Infections In Pregnancy

Question 1

How to diagnose parvovirus infections in mothers?

Answer 1

Maternal IgM and IgG
if IgM+ then check US for hydrops
Can check PCR in maternal serum and amniotic fluid

Question 2

How to treat Hep B transmitted from mother to infant

Answer 2

Give HBIG + Hep B vaccine within 12hrs of delivery (at birth, 1 month, 6 months)

Question 3

If GBS status unknown, when do you treat them as GBS positive?

Answer 3

• if ROM > 18 hours
• if preterm labour
• if intrapartum fever > 38 C

Question 4

Intrapartum prophylaxis for GBS

Answer 4

Benpen 3g initially then 1.8g 4hrly till birth
If allergic to penicillin: cefazolin 2g initially then 1g 8hrly till birth
If allergic and anaphylactic: clindamycin 900mg IV 8hrly till birth

Question 5

What and when to give when mom exposed to varicella in pregnancy

Answer 5

VZIG within 72 hours, must test for the antibody between 24-48 hours after

Question 6

When to give neonates VZIG

Answer 6

If mother had varicella within 5 days of delivery

Question 7

Congenital varicella syndrome

Answer 7

Chorioretinitis
Limb hypoplasia
Cicatrial lesions on skin
Cortical atrophy, microcephaly

Question 8

When to give acyclovir for varicella

Answer 8

If maternal pneumonia

If VZIG not given within 72 hours of exposure

Question 9

What can varicella cause to the mother in pregnancy

Answer 9

Pneumonia
Hepatitis
Encephalitis

Question 10

Fetal complications of parvovirus B19 and management

Answer 10

Aplastic anemia
Hydrops fetalis
High-output cardiac failure
Liver congestion

Intrauterine blood transfusion from 20 weeks

Question 11

How to diagnose parvovirus B19 in mother

Answer 11

Maternal IgM and IgG

If IgM+, check fetal ultrasound for hydrops and sample fetal blood for anemia

Question 12

What syndrome does rubella cause in the neonate and when is it transmitted?

Answer 12

Congenital rubella syndrome - cataract, deafness, cardiac anomalies like PDA

Very high risk transmission in first 8 weeks, teratogenic in first trimester

Question 13

How to diagnose rubella infection and what to do if detected?

Answer 13

Paired sera examined 10-14 days apart looking at a change in rubella IgM and IgG.
If there is a significant rise in rubella antibodies in the first 14-16 weeks, offer TOP

Rubella vaccination after pregnancy

Question 14

What are the neonatal complications of toxoplasma infection and when is it of highest risk to be acquired

Answer 14

Triad: chorioretinitis, intracranial calcification, hydrocephalus

Higher risk if acquired in late pregnancy

Question 15

How to diagnose toxoplasmosis and treatment

Answer 15

Seroconversion of IgG and IgM or >4 fold rise in paired specimen
PCR for T Gondii in amniotic fluid

Treat with spiramycin
No vaccine, just gotta be hygienic

Question 16

Congenital CMV complications and how it is spread

Answer 16

Hepatosplenomegaly, chorioretinitis, microcephaly, mental and motor retardation, deafness, periventricular calcification
- jaundice, anemia, rash, ascites

Spread via respiratory droplets

Question 17

How to diagnose CMV and treat

Answer 17

Maternal serum IgM and IgG, if primary infection confirmed then ultrasound and amniocentesis

No curative or prophylactic agent

Question 18

Listeria source, presentation and risk

Answer 18

Unpasteurized dairy products, raw meat, soft cheese, raw seafood

Flu-like, fever, malaise

Miscarriage, preterm

Question 19

Diagnosis of listeria and management

Answer 19

Culture from blood, vaginal swab, placenta
Meconium staining in preterm fetus raises suspicion

Treatment: ampicillin 2g IV 6hrly

Question 20

Congenital syphilis

Answer 20

Jaundice, hepatosplenomegaly, deafness, persistent rhinitis, bone and teeth abnormalities, osteochonrditis of long bone (pseudoparesis of Parrot), medial erosions of proximal tibia on X-day (wimberger sign), intrauterine death

frontal bossing, short maxilla, saddle nose,

Question 21

Diagnosis of syphilis and treatment

Answer 21

Screening: RPR, VDRL
Confirmatory: FTA-ABS, Dark field illumination: spiral organisms with characteristic movements
US: edema, ascites, hydrops, thickened placenta

Treatment: IM procaine penicillin/IV benpen

Question 22

Congenital Zika syndrome

Answer 22

Microcephaly
IUGR 
Craniofacial disproprotion 
Cerebellar hypoplasia 
Lissencephaly 
Hydrocephalus
Brainstem dysfunction 
Seizures 
Spasticity 
Arthrogryposis

Question 23

When is highest risk of abnormality of Zika

Answer 23

First trimester, reduces over time

Don’t get pregnant within 6 months of getting Zika!

Question 24

What is chlamydia and gonorrhea associated with at birth

Answer 24

PPROM, preterm delivery and LBW

Chlamydia: conjunctivitis and pneumonia
Gonorrhea: ophthalmicus neonatorum

Question 25

Principles of managing HIV infection pregnancy

Answer 25

• ART in all pregnant women regardless (if refused and not necessary, give at 28-32 weeks)
• monitor CD4+ counts and viral loads every trimester
• c-section if viral load >50 copies at 34-36 weeks
• avoid ARM unless expecting birth in the next 24 hrs
• reduce duration of ROM
• avoid invasive fetal monitoring
• IV Zidovudine for mother 4 hours prior to planned C-section/at onset of labour for vaginal birth
• avoid breast feeding
• Oral zidovudine syrup for newborn no later than 6 hours of life, continue for 4 weeks
• PCR for newborn within 48 hours of life

Question 26

Tests for chorioamnionitis

Answer 26

High vaginal swab
FBC
Amniotic fluid MCS (if amniocentesis done)
CTG: fetal tachycardia

Question 27

Management of chorioamnionitis

Answer 27

Antibiotics
- gram positive: ampicillin 2g IV 6hrly
- gram negative: gentamicin 5-6g IV daily
- anaerobes: metronidazole 500mg 8hrly
Consider urgent delivery of the baby, preferably Vaginal cause csect can lead to intraperitoneal sepsis

Question 28

Managing women with GBS bacteriuria and GBS positive

Answer 28

Bacteriuria: oral antibiotics in pregnancy and intrapartum prophylaxis regardless of symptomatic or not

GBS positive: intrapartum prophylaxis, must come to hosp at onset of labour