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GP, obstetrics, psych, paeds > perinatal infections > Flashcards

perinatal infections Flashcards

1
Q

what is the difference between intrauterine infections and perinatal infections?

A

intrauterine=infection acquired/carried by the mother and transmitted to the developing fetus

whereas perinatal infections occur around the time of delivery

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2
Q

when do we worry about chickenpox in pregnancy?

A
  1. severe maternal varicella during pregnancy causing maternal pneumonia!!
  2. infection in the 2nd and 3rd trimester of pregnancy–> congenital varicella syndrome
  3. perinatal infection around delivery
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3
Q

what are some complications of influenza in pregnancy?

A

primary viral pneumonitis
and secondary bacterial pneumonia

premature birth

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4
Q

what is the leading cause of neonatal sepsis?

A

GBS (group b strep)

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5
Q

how might a baby be colonised by GBS?

A

ascending infection

colonised during delivery (vertical transmission)

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6
Q

what is the clinical presentation of early onset GBS disease as compared to late onset GBS infection?

A

pneumonia, septicaemia and less commonly meninigitis in early onset GBS

meningitis and septicaemia much more prevalent in late onset GBS

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7
Q

which antibiotic do we use for maternal prophylaxis of GBS infection?

A

benzylpenicillin

or if there is an allergy to penicillin you can try clindamycin, vancomycin or cefazolin

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8
Q

what are the maternal risk factors for EOS GBS?

A 
Preterm labour
Early rupture of membranes
Maternal fever
Clinical diagnosis of choriamnionitis
A previous infant with GBS
GBS bacteriuria during current pregnancy
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9
Q

when do we do GBS screening during pregnancy and how?

A

35-37 weeks gestation

via vaginal and anal swabs

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10
Q

when do we give prophylactic intrapartum antibiotics for GBS for a high risk pregnancy?

A

4 hrs prior to delivery and every 4 hrly until delivery

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11
Q

what antibiotics do we use for neonates with GBS sepsis?

A

benzylpenicillin + gentamicin

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12
Q

how might hep b be transmitted to infants?

A

vertically (mum to baby during delivery) and horizontally

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13
Q

if you have a pregnant lady with surface antigen positivity for hep B and high viral load (eAg positive), what is the risk of vertical transmission of hep B? How might we reduce this risk?

A

Treat mother with lamivudine during pregnancy to reduce viral load

90% risk of vertical transmission

Hep B vaccine ( then at 2,4,6months) and HBIG at birth

give Aciclovir to the mother

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14
Q

how might we prevent vertical transmission of hep B

A

Hep B vaccine and immunoglobulin within 12 hrs post birth

the baby then receives HBV vaccine at 2, 4, 6 months according to the routine immunisation schedule

Check the baby’s serology at 12 months

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15
Q

do we screen all pregnant women for hep C?

A

according to RANZCOG- we screen all pregnant women

However, the national hep C testing policy advises selective screening based on risk factors bc of the following reasons:

  1. very low prevalence rate of hep c in Australia
  2. increased false positivity rate
  3. treatment for HCV are contraindicated in women- no studies available regarding safety of anti-hep c antiviral agents
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16
Q

what are the adverse effects of parvovirus in patients with thalassaemia or sickle cell disease?

A

acute life threatening red cell aplasia

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17
Q

how might we ix parvovirus?

A

maternal serology looking for seroconversion

invasive PCR analysis of amniotic fluid

18
Q

if we have confirmed fetal parvovirus infection, what is our management?

A

serial u/s monitoring every 2 weeks for 6-12 weeks

any signs of fetal anaemia warrants intrauterine transfusion

19
Q

what is the most diagnostic clinical examination feature of maternal rubella infection?

A

cervical lymphadenopathy at the back of the neck (occipital, post-auricular etc)

if you see this–> consider doing maternal serology

20
Q

what is the classic triad of congenital rubella syndrome?

A

Think HEAD

Heart- PDA, PA stenosis
Eyes- cataracts, glaucoma, retinopathy
Audiology- sensorineural conductive hearing loss
= Deafness

21
Q

A mother on her first antenatal visit is found to be seronegative for rubella (titre levels are low). what do you do to protect them?

