Infections in pregnancy Flashcards
PUO mx in pregnancy
Scenario 1 - 29yo 20/40 return from tropics (3rd world), fever/night sweats/chills/joint pain
DDx
- Malaria (q48, rigour/myalgia, 10-20d)
- Dengue
- Zika (flu-like, 2-14d)
- CMV (children, fever/flu-like/rash)
- Hepatitis
- FBE/UEC/LFT/CRP/BSL
- Hepatitic screen + Liver USS
- Thick/thin blood malaria films
- MCS - blood/stool/urine
- Obs USS +/- CTG
- Admission
- MDI - MFM/ID/Paeds
- antipyretic/antibiotic/analgesia
- VTE prophylaxis
- +/- steroid loading
- chase cultures +/- targetted rx
- monitor for improvement
- return to OP F/U + serial GS
- timing/MOD - obs indication
Hepatitic screen
Scenario 1 - pt with scleral icterus
- HIV/HBV/HCV/HAV/HDV/EBV/CMV
+/- consider cu, ceruloplasmin, ferrtin
+/- ANA (AAI hep 1, SLE), AMA(PBC), ASMA(AI hep type 1), anti KLM (AI hep2, hep C/D, drugs, immunoglobulins - Liver USS
Parvo virus exposure mx
Scenario 1 - 25yo primigravida childcare worker +’ve Parvo serology 8/40, twin preg
Scenario 2 - 18/40 referred by community imaging with finding of foetal hydrops on routine scan
Scenario 3 - 19/40 exposure to son’s slap cheek, symptomatic
DDx of hydrops (similar to poly)
- infection
- aneuploidy
- diabetes
- isoimmunization
- a-thalassemia
- structural
- F - risk - anemia/HF/Hydrops/SB
- 50% infection
- 1/3 - resolve spont/IUT/demise
- confirm serology IgG+IgM+
- tertiary scan to confirm hydrops
- MDI - MFM/ID/Paeds
- +/- amnio +/- anti-D if Rhesus -‘ve
- USS fn for 12/52 ?anemia/hydrop
- no anaemia by 30/40, no further rx
- anemia -> cordocentesis -> IUT
- timing/MOD as obstetric indication
HCV mx in pregnancy
Scenario 1 - 26yo P2, 11/40, new dx
partner hoping for termination
Scenario 2 - 23yo P0, complex psychosocial bkg, incidental HCV+
- M risk - cirrhosis/liver ca
- F risk - MTCT 5%/chronic carriage
- FBE/UEC/LFT
- HCV RNA lvl/Liver USS
- HBV/HIV serology
- MDI - Obs/ID/Gastro/D&A/SW/Paeds
- no invasive procedure (eg amnio)
- LFT each trimester
- timing/MOD - obs indication
- IP: no invasive procedures
PP:
1. bath prior to IM injection
2. don’t feed with cracked nipples
3. neonatal testing
4. PP rx of HCV & F/U
5. barrier contraception
Acute respiratory illness mx in preg
Scenario 1 - 34, P1, 27/40 p/w acute resp illness (details not in stem)
Scenario 2 - 32, multi, 22/40 p/w non-specific flu like sx
Scenario 3 - 19yo, min AN care, 29/40, develops ARD on bkg of influenza infection, hx of asthma
- M - risk - ARD/T2RF…
- F - risk - hypoxia/MTCT…
- FBE/UEC/LFT (AKI/transaminitis)
- Resp panel - PCR
- +/- Atypical pneumo serology
- +/- Hepatitic screen +/- EBV/CMV
- MCS - sputum
- CXR - ?consolidation
- MDI - Obs/Resp/ID/Ano/ICU
- Admit/Isolate/IVT/antipyretic
- monitor for PTL
+/- steroid loading
+/- antiviral +/- antibiotic - Daily CTG/formal Obs USS
- +/- delivery on mat/fet ground
- Clinical improve - OP AN care
- Follow-up G/S
CMV dx/mx in preg/education
