Infectious disease in Pregnancy Flashcards Preview

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Flashcards in Infectious disease in Pregnancy Deck (51):
1

What antenatal inectious disease screening tests should be routinely conducted?

-HBV / HCV
-HIV
-Rubella (Abs)
-Syphilis (TPHA / TPPT)
-Chlamydia (urine PCR / swab)
-GBS
-Asymptomatic bacteriuria
-VZV (Abs)

2

What are the routes of transmission?

-Transplacental
-Intrapartum
-Postpartum

3

Intervention if maternal HBsAg +ve?

Administer HepB immune globulin (HBIG) and vaccine to infant at birth (prevents carriage in 95%)

4

Syphilis maternal +ve intervention?

Treat with penicillin and consult with STI specialist

5

HIV maternal +ve intervention?

-Antiretroviral therapy for mother and infant
-greatly reduces vertical transmission
-consult HIV specialist

6

Chlamydia +ve intervention?

-Treat woman and sexual partners to prevent intrapartum transmission

7

HCV maternal +ve, child intervention?

Follow up infant for infection at 12 months; treat mother

8

Intervention if mother GBS +ve?

Intrapartum chemoprophylaxis to prevent neonatal GBS infection

9

Rubella virus family?

Togavirus

10

Rubella virus genus?

Rubivirus

11

Rubella virus structure?

ssRNA, enveloped

12

What is the reservoir for the rubella virus?

Humans only reservoir

13

When does rubella peak?

Winter - spring

14

How is rubella transmitted?

Droplet and direct contact

15

Rubella incubation period?

14 - 23 days

16

When is virus present in relation to rash?

7d before to 14d after

17

Clinical features of rubella?

-Mild or asymptomatic
-Generalised maculopapular rash
-Generalised lymphadenopathy
-Low grade fever
-Polyarthralgia

18

What are the features of congenital rubella syndrome?

Neurobiological fx:
-meningoencephalitis
-behavioural
-mental retardation
-deafness
Other fx:
-blueberry muffin rash
-thrombocytopenia
-radiolucent bone disease
-congenital heart disease (i.e. PDA)
-cataracts

19

When is risk of damage by rubella virus greatest?

20

Rubella prevention?

-Screen antepartum
-Vaccinate if -ve (or post partum if pregnant)
No Rx for pregnant woman infected with rubella.

21

Which syphilis stage is most likely to result in congenital syphilis?

Primary (90%) transmission.
-early latent 40%
-late latent

22

Features of congenital syphilis?

-Stillbirth
-Hepatosplenomegaly / LAD
-Snuffles
-Osteochondritis syphilitica
-Hutchinson's teeth
-Hereditary gumma

23

What are the non-treponeal tests?

VDRL, RPR
Ig to cellular lipids and lecithin
Positive 4-8/52 post infection

24

What are the treponemal tests?

TPHA, TPPA, FTA-Abs
-positive slightly earlier
-positive for life
-don't reflect disease activity

25

What is the most valuable marker for congenital syphilis?

IgM (90% cases positive)

26

What is the structure of HBV?

dsDNA virus with glycolipid envelope

27

What is the most important determinant of HBV transmission?

HBeAg status of the mother

28

HBIG efficacy?

If given with 2-12h of delivery = 95%

29

What determines risk of maternal foetal HIV transmission?

-Viral load and CD4 count
-Duration of ruptured membranes (4h)
-Mode of delivery

30

Management of HSV during pregnancy?

-Primary infection at term: LUSC and acyclovir
-Recurrent lesions at term: LUSC

31

what is the optimum approach for detection of GBS?

-Low vaginal + anal swab
-self collected at 35-37w gestation
-cultured in selective broth

32

What are the features of congenital varicella syndrome?

First trimester primary infxn
-limb hypoplasia
-dermatomal scarring
-microcephaly
-cataracts
-GIT/GUT abnormalities

33

When is risk greatest for VZV congenital syndrome?

13-20 weeks = 2%

34

When is acyclovir given during pregnancy?

Prophylaxis for significant exposure:
-VZIG not given (i.e. >96h)
-T3 / 2nd half pregnancy
-Chronic lung disease
-immunosuppression
-cigarette smoking

35

When is VZIG given?

Given post exposure (

36

What is VZV vaccine and when given?

Live attenuated virus given at 12 months of age (MMR-V).

37

Why is GBS screening important?

50% of exposed infants will become colonised; 0.2/1000 will develop GBS sepsis

38

How does early onset GBS manifest in the infant?

Septicemia and shock, pneumonia or meningitis in first week of life

39

What are the signs of congenital toxoplasmosis?

-severe mental retardation
-chorioretinitis
-blindness
-epilepsy
-intracranial calcifications
-hydrocephalus

40

Counselling re toxoplasmosis infection prevention?

-throughly cook meats
-wash hands after handling raw meats
-wash fruits and veggies of soil
-wear gloves if working with soil
-keep cats indoors and feed processed foods

41

Parvovirus consequences for foetus?

-Spontaneous abortion
-foetal non immune hydrops
-death
If hydrops doesn't develop, long term outcomes good.

42

Are pregnant women immunocompromised?

No. Although pregnancy complex situation where two immunologically different individuals coexist, not achieved through maternal immunosuppression. Infection (pneumonia, pyelonephritis) may be more severe however this is due to anatomic and physiologic changes rather than immunosuppression.

43

Why are infections in pregnancy important?

-Maternal morbidity and mortality (e.g. pneumococcal pneumonia)
-Harm to foetus (e.g. toxo etc)

44

What neonatal conditions are caused by GBS?

Two different entities: early onset infection (septicaemia) and late onset disease (usu meningitis). More common in preterm infants.

45

Which genital infections are implicated in preterm birth?

-Bacterial vaginosis
-Trichomonas
-Gonorrhoea
-Chlamydia
(last 3 inconsistently associated)

46

Should pregnant women be screened for CMV antibodies?

No. Most women have antibodies, usually represent prior disease. Even in cases of suspected infection, have limited value.

47

How should women with active HSV be delivered?

C section if active at time of delivery

48

Can VZV infection be prevented?

-Vaccinate non immune individuals
-Cannot vax during pregnancy
-VZIG to susceptible individuals with viral exposure
-Can give VZIG to exposed pregnant women; also protects foetus

49

Can anti-retroviral therapy be used in pregnancy?

Vertical transmission related to viral load. Antiviral therapy reduces viral load; therefore pregnant women should be offered medical therapy even if relatively low disease burden (CD4 counts and viral load). Usually multi drug therapy

50

How can HIV vertical transmission be reduced?

-1. Medical therapy during pregnancy
-2. If viral load greater 1000/mL; C section
-3. Should not breastfeed
Reduces transmission to less than 5%

51

How does HSV affect pregnancy?

-Relatively common genital infection; only risk to foetus if active disease at delivery
-neontal disease: asymptomatic infection - disseminated disease and death