MI: Viral Infections in Pregnancy Pt.3

Question 1

Describe the symptoms of measles.

Answer 1

• Prodrome (2-4 days): fever, malaise, coryza,
• Conjunctivitis
• Kopolik spots
• Maculopapular rash starting at hairline and spreading to trunk/limbs within 3 days

Question 2

List some maternal complications of measles infection.

Answer 2

• Secondary bacterial infection (otitis media, pneumonia, bronchitis)
• Encephalitis
• Subacute sclerosing panencephalitis

Question 3

What are the risks of measles in pregnancy?

Answer 3

• Foetal loss (miscarriage, intrauterine death)
• Preterm delivery
• Increased maternal morbidity

IMPORTANT: NO congenital abnormalities to the foetus

Question 4

How should pregnant women who have been in contact with suspected/confirmed measles be treated?

Answer 4

Measles immunoglobulin attenuates the illness if given within 6 days of exposure

Question 5

What type of virus is parvovirus B19?

Answer 5

• DNA virus
• Parvoviridae family

Question 6

Describe the clinical presentation of parvovirus B19 infection.

Answer 6

Mostly asymptomatic

• Erythema infectiosum (fifth disease, slapped cheeck syndrome)
• Transient aplastic crisis
• Polyarthropathy

Question 7

Outline the pathophysiology of parvovirus B19 infection.

Answer 7

• Tropism for rapidly-dividing erythrocyte precursors
• Causes suppression of erythrogenesis
• NO reticulocytes are available to replace egeing or damaged arythrocytes as they are cleared by the reticuloendothelial system

Question 8

At what stage in pregnancy is parvovirus B19 infection most concerning?

Answer 8

<20 weeks gestation

• 33% risk of tranmission to foetus
• 9% infection risk
• 50% of foetal infections result in intrauterine death

Infection >20 weeks has no documented risks

Question 9

What is the main complication to the foetus from parvovirus B19 infection?

Answer 9

• Viral destruction of erthrocyte precursors causes severe anaemia
• This leads to high-output heart failure and hydrops fetalis

Question 10

How is parvovirus B19 infection <20 weeks managed?

Answer 10

• Referral to fetal medicine for monitoring
• May require intrauterine blood transfusion
• Some will resolve spontaenously
• If the foetus survives the hydropic state, they have a good prognosis

Question 11

Describe how maternal parvovirus B19 infection can be diagnosed.

Answer 11

• Viral detection (PCR)
• Serology

Question 12

Name some human pathogenic enteroviruses?
How can they be transmitted?

Answer 12

Transmitted via respiratory droplets +/- faecal

Question 13

What are the symptoms of enterovirus infection?

Answer 13

• Hand, foot, mouth disease
• Rash
• Encephalitis
• Myocarditis

Question 14

Which enterovirus presents the biggest risk to the neonate?

Answer 14

Coxsakie virus

• Perinatal infection can occur in the last week of pregnancy
• Neonates are at risk of myocarditis, fulminant hepatitis, bleeding, and multi-organ failure

Question 15

Outline the symptoms of Zika virus.

Answer 15

• 80% asymptomatic
• May cause fever, rash, myalgia and arthralgia

Question 16

What are some consequences of Zika virus infection in pregnancy.

Answer 16

• Miscarriage
• Stillbirth
• Congenital Zika syndrome
  
  • Severe microcephaly
  • Decreased brain tissue
  • Seizures
  • Retinopathy/deafness
  • Talipes
  • Hypertonia

Question 17

What advice can be given to pregnant women who are concerned about Zika virus?

Answer 17

• Bite avoidance
• Avoid travelling to Zika endemic countries if pregnant
• Avoid conception 2-6 months after travel to Zika endemic country (6 months for men, 2 months for women)
• Test only if symptomatic or abnormalities seen on USS

Question 18

What questions to ask pregnant women presenting with rashes in history?

Answer 18

Question 19

What is the general investigations to conduct in pregnant women with rashes?

Answer 19

Question 20

What is subacute sclerosing panencephalitis?

Answer 20

• Fatal progressive degenerative disease
• Tends to occur 7-10 years after measles infection
• Present with delays motor skills and behavioural problems