Scenario 1/2 - 32, multi, 22/40 p/w non-specific flu like sx -> transaminitis on bloods and scleral icterus
Scenario 2 - 31yo multi, confirmed CMV infection (communication station)
- F - risk: IUGR/IC abn
- N - risk: cataracts/SNHL/seizures
- Confirm serology IgM+IgG+
- MDI - MFM/ID/Paed
- 30% MTCT/@birth 10%sx/90% asx
- +/- amnio +/- USS
- Continue preg vs TOP
- Serial G/S if continue
- Timing/MOD - obstetric indication
PP
- isolate/clarify status
- serology/urine/salvia PCR
- exam/opthal/cranial USS/audiology
- long term developmental F/U
Prevention
- assume every child under 3 carry CMV
- passed from saliva/urine
- hand hygiene/avoid sharing
- Hx of CMV doesn’t offer immunity
VZV exposure in preg mx
- M risk - resp cx/neuro/high fever
- F risk - CVS - eye/skin/limb/PTL/LBW
- check immunity e.g. urgent serology
- MDI - MFM/ID/Paed
- ZIG <96/24 +/- acyclovir >96/24 +RFs
- isolate @home, monitor sx - rash
+/- antipyretic/analgesia/hydration
+/- admission for IV antiviral if cx - F/U - G/S 5/52 post exposure ? abn
- PP - ZIG if mat infect within 7d of del
Mx of suspected shingles
Scenario - pt presents mid-trimester with painful rash.
- MDI - ID/Paeds
- admission - if unwell - resp comp
- antipyretic/antiviral/analgesia
- PO acyclovir within 72/24 of rash
- CTG/formal Obs USS
- isolate from vulnerable
Mx of syphilis in preg
Scenario 1 - 24yo sex worker, 22/40 present to ED vulval ulceration
Scenario 2 - 32yo refugee HIV+, routine AN screen RPR+ asx
- M risk - localized/systemic illness
- F - risk - syphilis/IUGR/PTB/SB/NND
- highest risk MTCT - primary >20/40
- Treponema specific - TTPA/TPHA/FTA
- Other STI screen
- MDI - Obs/ID/Paeds
- Notify DHS + contact tracing + avoid IC
- Rx benzathine penicillin as I/P
- Advise - no IC till 7d post rx
- Monthly RPR/VDRL till delivery
- retreatment if titer rise (30d pre-del)
- serial G/S (FGR/MCA/organ/hydrops)
- screen & support substance use
- psychosocial support
- chase STI screen +/- rx
- follow-up
PN
- placental histology + cord blood serol
- paed rv +/- F/U
- routine postpartum care
COVID infection in preg
- M risk - resp/myocard/VTE/PET
- F risk - PTB/SB/CS (severe/crit disease)
- Bloods (end-organ) + PCR +/- imaging
- Admit - if unwell
- MDI - MFM/ID/Resp
- O2 + covid specific therapy
+/- empiric rx bacterial pneumo
+/- HDU/ICU - VTE prevention
- CTG/formal Obs USS
HIV mx in preg
- M risk - GDM/PET/Infection
- F risk - MTCT/IUGR/PTB
- Partner risk - HIV infection
- Test - co-infection HCV/HBV
- MDI - MFM/ID - HIV expertise/Paed
- commence on ART - monitor M risks
- early OGTT/Tert morph -> serial G/S
- avoid invasive procedures
- test - VL 2-3mo, esp 36/40
- test - partner +/- rx, barrier contra
- timing - obs indication
- MOD - >400 = CS
- IP avoid invasive procedu/SROM>4/24
PP
- placenta histo + cord blood serology
- formula > breast feeding, LS
- paeds/ID - baby PEP/testing
- wipe down-vaccinate
- F/U specialist clinic
- Contraception
- Pre-preg counselling next time
