Obstetrics And Perinatal Infections Flashcards Preview

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Flashcards in Obstetrics And Perinatal Infections Deck (18)
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Risk factors modifying outcomes of infection in pregnancy-> mother

Physiological/ immunological changes may increase susceptibility and alter clinical manifestations
Many drugs are contraindicated
Urinary tract infections may be asymptomatic or lead to pyelonephritis
Varicella->develop varicella pneumonia
Maternal rash
-> rubella
-> parvovirus B19-> no congenital risks but in increased risk on mis carriage

1

Infections in pregnancy-> neonate

May effect fetal development
Neonatal immune system not fully mature
Different spectrum of infectious agents
Congenital infections may cause long term lie threatening illness

2

Maternal cytomegalovirus

May be primary or secondary-> both cause congenital infection and teal damage
Timing of infection doesn't appear important
Maternal infection is almost always asymptomatic

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Congenital cytomegalovirus

3-4 per 1000
Severe handicap-> 5-10%
minor -> 5%

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Prevention of congenital cytomegalovirus

Screening is not advocated
-> no advice to give positive women
-> recurrent CMV may also cause congenital CMV
Development of a vaccine

5

Congenital rubella

Transplacental transmission
Outcome dependent on timing within pregnancy
-> first trimester-> multiple developmental defects-> congenital rubella syndrome-> CNS, eye, heart
12-18 weeks-> deafness
After 18-> no risk
Universal MMR vaccine
Antenatal screening and post partum vaccination
Investigation of maternal rash

6

Congenital toxoplasmosis

Toxoplasma Gondi, protozoon
Transplacental transmission
-> brain damage, chorodio retinitis-> may not present until later life
Risk of fetal damage is greatest in early pregnancy

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Congenital syphilis

May be multi system
Range of clinical features which present at 5-15
Routine antenatal screening and treatment

8

Congenital varicella

Varicella embryopathy
Skin loss, scaring, usually unilateral
Impaired limb bud development
Many other less specific features-> microcephaly, cataracts, IUGR 1-2% risk following maternal varicella in first 20 weeks of pregnancy

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Blood Bourne virus transmission

Antenataly-> transplacental
Perinataly-> infected birth canal, exposure to maturation blood
Postnatally-> breast milk-> only HIV

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Mother to baby HIV

20% risk
Preventable by:
-> maternal antiretroviral therapy to reduce viral load
-> elective Caesarian
-> no breast feeding
Antenatal screening

11

Mother to baby HBV

5-90% transmission rate
Neonatal infection leads to very high carriage rates
Preventable by vaccination
-> active-> accelerate course
-> passive-> hep B immunoglobin
Universal antenatal screening-> HBsAg

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Mother to baby HCV

Rates very low compared to hep B
No intervention so no screening

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Neonatal septicaemia/meningitis

Main causes-> group B streptococcus, E.coli
Acquired from maternal birth canal/early rupture of membranes leading to chorioamniotits
Known carriers of GBS given antibiotics during labour
Listeria monocytogenes less common

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Group B streptococcus

Important causes of neonatal pneumonia, septicaemia and meningitis
Commonly found as normal gut flora
Colonise perineum/vagina in 1/4 of pregnant women
1/200 risk of neonatal infection
I.v antibiotics reduces risk to 1/4000

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Varicella in pregnancy

In mother-> varicella pneumonia
-> in first 20 weeks-> risk of fetal damage
->late pregnancy-> neonatal infection
Delivery >7 days after maternal rash-> safe
VZIg to neonates
Prophylactic aciclovir

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Neonatal herpes

Most infections acquired from primary Venetian herpes at term
50% of cases have no external lesions but have internal dissemination
Prognosis is awful
1 in 50,000 live births

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Ophthalmia neonatorum

Acute Purulent conjunctivitis
Neisseria gonorrhoeae or chlamydia trachomatis
Acquired from infected maternal birth canal
Neonatal pneumonia

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