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Microbiology Part 2 > Lec49 Intrauterine and Perinatal > Flashcards

Lec49 Intrauterine and Perinatal Flashcards

(49 cards)

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1
Q

What is relationship time of exposure in pregnancy and severity of infection / risk of infection?

A
  • decreasing severity of infection over time of pregnancy

- increasing risk of infection over time [as placental barrier breaks down]

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2
Q

What routes of transmission for CMV – placental, intrapartum, or breast milk?

A
  • placental or breast milk
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3
Q

What routes of transmission for HIV – placental, intrapartum, or breast milk?

A
  • intrapartum or breast milk
  • can also cross placenta but only if really serious disease [high VL, bad immune system]
  • normally its intrapartum
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4
Q

What routes of transmission for rubella – placental, intrapartum, or breast milk?

A

placental

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5
Q

What routes of transmission for VZV – placental, intrapartum, or breast milk?

A

placental

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6
Q

What routes of transmission for toxoplasma – placental, intrapartum, or breast milk?

A

placental

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7
Q

What routes of transmission for syphilis – placental, intrapartum, or breast milk?

A

placental

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8
Q

What routes of transmission for listeria – placental, intrapartum, or breast milk?

A

placental

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9
Q

What are potential effects maternal infection on pregnancy?

A
  • pregnancy loss
  • teratogenicity
  • in utero infection
  • chronic infection of fetus
  • acute infection of newborn
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10
Q

What are the torch infection?

A
  • in utero infections that present with ocular findings and rash
    T: toxoplasma gondii
    O: syphilis, parvo B19, varicella, HIV, Hep B, chlamydia
    R:Rubella
    C: CMV
    H: HSV
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11
Q

What are risk factors of perinatal HIV transmission?

A
  • advanced maternal disease
  • high maternal viral load
  • ruptured membrane for > 4 hrs [long labor]
  • breast feeding
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12
Q

What is current treatment for pregnant HIV+ to prevent transmission?

A
  • multi drug ARV regimen
  • cesarean delivery
  • ARV prophylaxis
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13
Q

What are signs of group B strep in pregnant woman?

A
  • asymptomatic, UTI, amnionitis, sepsis
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14
Q

How do you prevent baby with strep B?

A
  • screen at 35 wks

- treat during labor or 4 hrs before cesarean

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15
Q

What is risk of mother-infant transmission GBS?

A
  • 50% of infected mothers pass it on, only 2% have symptoms
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16
Q

What are symptoms of infant group B strep?

A

within first week of life:

  • early onset sepsis
  • pneumonia
  • meningitis
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17
Q

What are indications for giving GBS prophylaxis?

A
  • infant with invasive GBS during previous pregnancy
  • pos GBS screening during current pregnancy
  • unknown GBS AND deliver < 37 wks
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18
Q

What is treatment for GBS prophylaxis?

A

first choice: penicillin or ampicillin

2nd: clindamycin
3rd: vancomycin

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19
Q

When is maternal morbidity from pregnant influenza greatest?

A

highest maternal morbidity later in pregnancy

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20
Q

What are recommendations of influenza vaccine in pregnancy?

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A
  • give vaccine in any/all trimesters in pregnancy –> may passively transfer antibodies
  • fetus never in danger of picking up virus but itll help protect fetus early in life
21
Q

What is the most common congenital infection?

22
Q

What is effect of congenital CMV?

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A
  • congenital hearing loss
  • range moderate hepato-splenomegaly to fatal illness
  • 80-90% have complications in 1st year of life –> vision impairment, mental retardation, hearing loss
  • in 1st trimester –> pregnancy loss
  • 2nd or 3rd trimester –> congenital disease
23
Q

What is risk of vertical transmission of CMV?

24
Q

How do you screen for maternal CMV?

Study These Flashcards
A
  • sometimes do CMV serologic screening
  • CMV IgM = not reliable, high false pos rate
  • paired serum test
25
How do you screen for CMV in neonate?
- culture/PCR amniotic fluid but does not predict severity | - ultrasound to assess severity
26
Is there a vaccine for CMV?
NO
27
Where does listeria infection come from?
- processed food [deli meats]
28
When do most listeria infections occur in pregnancy?
- in 3rd trimester usually | - if 1st trimester = worse prognosis
29
How does vertical listeria transmission occur?
listeria infects placenta = reservoir
30
How can you get rid of listeria in pregnant woman?
only way is to remove placenta
31
What is effect of listeria infeciton in mom?
- 20-30% mortality in neonates - infection in early gestation --> sponatenous abortion - in late gestation --> risk of preterm birth
32
How do you prevent pregnant listeria infection?
- no deli meats - no soft cheeses - no unpasteurized milk
33
What is treatment for listeria?
antibiotic [penicillin, ampicillin, amoxicillin] that can cross placenta and penetrate cell wall
34
Is there higher risk for vertical transmission in early or late pregnancy of toxoplasmosis?
- later in gestation more likely to be transmitted | - early infections more likely to be severe
35
How do you dx congenital toxoplasmosis?
during pregnancy: serology, amniocentesis, toxoplasmosis test after birth: serology, CT, neuro exam, toxoplasmosis
36
classic in utero triad of toxoplasmosis
Chorioretinitis, intracranial calcifications, hydrocephalus
37
effects of toxoplasmosis?
- most infants asymptomatic but 85% have visual impairment later in life
38
What is treatment for toxoplasmosis?
in utero: spiramycin then pyrimethamine + sulfadiazine | post natal: pyrimethamine + sulfadiazine for up to yrs
39
What is preventive measure of HSV in pregnant women and at birth?
- neg women avoid intercourse with pos partner in 3rd trimester - at 1st episode genital herpes or frequent recurrences --> treat with acyclovir - C section recommended with active disease - maybe intrapartum IV acyclovir also
40
What is risk of vertical transmission HSV?
- 30-50% risk when primary infection near term | - low risk when recurrent infection
41
How do you prevent neonatal herpes?
- prevent maternal acquition HSV | - avoid exposure to herpetic lesions during delivery
42
What are effects of congenital rubella syndrome?
- deafness - blindness - mental retardation - fetal death up to 20%, premature delivery - defects rare after 20 wks gestation
43
When is highest risk of CRS? highest risk of transmission?
- highest risk of CRS early in pregnancy
44
What is treatment for congenital rubella?
supportive
45
What are effects of varicella in maternal?
- increased risk of varicella pneumonia, <1% of maternal infections transmitted vertically
46
What are signs of congenital varicella syndrome?
- chorioretinitis, congenital cataracts, cerebral cortical atrophy, variable degress of limb atrophy, skin scarring, GI reflux
47
What does neonatal congenital varicella transmission occur?
less than 5 days before birth
48
What is treatment of congenital varicella in mom? neonate?
- don't give vaccine [its life] - immediately give VZ Ig at exposure - mother --> hospitalize, acyclovir or valacyclovir - neonate: VZ Ig
49
What are signs of neonatal HSV? treatment?
- may be limited to skin/mucous membranes - may be systemic [including CNS] - treat: IV acyclovir if sero+ or if maternal infection was primary HSV

Microbiology Part 2 (30 decks)

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