Infections in Pregnancy and Postnatal Infection

Question 1

CHEAP TRCHSZ - Important causes of infection in pregnancy

Answer 1

Chickenpox
Hepatitis B and C
Everything else sexually transmitted
AIDS/HIV
Parvovirus

Toxoplasma gondii
Rubella
Cytomegalovirus
HSV
Syphilis
Zika

Question 2

What type of vaccinations are okay in pregnancy and which aren’t?

Answer 2

DO NOT use live vaccine in pregnancy. All others are okay.

Question 3

Which vaccines are recommended in vaccination?

Answer 3

Influenza, pertussis.

Question 4

How does parvovirus B19 present, and what are its implications for pregnancy?

Answer 4

Presentation:

• Flu-like illness
• Erythematous rash
• Joint pain

Pregnancy implications:

• Fetal loss
• HYdrops fetalis

Question 5

Does past infection of syphilis confer immunity?

Answer 5

NO

Question 6

How is syphilis screened and diagnosed?

Answer 6

Syphilis serology: Treponemal specific tests

• EIA (enzyme immunoassay automated) test = SCREENING test
• TPAA (treponema pallidum antibody-antigen agglutination) test = CONFIRMATORY test

Non-treponemal tests measure disease activity.

Question 7

How is syphilis treated?

Answer 7

Early syphilis

• Benzathine pencillin IM single dose

Late syphilis:

• Benzathine pencillin IM once weekly for 3 weeks

Question 8

What is the name of the common reaction experienced to treatement of syphilis in adults.

Answer 8

Jarisch-Herxheimer reaction

• Fever, chill, malaise, joint pain, hypotension, tachycardia
• Begins within 2 hours of treatment and self-resolves after 24 hours. Management is supportive.

Question 9

What is the significance of pregnant women in the Jarisch-Herxheimer reaction?

Answer 9

Jarisch-Herxheimer reaction can precipitate pre-term labour.

Question 10

What important virus in pregnancy is mostly asymptomatic, but can present with fevers and lethargy?

Answer 10

Cytomegalovirus (CMV)

Question 11

What does CMV avidity tell you?

Answer 11

CMV avidity = strength of binding between antigen and antibody

• weak bond = recent infection
• strong bond = distant infection

Question 12

What are intra-amniotic infections?

Answer 12

Polymicrobial infections caused by ascending cervico-vaginal organisms.

Involves amniotic fluid, placenta, fetus and fetal membranes.

Question 13

What streptococcus plays an important role in postnatal infection?

Answer 13

Group B streptococcus - Streptococcus agalactiae.

Gram positive cocci

Question 14

What can Group B strep cause in the mother and delivered baby?

Answer 14

Mother:

• UTI
• Post-partum endometritis

Baby:

• Sepsis
• Pneumonia
• Meningitis
• Death

Question 15

What is the most important risk factor in Group B streptococcus (GBS) infection of the mother/baby

Answer 15

Recto-vaginal colonisation of the mother

Question 16

What are the two methods of prevention of GBS complications?

Answer 16

Screening:

• Swabs from rectum and vagina
• Treated with IAP (intrapartum antibiotic prophylaxis)

Risk-based approach:

• Treat those with risk factors (GBS bacteruria, fever >38 degrees)

Question 17

What are the cons of screening and risk-based approach?

Answer 17

Screening - increased exposure to antibiotics, increased GBS resistance, increased medicalisation of pregnancy (stress)

Risk-based approach - some women who should be given antibiotics will be missed

Question 18

Which bacteria, which can cause flu-like symptoms, is found in undercooked meat and multiplies at low-temperatures (e.g. in a fridge)

Answer 18

Listeria monocytogenes

Question 19

What is the definition of post-partum fever?

Answer 19

Fever >38 degrees 2 to 10 days after birth.

It is normal to have an elevated temperature directly after birth.

Question 20

What are 4 possible causes of post-partum fever?

Answer 20

• Surgical site infection
• Endometritis
• Mastitis
• UTI

Question 21

What is endometritis?

Answer 21

Inflammation/infection of the endometrium (lining of the uterus)

Question 22

What is the most important risk factor for developing endometritis?

Answer 22

Having a Caesarean section.

Question 23

What can cause endometritis?

Answer 23

Migration of vaginal flora into the uterus

• Aerobes: SEKPEMP
• Anaerobes: Peptostreptococcus, Clostridium

Question 24

What is the treatment regiment for endometritis?

Answer 24

Since endometritits can be cause by a wide variety of flora from the vagina, the triple drug regimen is used:

• Amoxycillin (Gram +ve)
• Gentamicin (Gram -ve)
• Metronidazole (protozoans + gram +ve/-ve)

Question 25

What is mastitis?

How does it present?

Answer 25

Inflammation of the breast caused by milk stasis.

Milk becomes sludgy, ducts become inflamed and infection can occur.

Presents with:

• Red, hot, swollen, tender breasts
• Fever
• Breast abscess

Question 26

What are the risk factors for developing mastitis?

Answer 26

Risk factors centre around poor drainage:

• Poor positioning/attachment
• Damaged nipples
• Incomplete draining of breast
• Abrupt weaning
• Scarring (e.g. from prev surg.) causing incompleted draining

Question 27

What are the 3 steps of treatment for mastitis?

Answer 27

1. Send expressed breast milk (EBM) for testing
2. Flucloxacillin for infection
3. Continue to drain (pump or feed)

Question 28

What is the risk of antibiotic use to treat mastitis by the mother on the feeding baby?

Answer 28

Possible impact on bowel flora and associated symptoms such as diarrhoea.

However, current recommendations are to continue breastfeeding in the setting of mastitis, with or without concurrent antibiotics.