Infections in pregnancy Flashcards
(24 cards)
What causes congenital rubella syndrome?
Maternal infection with the rubella virus during the first 20 weeks of pregnancy - risk is highest before 10 weeks gestation.
What do women who are planning for pregnancy need to have?
MMR vaccine but they can’t have this whilst pregnant as it is a live vaccine so offer it after birth.
Features of congenital rubella syndrome?
Congenital deafness (sensorineural), congenital cataracts, congenital heart disease (PDA and pulmonary stenosis), learning disability, growth retardation.
Why is chickenpox (caused by varicella zoster) more dangerous in pregnancy?
Can lead to varicella pneumonitis, hepatitis or encephalitis, fetal varicella syndrome, severe neonatal varicella infection (if infected around delivery).
When testing immunity from chickenpox what determines immunity?
Positive IgG.
What do you do if the woman is not immune to chickenpox?
Treat with IV varicella immunoglobulins as prophylaxis against developing chickenpox given within 10 days of exposure.
What do you give if chickenpox rash starts in pregnancy?
Treat with oral aciclovir if they present within 24 hours and are more than 20 weeks gestation.
When does congenital varicella syndrome occur?
When infection occurs in first 28 weeks of gestation in 1% of cases of chickenpox in pregnancy.
What are typical features of congenital varicella syndrome?
Fetal growth restriction, microcephaly, hydrocephalus and learning disability, scars & significant skin changes in specific dermatomes, limb hypoplasia, cataracts and inflammation in eye.
What is listeria?
An infectious gram positive bacteria which causes listeriosis and is more likely in pregnancy.
How does listeriosis present in pregnancy?
Mother may be asymptomatic, flu like illness or pneumonia or meningoencephalitis. High risk of miscarriage or fetal death and can cause severe neonatal infection.
What typically causes listeriosis?
Unpasteurised dairy products, processed meats and contaminated foods so pregnant women are advised to avoid high risk foods eg blue cheese.
When does congenital cytomegalovirus occur?
Occurs due to a cytomegalovirus infection in mother during pregnancy which is mostly spread via infected saliva or urine of asymptomatic children.
What are features of congenital cytomegalovirus infection?
Fetal growth restriction, microcephaly, hearing loss, vision loss, learning disability, seizures.
What is congenital toxoplasmosis?
Infection with Toxoplasma gondii parasite is normally asymptomatic and primarily spread by contamination with faeces from a cat that is a host of the parasite. But when it occurs during pregnancy it can lead to congenital toxoplasmosis - risk is higher later in pregnancy.
What is the triad for congenital toxoplasmosis?
Intracranial calcification, hydrocephalus, chorioretinitis (inflammation of choroid and retina).
What does infection with parvovirus in pregnancy lead to?
Miscarriage or fetal death, severe fetal anaemia, hydrops fetalis - fetal heart failure, maternal pre-eclampsia like syndrome.
What is fetal anaemia caused by?
Parvovirus infection of erythroid progenitor cells in the fetal bone marrow and liver which produce RBCs so the infection causes them to produce faulty blood cells which have a shorter life span leading to anaemia.
What is maternal pre-eclampsia like syndrome?
A rare complication of severe fetal heart failure which involves a triad of: hydrops fetalis, placental oedema, oedema in the mother.
What tests do women suspected of parvovirus infection need?
IgM to parvovirus, which tests for acute infection within the past four weeks; IgG to parvovirus, which tests for long term immunity to the virus after a previous infection; Rubella antibodies.
What is the treatment for parvovirus B19?
Supportive - woman with parvovirus need a referral to fetal medicine to monitor for complications and malformations.
How is zika virus spread?
Spread by host Aedes mosquitos in areas of the world where the virus is prevalent. Can also be spread by sex with someone infected with the virus.
What is congenital Zika syndrome?
Microcephaly, fetal growth restriction, other intracranial abnormalities, such as ventriculomegaly & cerebellar atrophy.
What do if a pregnant woman is suspected to have Zika?
Test with viral PCR and antibodies to Zika virus. Women with a positive result should be referred to fetal medicine for close monitoring of pregnancy but there is no treatment.
