Infections in Pregnancy

Question 1

Mother - Slapped check, reticular rash or “mirror syndrome” preeclampsia w anemia and swelling

Answer 1

Parvovirus

Question 2

How does parvovirus present in the fetus?

Answer 2

Most lethal - stillbirth, hydrops, abortion

Question 3

What is the treatment for parvovirus?

Answer 3

None

Question 4

What are the labs for parvovirus?

Answer 4

IgG, IgM, and PCR

ONLY complete absence of all 3 will endorse non-exposure

Question 5

% of fetuses severely infected with parvovirus if exposed at 1-12 weeks

Answer 5

20% of fetuses are severely infected

Question 6

% of fetuses severely infected with parvovirus if exposed after 20 weeks

Answer 6

6% of fetuses are severely infected

Question 7

How does CMV present in the mother?

Answer 7

Mononucleosis sx

Question 8

How does CMV present in the fetus?

Answer 8

Congenital hearing loss (from maternal reactivation)

Blueberry muffin baby

Question 9

Treatment for CMV

Answer 9

None

Question 10

Labs for CMV

Answer 10

Avidity = 0.6 or higher

Acute Infection with IgM Ab in the absence of IgG (positive for up to 9 months, hence avidity)

Question 11

What is associated with the worst presentation of CMV?

Answer 11

If contracted in the first trimester

Question 12

Ultrasound findings of CMV

Answer 12

Microcephaly
Ventriculomegaly
Intracerebral calcification
Ascites
Hydrops
Echogenic bowel
IUGR
Oligohydramnios

Question 13

How does varicella present in the mother?

Answer 13

It is highly contagious with a 30% mortality rate if co-existing w PNA

Question 14

How does varicella present in the fetus?

Answer 14

Limb hypoplasia
Neonatal death
Chorioretinitis
Cataracts
Cutaneous scarring

Question 15

What is the tx for varicella?

Answer 15

Immune globulin

Acyclovir, Valcyclovir

Question 16

Labs for varicella

Answer 16

If no hx/unsure of prior infection or immunization –> draw IgG serology

If negative then administer immune globulin

Question 17

Results of varicella if exposure occurs <20 weeks gestation

Answer 17

Abortion

Fetal varicella syndrome (2%)

Question 18

Results of varicella if exposure near term

Answer 18

Congenital disseminated varicella

5 days before delivery - varicella PNA

2 days after delivery - can be FATAL

Question 19

Possible results of varicella exposure regardless of timing

Answer 19

Fetal death

Herpes zoster 1st year of life

Question 20

Ultrasound findings of varicella

Answer 20

Growth restriction

Limb hypoplasia

Microcephaly

Question 21

How does toxoplasmosis present in the mother?

Answer 21

Fever
Malaise
Night sweats

Question 22

How does toxoplasmosis present in the fetus?

Answer 22

Hearing and vision deficits

Question 23

Tx of toxoplasmosis

Answer 23

Spiramycin

Question 24

Labs of toxoplasmosis

Answer 24

IgG stays positive a long time after exposure

If IgM positive and IgG negative; a reference lab should be completed

If IgM and IgG positive; an infection should be assumed

Collect second sample two weeks prior to 1st to confirm possible false positive IgM

Question 25

What is the most common source of toxoplasmosis?

Answer 25

Undercooked meats that were infected

Cat litter is more rare