Infections in Pregnancy and the Neonate

Question 1

What is the perinatal period defined as?

Answer 1

• Commences at 22 weeks (154 days) of gestation and ends 7 days after birth

Question 2

What is the neonatal period defined as?

Answer 2

First 28 days of life

Question 3

What is the postnatal period defined as?

Answer 3

First 6 weeks after birth

Question 4

What can vertical transmission be?

Answer 4

• Across placenta (intrauterine)
• During birth
• Direct contact with maternal body fluids
• Prolonged rupture of membranes
• After birth (from mother or other contacts)

Question 5

When can rubella be transmitted to the baby from the mother?

Answer 5

1st trimester

Question 6

What is the risk of the baby developing congenital rubella syndrome?

Answer 6

60%

Question 7

What are the initial signs of rubella?

Answer 7

• Hepatitis associated jaundice
• Haemolysis
• Thrombocytopaenia

Question 8

What can the effects of rubella be on the baby?

Answer 8

• Microcephalus
• Cataract
• Deafness
• Heart defects
• Low birth weight
• Termination of pregnancy

Question 9

What virus causes chicken pox?

Answer 9

• Varicella Zoster Virus (VZV) also causes shingles

Question 10

WHat can primary maternal VZV infection cause in the 1st 20 weeks of gestation?

Answer 10

• Congenital varicella syndrome

- Eye defects, hypoplastic limb, microcephalus

Question 11

What ccan VZV around delivery cause?

Answer 11

• Neonatal varicella syndrome

- Rash, pneumonitis

Question 12

What is given to treat chicken pox / VZV?

Answer 12

• Aciclovir (IV) - high dose

- VZV immunoglobulin (within 7-10 days of exposure - prevents fetal/neonatal varicella syndrome)

Question 13

What is the vaccine for VZV?

Answer 13

• Live vaccine
• Varivax
• Varilrix

Question 14

When is infection from mother to child for parvovirus B19?

Answer 14

1st 20 weeks of gestation

Question 15

What does Parvovirus B19 cause?

Answer 15

• Slapped cheek syndrome
• Fetal anaemia (hydrops in <10%)
• Fetus monitored for ascites

Question 16

How is parvovirus diagnosed?

Answer 16

• Amniocentesis
• Chorionic villus sampling
• Cordocentesis (decreasing use)

Question 17

What family of viruses is Cytomegalovirus in?

Answer 17

Herpes family

Question 18

What can cytomegalovirus cause in the fetus?

Answer 18

• Deafness

- Retardation in fetus

Question 19

How is CMV diagnosed?

Answer 19

• NAAT on amniotic fluid or neonatal blood/urine within 3 weeks of birth

Question 20

What is listeriosis caused by?

Answer 20

Listeria monocytogenes (certain foods e.g soft cheeses)

Question 21

How is listeriosis spread to the child?

Answer 21

• Transplacental (oftenunapparent maternal infection)

- Intrapartum

Question 22

What can infection in early pregnancy cause?

Answer 22

Fetal death

Question 23

What can infection in later pregnancy cause?

Answer 23

Premature birth

Question 24

What are the chances of transplacental transmission of toxoplasmosis?

Answer 24

1:3

Question 25

What can toxoplasmosis infection in the 1st or 2nd trimester lead to?

Answer 25

- Stillborn - Death soon after birth - Cerebral calcification - Cerebral palsy - Epilepsy - Chorioretinitis

Question 26

How is toxoplasmosis treated?

Answer 26

Spiramycin

Question 27

How is maternal infection of toxoplasmosis confirmed?

Answer 27

Presense of IgM

Question 28

How is listeriois diagnosed?

Answer 28

Culture - Blood - CSF - PLacental tissue - Lochia (vagina after delivery)

Question 29

What can the complications be of listeriosis?

Answer 29

``` Fetal infection - Bacteraemia - Hepatosplenomegaly - Meningoencephaly - Thrombocytopaenia - Pneumonitis Intrapartum exposure - Meningitis - Bactraemia ```

Question 30

What is the percentage risk of vertical transmission of HIV?

Answer 30

25 - 30% | - Greatest risk with advanced maternal disease / high viral load

Question 31

How is vertical transmission prevented?

Answer 31

- HIV testing - Counselling - Antiretroviral medication - Delivery by C-section - Discouraging breastfeeding

Question 32

How is syphilis treated?

Answer 32

Benzylpenicillin (rare in child due to pre-natal screening)

Question 33

What does syphilis present with in baby?

Answer 33

- Fever - Rash - Condylomata - Mucousal fissures

Question 34

What can staph aureus cause in the baby?

Answer 34

Scalded skin syndrome

Question 35

How is zika virus spread?

Answer 35

Bite of aedes species of mosquito

Question 36

What can zika cause during pregnancy?

Answer 36

Severe congenital brain effects - Microcephaly - Guillain-Barre syndrome

Question 37

Dormancy is a characteristic of what type of viruses?

Answer 37

Herpes viruses (e.g CMV, VZV)