Infectious Diseases in Pregnanct

Question 1

What are prenatal infections?

Answer 1

Infection acquired/carried by the mother and transmitted to the developing fetus

Question 2

What are perinatal infections?

Answer 2

Infection transmitted around the time of delivery

Question 3

What are some complications of chickenpox?

Answer 3

Secondary bacterial infection - Staph, strep
Pneumonitis - particularly maternal
Acute cellular ataxis

Question 4

What manifestations of varicella do we worry about around pregnancy?

Answer 4

Severe maternal illness
2nd and 3rd Trimester - fetal anomalies
Perinatal infections

Question 5

How do mothers die from varicella?

Answer 5

Severe pneumonitis, particularly during third trimester

Question 6

What is the pathophysiology of congenital varicella syndrome?

Answer 6

Zoster reactivation in the fetus

Question 7

What is the risk of developing CVS?

Answer 7

2-12 weeks: 0.55%

12-28 weeks: 1.4%

Question 8

How does perinatal varicella occur?

Answer 8

Primary maternal varicella -7 to +2 days from delivery

- 17-30% rate of transmission to baby

Question 9

How do you treat varicella exposure?

Answer 9

If known exposure, no worries

If unknown exposure status
- Test IgG status, if non-immune give VZIG with 96 hours to 10ds

Also give VZIG to preterm baby if exposed

Question 10

Can you give varicella vaccine in pregnancy?

Answer 10

No, live dose

Question 11

What types of CMV infections are there?

Answer 11

Primary
Reactivation
New primary of different strain

Question 12

What is the most common fetal infection?

Answer 12

CMV

Question 13

What is the pathophysiology of CMV in neonates?

Answer 13

90% asymptomatic - 10-15% long term sequelae

10% Symptomatic - 80-100% long term sequelae

Question 14

How helpful is CMV IgM?

Answer 14

Not very, doesn’t only occur in primary infection

Question 15

Which anti-virals are used in CMV?

Answer 15

Ganciclovir
Valganciclovir - oral

For 6 months

Question 16

What problems does influenza cause in pregnancy?

Answer 16

Maternal - viral pneumonitis or secondary bac pneumonia (particularly third trimester)
Premature birth
?Early and late fetal death
?Congenital neurological defects
Fever - indirect teratogenic effect

Question 17

What proportion of mothers are carriers of GBS?

Answer 17

15-25%

Question 18

How does GBS get to the baby?

Answer 18

Up the vagina

During delivery

Question 19

How does GBS present?

Answer 19

Early onset - 1-2 days
- Pneumonia, septicaemia

Later onset
- Meningitis

Question 20

How do we predict GBS infection?

Answer 20

Identify risk factors

Swab at 35-37 weeks

Question 21

How is GBS screened for?

Answer 21

At 35-37 weeks

Vaginal and anal swab

Question 22

When are abx for GBS given?

Answer 22

4 hours prior to delivery

Question 23

What abx for are given for GBS?

Answer 23

Penicillin

If allergic

• If rash: cephazolin
• If anaphylactic: Clindamycin or vancomycin

Question 24

When does hepatitis B transmission occur?

Answer 24

Usually labour and birth

Question 25

How do you predict the chance of transmission in Hep B positive mother?

Answer 25

eAg Viral titre sAg

Question 26

How do you prevent maternal transmission?

Answer 26

Vaccine and Immunoglobulin Anti-viral therapy in third trimester

Question 27

How do you confirm Hep C status? Why?

Answer 27

HCV RNA | Ab positivity continues after cure

Question 28

How do you reduce risk of Hep C transmission?

Answer 28

Delay IM injections until after washing the baby

Question 29

How is parvo transmitted?

Answer 29

Respiratory Vertical Blood products

Question 30

What are complications of maternal primary parvo infection? What is the pathophysiology?

Answer 30

Fetal hydrops - 3% Fetal death - 0.6% Anaemia and heart failure

Question 31

How do you manage maternal parvo?

Answer 31

Weekly US | Treat anaemia

Question 32

How does rubella present?

Answer 32

``` Low-grade fever Lymphadenopathy (95%) – occipital, postauricular, posterior cervical Exanthem –maculopapular; face > trunk >limbs Polyarthralgia / arthritis ```

Question 33

When is the baby must susceptible?

Answer 33

1st trimester

Question 34

What is the classical triad of congenital rubella?

Answer 34

* Ophthalmological – cataracts, glaucoma, retinopathy * Cardiac – PDA, PA stenosis * Auditory – sensorineural deafness

Question 35

Do you vaccinate for rubella in pregnancy?

Answer 35

No, it's live

Question 36

Which infections are teratogenic?

Answer 36

``` TORCH Parvo Varicella Syphilis Zika ```

Question 37

How do you manage a fever in pregnancy?

Answer 37

Lower the fever - panadol +/- steroids +/- tocolytics +/- abx

Question 38

What are the ddx for fetal hydrops?

Answer 38

``` Alloimmunisation Infections - CMV - Parvo Congenital - Heart failure due to structural/rhythm disturbance - Aneuploidy Anaemia - Thalassaemia - Aneuploidy ```

Question 39

How do you investigate for Parvo?

Answer 39

IgM and IgG testing over a period of time | - compare to previous samples that are stored

Question 40

How do you ix fetal hydrops?

Answer 40

Cord sampling and blood testing - Parvo serology Cross match with mother's blood