Perinatal Infections Flashcards by Tayla Phillips

What problems does sustained pyrexial illness cause in 1st trimester?

Miscarriage

NTD

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What problems does sustained pyrexial illness cause in T2/T3?

Preterm labour

Fetal death

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What is the most common cause of fetal or neonatal death?

Preterm labour

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What are the two most common bacterial infections in pregnancy?

UTI, chorioamnionitis

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What are the two most common causes of preterm labour?

Chorioamnionitis followed by UTI

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What causes chorioamnionitis?

Low pathogenic commensalism anaerobic vaginal or bowel bacteria
Bacterial vaginosis
GBS (rarely in SA)

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How does chorioamnionitis affect the mother and the etus?

The mother is usually asymptomatic

Infection causes inflammation in the baby, affecting the prostaglandin pathway, leading to preterm labour

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What are complications of chorioamnionitis in the mother?

PPROM
Preterm labour
Endometritis
Septicaemia

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What are the complications of chorioamnionitis in the baby?

Congenital bacterial infection (due to colonization at birth or acute chorioamnionitis)
Early onset (7/7) meningitis

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How is chorioamnionitis managed in mother and/or baby?

IVI ampicillin - crosses placenta

+/- gentamicin/ metronidazole (if septicaemic)

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What is the most common cause of puerpural sepsis?

GBS

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What is the indication if the baby is sick and proved to have GBS?

The mother is a carrier and needs prophylactic antibiotics in the next pregnancy

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When are antibiotics effective in women with preterm labour?

PPROM

Mother ill- maternal fever in labour, clinical signs of bacterial infection

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What is chlamydial infection associated with in the newborn?

Eye infection

Pneumonia

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What is gonorrhoeal infection associated with in the newborn?

Eye infection

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Regarding TB, what type is problematic and what is the management plan?

Cavitatory TB is the problem
Treat mother - no longer infectious after 2/52
Give baby INH prophylaxis if mother

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How does primary symptomatic syphilis present?

Chancre

Painless regional lymphadenopathy

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How does secondary syphilis present?

Rash (palms and soles)
Also pedis
Snail track ulcers
Generalized adenopathy
Malaise

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Is latent syphilis still infectious to the fetus?

Yes

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What tests are used in primary syphilis screening?

VDRL
RPR
Strip test

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What tests are used in secondary syphilis screening?

FTA

TPHA

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What are the benefits of RPR?

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Very cheap
Expressed as positive or negative
Rapid test available
Can be performed on CSF

How is VDRL performed?

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In lab.

Expressed as titre- rx if >1/16. If

What are the benefits of the strip test?

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Cheap
High sensitivity and specificity
Result in 5-20 min

How is primary syphilis managed?

Benzathine benzyl penicillin 2.4mU IMI x 3 doses 1/week

How is secondary or early latent syphilis managed?

Benzathine benzyl penicillin 2.4mU IMI x 3 (weekly)

How is syphilis treated if penicillin allergy? What is the problem with this?

Doxycycline or erythromycin - may not protect fetus

What are the signs of congenital syphilis?

``` LBW, Preterm, UGA HSM + Jaundice + Purpura + Anaemia Blisters on palms and soles (contagious) + Peeling skin Oedema Osteitis Pneumonia alba ```

What is the neonatal rx of congenital syphilis?

If symptomatic or XR involvement: procaine penicillin 50000iU/kg for 19 days (Congenital syphilis is equivalent to secondary in adults)

When do you treat an asymptomatic baby for syphilis?

Mother asymptomatic but treated (latent) Partially treated Rx completed within last 4/52 pregnancy Treated with erythromycin

What do you use to treat an asymptomatic baby exposed to syphilis in utero?

Benzathine penicillin 50000iU/kg IMI stat | Equivalent to latent phase in adults therefore stat dose

What are the TORCHES infections?

Toxo Rubella CMV Herpes

When does an infant contract congenital hep B and from what?

Contracted at delivery or after birth from blood or vaginal secretions

When, according to national protocol, is an infant vaccinated against hep B?

At 1/12

Which two clinical scenarios result in a different hep B vaccination protocol for the infant?

Mother known carrier | Acute hepatitis during pregnancy

What is the management for an infant of a known hep B carrier or of mother with acute hep in pregnancy?

Baby gets extra vaccine at birth and hep B IgG if available

What is seen on histology in a CMV infection?

Infected cells are swollen | Multinucleate giant cells

What are the complications seen in the infant with congenital CMV infection?

``` Seizures, mental retardation, microcephaly Micropthalmia, Chorioretinitis HSM, Blueberry muffin rash Late onset neural deafness Pneumonitis ```

How does rubella present?

Fever and flu-like symptoms Red maculopapular rash, face to extremities Lymphadenopathy, posterior auricular and suboccipital '3/7 day measles' but not as severe (no encephalitis) Self-limiting arthritis in young women

How is rubella diagnosed antenatally?

Antenatal USS | Amniotic fluid culture

What complications follow T1 rubella infection?

Malformations - cardiac

What are the complications of rubella in pregnancy?

Seizures, mental retardation, microcephaly Deafness Micropthalmia, chorioretinitis, cataracts HSM, blueberry muffin rash

What are the signs of congenital toxoplasmosis?

Seizures, mental retardation, microcephaly Encephalitis, peri ventricular hydrocephaly, intracranial calcification Deafness Micropthalmia, chorioretinitis

When is the baby at increased risk of getting herpes?

If the mother has active herpes at delivery | If mother's first infection is during pregnancy (no antibodies to cross placenta)

How does the infant contract herpes?

Through exposure to infected maternal secretions at delivery or if prolonged ROM

What is heroes treated with?

Acyclovir

What duration of treatment is required before the baby is safe from herpes infection at delivery?

48 hours rx

How does HIV affect the pathogenesis of herpes virus?

More viral replication and shedding

Up until when does viral shedding occur?

Up to 6/52 after infection

How is herpes diagnosis confirmed?

PCR, culture, serology

How does herpes infection present in the newborn?

Local involvement of mouth, skin or eyes Encephalitis Disseminated herpes infection

What signs on USS should raise suspicion regarding congenital infection?

``` Symmetrical IUGR Big placenta Hydrops fetalis Big liver or spleen Brain calcifications ```

What signs raise suspicion about congenital infections in a newborn?

SGA baby Flat, unwell, poor feeding Mother RPR positive and untreated, or unknown- always check Heavy placenta (>1/7 baby's weight) Any specific signs or symptoms of individual infections

What infections are of perinatal relevance?

Bacterial- UTI, chorioamnionitis, TB, gonorrhoea/chlamydia, syphilis Viral - Hep B, CMV, rubella, herpes Other- toxo

Perinatal Infections Flashcards

(54 cards)