Infcetions in Pregnancy

Question 1

How is chicken pox spread?

Answer 1

Respiratory droplets

Question 2

What are the symptoms of chicken pox?

Answer 2

Fever
Malaise
Itchy vesicular rash

Question 3

When is chicken pox infective?

Answer 3

48hrs before rash develops to once the chicken pox lesions have crusted over (usually 5-7 days after the rash starts)

Question 4

In children, what is the treatment for chickenpox?

Answer 4

Nothing as usually harmless and self-limiting

Question 5

In adults, chickenpox is associated with a greater morbidity and can increase risks of the development of what?

Answer 5

Hepatitis
Pneumonitis
Encephalitis

->risk especially pronounced in immunocompromised and in pregnancy so important to ask women about chicken pox history in their appointment

Question 6

If a women is pregnant and has no history of chickenpox, what advice should be given?

Answer 6

Avoid exposure to anyone with chickenpox or shingles during pregnancy and seek urgent medical help if they do

Question 7

What syndrome may occur in the foetus if there was maternal primary chickenpox?

Answer 7

Foetal varicella syndrome

Question 8

What can foetal varicella syndrome cause to happen?

Answer 8

Skin scarring
Congenital eye abnormalities
Hypoplasia of ipsilateral limbs
Neurological abnormalities

Question 9

What happens if chickenpox infection occurs in the last four weeks of pregnancy?

Answer 9

Risk of infection in the newborn

Question 10

If a pregnant women has had significant exposure to chickenpox but is unsure if she is immune, what can be done?

Answer 10

Take serum IgG:

If immune (IgG positive), reassure
If non-immune (IgG negative) , offer Varicella Zoster immunoglobulin asap

Question 11

What shoulder be done if a pregnant person develops mild chickenpox infection and presents within 24hrs of onset of rash?

Answer 11

Advise to avoid other potentially susceptible individuals e.g. other pregnant people or neonates

Oral aciclovir

Advise regarding symptomatic treatment and hygiene to prevent secondary bacterial infection

Question 12

What shoulder be done if a pregnant person develops mild chickenpox infection and presents after 24hrs of onset of rash?

Answer 12

Advise regarding symptomatic treatment and hygiene to prevent secondary bacterial infection

Question 13

What shoulder be done if a pregnant person develops severe chickenpox infection?

Answer 13

IV aciclovir
Admit to hospital

Question 14

What causes shingles?

Answer 14

Reactivation of the chickenpox virus which has remained dormant in the sensory nerve root ganglion

Question 15

Can you catch chickenpox from someone with shingles?

Answer 15

Yes, but it’s rare

Question 16

What is parvovirus B19?

Answer 16

Common and mild febrile illness, commonly seen in childhood.

50% approx of women will be immune

Question 17

How is parvovirus B19 spread?

Answer 17

Respiratory secretions

Question 18

How does parvovirus B19 present?

Answer 18

Fever
Erythema of cheeks
Rash

->can be known as slapped cheek disease
Most adults are completely asymptomatic

Question 19

What is the treatment for parvovirus B19?

Answer 19

No treatment or vaccine available as usually harmless

Question 20

What can parvovirus B19 cause in immunocompromised patients?

Answer 20

Aplastic anaemia
Haemolysis

Question 21

What can parvovirus B19 infection in pregnancy lead to?

Answer 21

Foetal anaemia leading to cardiac failure, hydrops fatalis and foetal death

->rare but can cause preeclamptic condition in mother with significant oedema

Question 22

What is the most critical exposure period of parvovirus B19 in pregnant people?

Answer 22

12-20wks
Foetal infection occurs 5wks after maternal infection

Question 23

What should be done if a pregnant person reports exposure to parvovirus B19?

Answer 23

Blood samples for immunoglobulin testing

Question 24

What happens if immunoglobulin testing for parvovirus B19 comes back positive?

Answer 24

Weekly scans are offered to monitor foetal complications

Question 25

Which microorganism causes toxoplasmosis?

Answer 25

Toxoplasma Gondi

Question 26

How is toxoplasmosis infection usually transmitted?

Answer 26

Usually from infected cat faeces or consumption of undercooked meats

Question 27

Symptoms of toxoplasmosis?

Answer 27

Usually asymptomatic in adults Mild, flu-like symptoms e.g. fever, sore throat, arthralgia

Question 28

What are some of the potential serious complications which can occur as a result of toxoplasmosis?

Answer 28

Chorioretinitis Encephalitis Myocarditis Pneumonitis

Question 29

How long after ingestion of the parasite does parasitaemia of toxoplasmosis occur?

Answer 29

Within 3wks of ingestion

Question 30

What measures should pregnant people take to reduce risks of toxoplasmosis?

