Maternal Infections Flashcards by Hannah Farquhar

How does rubella present?

Fever, rash, lymphadenopathy, polyarthritis

Transmitted by direct contact/respiratory droplet exposure

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What is the rubella triad?

Cataracts
Patent ductus arteriosus
Deafness (due to microcephaly)

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Describe the likelihood of rubella complications depending on gestation

<8-10 weeks - 90% chance of multiple defects
11-20 weeks 10-20% chance of single defect
16-20 weeks low chance of deafness

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How is rubella in pregnancy managed?

If <12 weeks consider TOP
Specific IgG can be detected after natural infection/vaccination and blood IgM within 10 days of exposure
Supportive treatment - rest, fluids, paracetamol, postnatal vaccination

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What causes measles?

Paramyxovirus

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How does measles present?

Fever, runny nose, cough, red eyed, rash, Kopek white spots inside mouth, rash appears on forehead first

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Is measles teratogenic?

No but the high fever can cause IUGR, microcephaly, miscarriage, stillbirth or preterm labour

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What maternal complications can measles cause?

Pneumonia and encephalitis

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How is measles managed?

Supportive care to reduce fever

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What causes chicken pox and how is it transmitted?

VZV DNA virus of herpes family - transmission is mainly via droplets

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How does chicken pox present?

Fever, malaise followed by itch vesicular rash starts on trunk and moves to peripheries

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What proportion of people are seropositive for chickenpox by age 10?

9/10

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Describe the chicken pox risk depending on gestation

7-28 weeks - fetal varicella syndrome
4 weeks before delivery - neonatal chicken pox
7 days before delivery - neonatal chicken pox with septicaemia

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Describe fetal varicella syndrome

Trans-placental infection during pregnancy causes;

hypoplasia
psychomotor retardation
IUGR
cataracts
microcephaly
cutaneous scarring

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If a mother has been exposed to chicken pox how can immunity be check and what is done if she is not immune?

IgG antibodies to VZV

VZVIg given within 10 days of exposure

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How long is the patient infective with VZV for?

2 days before the symptoms until the lesions crust over

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What is classed as significant exposure?

> 15 minutes face to face contact

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When should acyclovir be given?

If >20 weeks or <24 hours within rash developing

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Name the maternal complications of chicken pox

Hepatitis, encephalitis, pneumonia

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What should be done to assess complications post infection?

5 week post infection scan

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What type of virus is cyclomegalovirus?

Herpes virus

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What are the risks of CMV to the foetus?

Miscarriage, stillbirth, IUGR, microcephaly, intracranial calcifications, hepatosplenomegaly, chorioretinitis, deafness

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Is primary or reactivation of CMV more likely to cause congenital infection?

Primary - 30-40%

Reactivation - 1-2%

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Which trimester carries higher risk of congenital CMV infection?

3rd trimester

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How is CMV diagnosed?

Amniocentesis IgG in reactivation IgM with low avidity index

What percentage of asymptomatic CMV babies will go on to have hearing loss?

8-23%

How will CMV present in a baby?

Jaundice, petechial rash, hepatosplenomegaly, microcephaly

What screening is done on babies who's mums have had CMV?

Ultrasound every 2-4 weeks Fetal MRI Fetal blood sample Post natal examination of placenta

If CMV causes severe cerebral ultrasound abnormalities what may be required?

TOP

How is CMV treated?

Valacyclovir | Hyper immune globulin

What percentage of parvovirus does fetal infection occur?

30%

What is the incubation period of parvovirus?

4-20 days

How long is a person infectious with parvovirus for?

7-10 days prior to rash and 1 day following

When is there a higher risk of fetal loss with parvovirus?

<10 weeks gestation

What does parvovirus do to the foetus?

Affects erythroid precursors - aplastic anaemia, congenital heart failure, hydros and death

How is parvovirus diagnosed?

IgM - serial USS and fetal MCA doppler

Describe mumps in pregnancy

RNA virus no effect on pregnancy, low incidence but MMR vaccine is contraindicated in pregnancy

Is influenza teratogenic?

No but if the infection is virulent there is a risk of miscarriage/preterm labour

What can prevent influenza in pregnancy?

Vaccine - safe in pregnancy and breast feeding

How can influenza in pregnancy be treated?

Antivirals to prevent complications e.g pneumonia

What is zika virus?

Primary infection though mosquito bite can cause serous birth defects

How long does zika virus remain active?

2-7 days most have minimal symptoms

What are the fetal risks of zika virus?

Microcephaly, brain defects, vision and hearing issues, limited joint movement, seizures, swallowing abnormalities, developmental delay

What is the percentage of verticle transmission of HIV?

14-25%

What increases the risk of HIV transmission?

Preterm birth and prolonged rupture of membranes

What are the risks of HIV in pregnancy?

IUGR, miscarriage, perinatal mortality

How are HIV positive pregnant women managed?

Routine screening for HIV, STIs, CMV, TB, toxoplasmosis Partner screening Viral load and CD4 count HAART and prophylactic antibiotics

What can be done to reduce risk of transmission?

Elective c-section (reduces risk by 50%) Avoidance of breastfeeding (reduces risk by <1%) ZIidovudine infusion 1 hour before c -section

At what viral load can vaginal delivery be considered?

<50 copies/ml

Define sepsis

Life threatening organ dysfunction caused by the body's response to infection

What are the signs of sepsis in pregnancy?

RR>22, HR >100bpm, temp>38 or <35, hypotension with systolic <90mmHg, low oxygen and poor peripheral perfusion, clamminess, confusion, rash and mottled skin

How is sepsis managed?

Sepsis 6 | Lactate is raised in normal active labour

Where is toxoplasmosis gondii found?

Raw or uncooked meat and infected cat faeces

What are the risks of toxoplasmosis gondii?

Hydrocephalus, choriorentitis, cerebral calcification, microcephaly, mental retardation

How is toxoplasmosis gondii managed?

Spiramycin

What is listeriosis?

Gram positive bacteria found in soil and vegetation - caused by eating infected food or contact with infected miscarried products of animals

How will listeriosis present?

Flu like or food poisoning

What are the complications of listeria?

Neonatal death due to septicaemia, late miscarriage and preterm labour, stillbirth

How is listeriosis treated?

Ampicillin and gentamicin | Trimethoprim and sulfamethoxazole

How can group B strep be treated?

Penicillin

What are the risk factors for GBS?

Preterm birth, prolonged ROM, raised temperature

What is the treatment of UTI in pregnancy?

Nitrofurantoin | Trimethoprim is teratogenic in the first trimester as it inhibits folic acid

Maternal Infections Flashcards

(62 cards)