Infection in pregnancy Flashcards
(36 cards)
Classified into screened infections [4] and non-screened infections [8]
Screened infections Congenital syphilis Hep B HIV Asymptomatic bacteriuria
Non-screened infections GBS VZV Measles Parvovirus Listeriosis Chlamydia trachomatis Clostridium perfringens TORCH
Congenital syphilis
Presentation [6]
Investigation [3]
Presentation:
- IUGR, Stillbirth 1/3 cases
- Haemorrhagic rhinitis, Rash
- Lymphadenopathy
- Thrombocytopenia, anemia
- Hepatosplenomegaly, jaundice, ascites
- Meningitis, keratitis, sensorineural deafness
Ix:
- nasal discharge exam for spirochetes
- CSF (increased monocytes, protein)
- positive serology
Congenital syphilis
Management
Mother [3]
Neonate [3]
- Maternal syphilis: maternal IM BENZYLPENICILLIN for 10d
* Congenital syphilis: IM BENZYLPENICILLIN for 21d
Vertical Hepatitis B infection
Routes of transmission [2]
Complications [2]
Labour, delivery, breastfeeding implications
During labour or transplacental
Complications: chronic hep B infection, HCC
Labour and delivery: normal
Breastfeeding: safe
Vertical Hepatitis B infection
Management of neonate [4]
- Dose of immunisation within 24h of birth (+ HBIG if no anti-Hbe or HBeAg +ve or BW<1500g)
- 6 in 1 at 8, 12 and 16w
- then another dose of the monovalent vaccine at 1y
- serology at 12-15m (protected if HBsAg -ve and anti-HBs +ve)
HIV
Antenatal care [4]
Management of neonate born to positive mothers [2]
Antenatal care:
- Screen for other infections
- Give pneumococcal, HBV, flu vaccines
- Start HAART
- If on cotrimoxazole, give 5mg folic acid in first trimester
Mx:
- Oral zidovudine if viral load <50
- > 50 viral load, Triple ART therapy for 4-6w
HIV
Labour and delivery: PROM [4], NVD [1], LSCS [2]
Breastfeeding
o PROM: - deliver if >34w - give steroids - ERYTHROMYCIN - ensure on HAART if <34w o Vaginal delivery: - if viral load <50 copies/mL at 36w o Caesarean section: - ZIDOVUDINE infusion started 4h before
Breastfeeding is not safe - risk of transmission
Asymptomatic bacteriuria
Effect on fetus [3]
Management [3]
IUGR, fetal death, premature labour
Mx:
- Cefalexin
- Avoid trimethoprim in first trimester (folate antagonist)
- Avoid nitrofurantoin in third trimester (neonatal hemolytic anaemia)
GBS
Investigation [2]
Effect on fetus [3]
RF [4]
- Urine culture or high vaginal swab
- Severe/early onset infection - meningitis, pneumonia, sepsis
Risk factors for Group B Streptococcus (GBS) infection:
- prematurity
- prolonged rupture of the membranes
- previous sibling GBS infection
- maternal pyrexia e.g. secondary to chorioamnionitis
Rubella Maternal consequences How is it spread? Investigation If exposed, management? [2] If no autoantibodies, management?
- Stillbirth, miscarriage
- Spread by respiratory droplets
- Ix: rubella autoabs (means previous infection or immunization)
- Exposure: contact health protection, offer TOP if confirmed in first trimester
- No autoantibodies: offer mum post-natal immunisation
If a mother tests negative for rubella autoantibodies what precautions should you advise?
Avoid anyone with rubella
Congenital rubella syndrome features [8]
Deafness Cardiac lesions Purpura Jaundice, hepatosplenomegaly CP, LD, microcephaly Cerebral calcification Micropthalmia, salt and pepper chorioretinitis Cataract Growth disorder
Maternal HSV
Why is it only a problem if its a primary infection?
Investigation [3]
Management [2]
Only a problem if primary cos secondary infections have maternal antibodies
Ix: refer mum and partner to GUM for PCR of HSV (also check if primary) and other infections
Mx:
- Oral aciclovir until due date with elective LSCS at term
Neonatal HSV
Effects on neonate [7]
Mx [2]
Blindness, LD, epilepsy, jaundice, respiratory distress, DIC, death
Mx: high dose IV acyclovir
Maternal chickenpox
Ix
Mx [3]
Investigation: varicella ab
Mx:
- If not immune, give VZIG up to 10d after exposure
- Oral acyclovir
- Refer to fetal medicine for detailed scan at 16-20w
Fetal varicella syndrome [6]
- complicates 1% of mothers infected between 3 and 28w due to reactivation in utero
- skin scarring
- micropthalmia
- chorioretinitis, cataracts
- microcephaly, cortical atrophy, LD
- bladder and bowel sphincter abnormalities
Neonatal varicella prognosis
Can cause death if mum pelops rash 2d- 5d before birth
Measles
Maternal Ix [2] and Mx
Fetal measles [3]
Ix: IgM positive after 4d but before 1m, test viral RNA in saliva
Mx:
- HNIG if maternal rash 6d pre- or post-delivery
Fetal:
- Fetal loss
- Preterm delivery
- No congenital infection unless 6d before/after delivery
What does HNIG prevent in measles infection?
to prevent neonatal subacute sclerosing panencephalitis
CMV
Maternal presentation [3]
Ix [3]
Route of transmission
Presentation
- Pyrexia
- Lymphadenopathy
- Sore throat
Ix:
- Paired sera
- Amniocentesis at >20w
- Viral shell culture (throat and urine)
Can be transmitted from toddler’s urine
Congenital CMV
Features [6]
Mx
- IUGR
- hepatosplenomegaly, jaundice
- thrombocytopenia
- chorioretinitis
- late onset problems are motor or cognitive impairment
- sensorineural deafness
90% of affected foetuses normal at birth; 10% are symptomatic (33% of these die)
Mx: supportive care
Maternal Toxoplasmosis
Presentation [3]
Ax [3]
- like glandular fever
- fever, rash
- eosinophilia
Ax: - transmitted from cat litter, lambing and uncooked meat
Maternal Toxoplasmosis
Ix [2]
Mx [5]
Ix: IgM and IgG
Mx:
Infected: SPIRAMYCIN
Symptomatic non-immune:
- re-test every 10w
- if +ve do amniocentesis to see if fetus infected
- if so give PYREMETHAMINE and SULFADIAZINE
Congenital Toxoplasmosis [7]
- intracranial calcification, hydrocephalus
- choroidoretinitis
- hepatosplenomegaly
- thrombocytopenia
- encephalitis, epilepsy
- physical and mental developmental delay
- skin rashes
