Infections In Pregenncy Flashcards
(28 cards)
Which maternal infectious viruses can be passed on to the fetus and what are the clinical features
Varicella
Rubella
CMV
Clinical features of Rubella Congenital infection
1.Cataracts, glaucoma, microphthalmia
2.Pulmonary stenosis, patent ductus arteriosus, VSD
3.Microcephaly, mental retardation, deafness
4.Hepatosplenomegaly (HSM), jaundice, thrombocytopaenia
(purpura/petechiae), extramedullary haematopoiesis (“blueberry muf in” rash)
Investigations for rubella perinatally ¿
Exposed mother: IgG = immune
IgM = acute infection (2 samples 3 weeks apart)
Neonate: IgM = acute infection
Clin features of herpes in both mom and baby
Painful vesicles on vulva or vagina – often too painful to touch or urinate
May be asymptomatic, especially if lesions are on the cervix only
Lesions persist for 2-3 weeks.
Clinical features in the baby:
Infection in early pregnancy may cause miscarriage.
Congenital infection may cause microcephaly, jaundice, HSM and pneumonitis.
Neonatal infection (most common form) manifests as:
- Local skin lesions, eye and mouth involvement
- CNS involvement – encephalitis: with Rx, 6% mortality, 70% neurological
morbidity
- Disseminated disease: with Rx, 30% mortality, 17% morbidity.
Investigation for herpes perinatally
Viral PCR or culture of luid from vesicles
Clinical features of CMV
Mom
-most asymptomatic
-fever and malaise occasionally
-if immunocompromised May care retinitis, pneumonia, colitis, and disseminated infection
In baby
In first half:
- Mental retardation, microcephaly
-micropthalmia
-deafness
-seizure
-IUGR
-non-immune hydrops
-IUFD
Late in pregnancy
-jaundice
Petechia or purpuric rash
Blueberry muffin rash
Chorioretinitis
Pneumonitis
Haemolytic anaemia
Classic Tetrad
1. Mental retardation
2. Microcephaly or hydrocephaly
3. Cerebral calcification
4. Choriretinitis
How to diagnose CMV in pregnancy
Suspected CMV infection is NOT an indication for termination of pregnancy.
If suspected in a neonate, viral cultures or PCR (urine or blood) should be used.
IgG is not helpful (could be maternal).
IgM is positive in only 70% of infected neonates.
No vaccine is available yet
Management of CMV
Antiviral agents such as Foscarnet and Gancyclovir (very toxic) could have a
role in neonates with neurological involvement.
Clinical features if hepatitis in mom and baby
In mom
Jaundice
Dark urine
Fever
Malaise
Chronic hepatitis (10%)
In baby
High risk of asymptomatic chronic hepatitis, which may eventually be fatal,
causing cirrhosis and sometimes hepatocellular carcinoma in later life.
Management of hepatitis in pregnancy
Exposed babies: give hepatitis B hyperimmune globulin (HBV IgG) within 12
hours of birth, as well as the hepatitis B vaccine. Unless this is done, the infected
mother should not breastfeed.
Unexposed babies: routine hepatitis B vaccination.
Antiviral agents: tenofovir and lamivudine, interferon α, ribavirin
Clin features of varicella zoster in pregnancy 🫃
Varicella infection of the newborn is a severe infection with a mortality rate up
to 25%.
In baby
-Mental retardation, cortical atrophy
-cataracts, micropthalmia, chorioretinitis
-dermatomal scarring
-IUGR
-limb malformations
Management of varicella infection in pregnancy
Acyclovir
If a pregnant woman becomes exposed, assess immunity by serology.
90
If non-immune, offer varicella-zoster immune globulin (VZIG) – effective up to
10 days post exposure.
If a pregnant woman develops chickenpox during pregnancy, offer acyclovir
within 24 hours of the rash developing, and follow closely – there is high
incidence of complications and even mortality during pregnancy.
cover the baby with VZIG if exposed. If infected Acyclovir.
Clin features of parvovirus
In pregnancy, Parvovirus B19 may be asymptomatic, or result in a 10-15% risk
of fetal loss <20 weeks, 1% risk of loss >20 weeks, and a 3-10% risk of hydrops,
usually resulting in stillbirth
In mom
Transient fever
Arthritis
Which congenital infection is also know as the fifth disease of slapped cheek
Parvovirus B19
Clinical features of Toxoplasmosis
In baby
Periventricular hydrocephaly, convulsions, microcephaly, mental retardation,
encephalitis, intracerebral calci ications
Stillbirth
In mom
Mild flulike sx fever, fatigue, lymphadenopathy
Management of Toxo
Inv: igM in neonate or cord blood
Tx: sulfadiazine and Pyrimethamine, Spiramycine or Cotrimaxazole
Clin features of malaria
In mom
Periodic fever and chills, myalgia, malaise
Headache, convulsions, coma
Nausea, vomiting, diarrhoea; jaundice,
Respiratory distress, shock, metabolic acidosis, renal failure, hypoglycaemia
DIC, haemoglobinuria, anaemia, thrombocytopaenia
In baby
Increased incidence of
-miscarriage
-IUGR
-preterm delivery
-stillbirth
-fetal distress
Management of malaria in pregnancy
ABCD
-Avoid malaria areas
-Bite prevention with nets, repellents
-Chemoprophylaxis
-Diagnose and treat early
Prophylaxis: Me loquine (teratogenic), chloroquine & proguanil, atovaquone &
proguanil
Treatment: Quinine, or artemesinin-combination drugs.
Supportive treatment i.e. glucose control, transfusion, dialysis,
ventilation etc
Clinical features of listeriosis
In mom
Mild flu like sx eg fever, malaise, sore throat,, headache, conjunctivitis, diarrhea/vommiting
In baby
-Infections via ascending spread or trans placental
-Causes miscarriages or stillborn
-May cause recurrent pregnancy loss
-Listeria is the third most common organism causing neonatal meningitis.
If live birth, can get early onset disease ( irst 5 days of life)
- respiratory distress, fever,
skin rash and neurological involvement,
late onset disease (after 1-8 weeks)
-usually meningitis.
Management of listeriosis
Tx: IV Ampicillin and agent or Amoxicillin and Erythromycin
Pregnant woman should avoid unpasteurised dairy and unwashed raw vegetables
Clinical features of chlamydia
In mom
-often asymptomatic
-cervicotis with mucopurulent discharge
-PID, infertility and ectopic
-preterm labour, preterm ROM
In baby
-50-60% of babies delivered vaginally will be colonised
-18-50% of these develop neonatal conjunctivitis in the 1st 2 weeks
-11-18% of these will develop pneumonia in the 1st 4 months of life
Management og chlamydia
Inv: PCR, culture is difficult
Tx: Azithromycin or Erythromycin PO
Clin features of Group B strep
In baby
-Pneumonia
-Disseminated Sepsis
-Meningitis
-The baby is more at risk if it is <34/40, <1000g at birth, membranes were
ruptured for >18 hours, or if there was intrapartum maternal pyrexia.
In mom
-preterm ROM, preterm labour
-Chorioretinitis
-UTI
-Endometritis
Management of Group B strep
Tx: Ampicilin for infection
It can not be eradicated
Prophylaxis if mom is colonised: Penicillin or Ampicillin