Answer 30

Avoid cleaning cat litter trays Avoid consumption of undercooked meats

Question 31

Congenital infection of toxoplasmosis is rare but can have serious foetal complications if it does occur. What are some of these?

Answer 31

Hydrocephalus Intracranial calcifications Microcephaly Chorioretinitis Ascites Hepatosplenomegaly Can cause miscarriage and intrauterine death

Question 32

How can toxoplasmosis of the foetus be diagnosed?

Answer 32

PCR of amniotic fluid

Question 33

A 24wk pregnant woman phones you, her GP, as she has just found out her nephew has chicken pox. She had had significant contact with him on Saturday and the rash appeared on Sunday evening. She is unsure is she has been previously infected. What is the most appropriate action? A. Give Varicella Zoster immunoglobulin B. Give IV aciclovir C. Give oral aciclovir D. Take serum IgG to check her immunity status E. No action, as you are not infectious before developing the rash.

Answer 33

D- take serum IgG to check her immunity status ->if found to have no immunity, give Varicella Zoster immunoglobulin

Question 34

Does HIV increase risks of congenital abnormalities?

Answer 34

No

Question 35

What can HIV increase risks of in pregnancy?

Answer 35

Pre-eclampsia Miscarriage Preterm delivery Low birth weight

Question 36

What can be offered to pregnant people with HIV?

Answer 36

Serial four weekly foetal growth scans

Question 37

What should all babies born to HIV positive mothers be referred to?

Answer 37

Neonatology for HIV testing

Question 38

How does breastfeeding increases risks of HIV in the foetus?

Answer 38

Can increase risks of vertical transmission

Question 39

Which type of meds are pregnant people with HIV put on?

Answer 39

Anti-retrovirals

Question 40

Throughout pregnancy, what do people on anti-retrovirals be monitored for?

Answer 40

LFTs CD4 count HIV viral load ->if HIV viral load is low, vaginal birth is supported, otherwise C-section is advised

Question 41

How can hepB be transmitted?

Answer 41

Many cases spread by vertical transmission Bloods or other bodily fluids

Question 42

What can happen to babies born to mothers with acute HepB infection?

Answer 42

Majority will contract HepB Increased risks of cirrhosis and hepatocellular cancer

Question 43

What should women with chronic hepatitis B with a high viral load be offered in their third trimester?

Answer 43

Tenofovir monotherapy to reduce risks of HepB transmission to baby

Question 44

What can be given to pregnant women who are at high risks of HepB?

Answer 44

HepB vaccine as it is inactivated so safe in pregnancy ->just so you know, risks of HepB include IVDU, partner with HIV or HepB

Question 45

Is vaginal birth safe if the mother has HepB?

Answer 45

Yes

Question 46

What should be offered to babies who's mother has HepB?

Answer 46

Hepatitis B immunoglobulin

Question 47

What can HepC lead to?

Answer 47

Severe hepatitis Chronic liver disease Increased risk of liver cancer

Question 48

What are most cases of HepC associated with?

Answer 48

Prior injecting drug usage

Question 49

What can decline in pregnancy in those with HeoC?

Answer 49

Liver function

Question 50

How common is vertical transmission in pregnant people with HIV and their child?

Answer 50

Common, 1 in 20, higher in coinfected with HIV

Question 51

How is HepC treated in pregnancy?

Answer 51

Should not be treated as the drugs are teratogenic and are contraindicated

Question 52

Can vaginal birth occur if mother has HepC?

Answer 52

Yes

Question 53

Which microorganism causes syphilis?

Answer 53

Treponema palladium

Question 54

How is syphilis transmitted?

Answer 54

Direct contact with skin lesion

Question 55

How can syphilis be treated?

Answer 55

With a course of antibiotics

Question 56

If untreated, what can chronic syphilis cause?

Answer 56

Neurological, cardiac, skeletal and skin abnormalities for adults and babies affected in utero

Question 57

What does syphilis in pregnancy increase risks of?

Answer 57

Miscarriage Stillbirth Hydrops fetalis Growth restriction Congenital infection

Question 58

How can syphilis be transmitted to babies?

Answer 58

Via placenta of infected mother Exposure to infected lesion at time of birth

Question 59

What is primary syphilis characterized by?

Answer 59

Painless local ulcer known as a canker

Question 60

What treatment is given if a pregnant person is found to have syphilis infection?

Answer 60

Prompt treatment of intramuscular penicillin

Question 61

Rarely seen in the UK, late congenital syphilis is a subset of congenital syphilis. It presents with Hutchinson's triad. What makes up this?

Answer 61

Deafness Interstitial keratitis Hutchinson's teeth- widely spaced, peg like