoplasma/VZV

Rubella no longer part of antenatal screening from April 2016

41
Q

Sepsis

A

Leads to premature labour or IUGR

42
Q

UTI

A

Higher risk of outflow obstruction

Gestational diabetes

43
Q

Peripartum sepsis

A

Infection of retained products of conception, chorioamnionitis

44
Q

Group B strep

A

Risk of neonatal sepsis

45
Q

Termination >24 weeks

A

Only if substantial risk that child born would be severely handicapped

46
Q

Ethics around antenatal screening

A

Allows early detection of high risk pregnancies
Serology can be difficult to interpret
Retrospective testing for TORCH infections may lead to
–> future diagnostic procedures e.g. amniocentesis
–> decisions regarding continuation of pregnancy
–> often no treatment available