Infections in Pregnancy

Question 1

What are the congenital TORCH infections?

Answer 1

Toxoplasma gondii
Other: Syphilis, Parvovirus B19, VZV + Listeria
Rubella
Cytomegalovirus
Herpes Simplex 2

Question 2

Give 4 common clinical signs of TORCH infections

Answer 2

Delayed growth
Hepatosplenomegaly
Jaundice
Thrombocytopenia

Question 3

What is Toxoplasmosis caused by? How is usually acquired? How is it transmitted to the foetus?

Answer 3

Protozoan: Toxoplasma gondii

Contact with cat faeces/ litter
Undercooked meat, esp. pork + lamb.

Transmitted via placenta. If in first 6m- congenital toxoplasmosis

Question 4

How does Toxoplasmosis manifest in the mother?

Answer 4

Usually asymptomatic
Lymphadenopathy (rarely)

Question 5

What is the classic triad of congenital toxoplasmosis?

Answer 5

Chorioretinitis- yellow/ white scars on fundoscopy
Hydrocephalus- macrocephaly
Intracranial calcifications- seen on CT

Question 6

What dermatological manifestation can arise in congenital toxoplasmosis?

Answer 6

Blueberry muffin rash
(purple-blue marks)

Question 7

What is syphilis caused by? How is it transmitted?

Answer 7

Spirochete bacterium: Treponema pallidum

Sexual contact, inc. vaginal, anal, + oral

Question 8

What is primary syphilis characterised by?

Answer 8

chancres (painless skin ulcers)
usually on the labia, anal region or cervix.

Question 9

When does the second stage of syphilis occur? How can this manifest?

Answer 9

2-10w post infection- disseminated in blood stream

Generalised lymphadenopathy

Maculopapular rash: start on trunk + spread to limbs, eventually to palms, soles, genitalia, + other mucous membranes.

Condyloma lata: smooth, white, painless, wart-like lesions on genitals + around anal region.

Question 10

How does tertiary syphilis present?

Answer 10

Gummas: granulomatous lesions form
Cardiovascular damage
Neurosyphilis

Question 11

When is syphilis most infectious to a foetus?

Answer 11

Primary + Secondary stages
Via placenta/ during childbirth

Question 12

What does congenital syphilis often result in?

Answer 12

Hydrops fettles: abnormal accumulation of fluid in soft tissues.
Greatly increases risk for still-birth

Question 13

What happens to babies born with congenital syphilis?

Answer 13

Develop characteristic features:
Early signs: appear within 2y of life
Late signs: after child is 2y old

Question 14

Give 2 early signs of congenital syphilis

Answer 14

Maculopapular rash involving palms + soles
Snuffles/ increased nasal secretions (laden with treponema)

Question 15

What are 6 late signs of congenital syphilis?

Answer 15

Frontal bossing
Saddle nose
Short maxilla
Hutchinson teeth: small, notched, + widely spaced permanent teeth.
Saber shins: bending of shinbone or tibia.
Progessive damage to vestibulocochlear nerve (CNVIII): deafness or hearing loss.

Question 16

How is parvovirus B19 transmitted to the mother? How is it transmitted to the foetus?

Answer 16

Mother: resp secretions
Foetus: Placenta

Question 17

What are the signs and symptoms of parvovirus B19 in the mother?

Answer 17

Arthritis: small joints of hands, wrists, knees, + feet, often symmetrical
Red cell APLASIA: decreased RBC production in BM= absence of reticulocytes in BM

Question 18

What happens to a foetus if they acquire parvovirus B19?

Answer 18

Develop anemia.
Fewer RBCs to carry oxygen, so the heart will pump a larger volume of blood to give the growing fetus all the oxygen it needs.
This raises the pressure inside fetal blood vessels, + fluid may start to leak out.
Ultimately result in hydrops fetalis- great risk for spontaneous abortion or still-birth (esp. in first half of pregnancy)

Question 19

What happens to a foetus if they survive parvovirus B19 in utero?

Answer 19

No permanent defects/ malformations

Question 20

How is VZV transmitted to the mother? How is it transmitted to the foetus?

Answer 20

Mother: Resp secretions/ Contact with the oral or skin lesions
Foetus: Placenta

Question 21

How does VZV manifest in a mother?

Answer 21

Fever, headache, + overall weakness.
After 2-3 days, develop an intensely pruritic, vesicular rash, which starts on the trunk + spreads outward, eventually covering entire body.

Question 22

When is the foetus most vulnerable to VZV?

Answer 22

First + Second trimester as still undergoing major development

Question 23

How does congenital VZV manifest?

Answer 23

Underdeveloped
Low birth weight
Limb atrophy
Microcephaly
Eye defects: cataracts (opacification of the lens)
Neuro defects: cortical atrophy or brain degeneration, + intellectual disability.

Question 24

How does Listeria present in the mother?

Answer 24

Fever
Fatigue
Gastroenteritis: D+V + abdo cramps.
Amnionitis
Sepsis

Question 25

What is Listeria? How is it transmitted to the mother? How is it transmitted to the foetus?

Answer 25

Bacteria: Listeria Monocytogenes Mother: Unpasteurized dairy products + deli meats. Foetus: placenta

Question 26

What are the consequences of Listeria transmission to the foetus?

Answer 26

Spontaneous abortion or still-birth. If survives to term: may develop sepsis + meningitis (fatal if untreated)

Question 27

What is Rubella? What is it caused by? How is it transmitted to mother? How is it transmitted to foetus?

Answer 27

Rubella aka. German Measles Virus: Rubella virus Mother: Resp secretions Foetus: Placenta, 1st trimester-congenital rubella syndrome.

Question 28

How does rubella manifest in the mother?

Answer 28

Maculopapular rash: starts from head + neck, spreads downward Postauricular lymphadenopathy Polyarthritis: >,5 joints.

Question 29

What is the characteristic triad of congenital rubella syndrome?

Answer 29

Cataracts Congenital heart defects: PDA Deafness

Question 30

What murmur may be heard in a baby with congenital rubella syndrome?

Answer 30

Continuous rumbling murmur, AKA “machinery” murmur.

Question 31

Which congenital infections may cause a "blueberry muffin rash"?

Answer 31

Toxoplasmosis Rubella Cytomegalovirus

Question 32

How is cytomegalovirus transmitted to the mother? How is it transmitted to the foetus?

Answer 32

Mother: Sexual contact/ organ transplantation. Foetus: Placenta

Question 33

How does CMV manifest in the mother?

Answer 33

Usually asymptomatic Some develop mononucleosis-like Sx: fever, lymphadenopathy, + sore throat.

Question 34

How does congenital CMV present? (5)

Answer 34

Petechiae Progressive + permanent deafness Eye abnormalities: chorioretinitis Neuro: Seizures + intellectual disability, often a/w microcephaly. Periventricular calcifications: seen on CT

Question 35

How is HSV-2 transmitted? When is it usually transmitted to the foetus?

Answer 35

direct contact with infected areas of the skin or mucous membranes foetus: During birth when passing through vaginal secretions

Question 36

How does HSV-2 manifest in the mother?

Answer 36

Usually asymptomatic Can develop genital herpes: vesicular skin lesions on vaginal mucosa, mons pubis, cervix, + labia.

Question 37

How does congenital HSV-2 present?

Answer 37

Vesicular skin lesions- mainly involve scalp, eyelid margins, + oral mucosa. Can lead to meningoencephalitis: presents with lethargy, irritability + seizures.