A

give rubella vaccine in the postpartum period

22
Q

from which viral family does the VZV virus arise?

A

herpesviridae family

23
Q

how is VZV spread?

A

through respiratory droplets and direct contact

24
Q

who do we give prophylactic IVIG to and when?

A

Prophylactic VZIG is given post exposure, up to 96 hours to susceptible pregnant women, immunocompromised, perinatal varicella infants, premature babies

25
Q

how might we confirm whether a fetus is infected with CMV?

A

testing of the amniotic fluid–> via PCR

or testing the fetal cord blood

note that if CMV is confirmed, these tests can’t determine whether the baby is affected/damaged (e.g. need to do a serial u/s for this)

26
Q

what is the percentage of babies who are infected with CMV in utero who have symptomatic infection at birth?

A

10%

27
Q

what is our management of symptomatic CMV infected babies at birth?

A

confirm dx with urine looking for CMV
cranial u/s

multidisciplinary approach

  • developmental paediatrician
  • +/- speech path, OT, PT
  • audiometry, visual assessments
28
Q

what is our management of ASYMPTOMATIC CMV infected babies at birth?

A

For the 90% of asymptomatic CMV babies:

Serial audiometry, serial visual assessments, monitor for developmental delay and pneumonitis

29
Q

what antiviral do we use for symptomatic CMV infection

A

ganciclovir +/- valganciclovir

30
Q

when is the fetus at highest risk of congenital rubella syndrome?

A

first trimester

the earlier the gestation period, the more likely

31
Q

what is the main fetal outcome of congenital syphillis?

A

stillbirth (40%)

32
Q

when do we screen antenatally for syphilis in pregnancy?

A

routine screen at 1st antenatal visit

secondary screening at 28-32/40 weeks gestation and at delivery in high risk women

33
Q

what are some clinical manifestations of congenital chlamydia?

A

conjunctivitis

pneumonia

34
Q

what is the antibiotic regimen for chorioamnionitis?

A
  • amoxycillin/ampicillin 2 g intravenously 6-hourly plus
  • gentamicin 5 to 6 mg intravenously 24-hourly for three doses (if normal renal function) plus
  • metronidazole 500 mg 8-hourly.
35
Q

what is the risk of parvovirus in pregnancy and how do we monitor it?

A

pregnancy loss

hydrops due to anaemia

-monitor with MCA ultrasounds measuring the peak systolic velocity

36
Q

how do we manage HSV lesions during pregnancy and in the intrapartum period?

A

Give analgesia
Give oral acyclovir to the mother

Perform caesarean section if active infection at the time of delivery to reduce maternal-fetal transmission

37
Q

what are some management practice points for pregnant women with known HIV?

A

Anti-retrovirals to reduce viral load
-zidovudine

Elective caesarean section 38-39 weeks

Avoid breastfeeding (in developed countries only)

Baby is followed up and has antiretroviral treatment after birth
-don’t give vitamin K and hep B vaccination right away

38
Q

which perinatal infections cause congenital abnormalities?

A 
Cytomegalovirus
• Parvovirus B19
• Rubella
• Toxoplasma gondii
• Treponema pallidum (syphilis)
• Varicella zoster virus
39
Q

what is the main risk of CMV perinatal infection?

A

sensorineural hearing loss

40
Q

when is the risk of fetal infection and damage greatest secondary to rubella infection?

A

first 8 weeks in utero

41
Q

when is the risk of fetal infection greatest secondary to parvovirus?

A

highest transmission between 8-20 weeks. (least likely during first trimester and 3rd trimester)

42
Q

what should a pregnant woman do if she has symptoms of the flu?

A

If your GP suspects that you have the flu they may prescribe antiviral medications (such as Relenza or Tamiflu). These should be commenced in the first 2 days of the illness to have the greatest benefit.

GPs do not routinely test everyone with flu-like symptoms. However, because you are pregnant your doctor may decide to test you. This will involve collecting a nose and throat swab to look for the virus.

Women who are near term (>38 weeks gestation) or those with pregnancy complications may need to be admitted to hospital.

GP, obstetrics, psych, paeds (55 decks)

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