perinatal infection by dr mohamed khalil md mrcog
Post on 22-Dec-2015
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For which infections should pregnant women be screened?
HIV
Syphilis
GBS
Rubella
Cytomegalovirus?
Toxoplasma?
Bacterial vaganosis?
Early onset infection/ septicemia
Late onset disease/meningitis
What neonatal conditions are caused by Group B streptococcus ?
How can they be prevented?
Screening for all pregnant women at 35-37
ttt +ve women/penicillin, vancomycin, cefazolin
Identifying women with risk factors eg PTL <37 wks, SROM>18hs, intrapartum fever>38c,
previous affected child, GBS bacteruria
Which common genital infections are implicated in preterm birth?
Bacterial vaganosis/Bad odor, PH>4.5 ,KOH, Clue cell ,
Metronidazol/ Clindamycin/ safe in pregnancy
Human Parvovirus ,
Cytomegalovirus
Toxoplasma
What are examples of infections with minimal maternal effects but the potential for significant fetal
compromise?
Usually asymptomatic in adult
Maternal infection diagnosed by igG, igM
Fetal anaemia, none immune hydrops/ death
Fetal anaemia can be diagnosed by DOPPLER of MCA------MCAPSV
Intrauterine transfusion may be necessary if MCPSV > 1.5 MOM
What maternal and fetal effects are caused by parvovirus ? =fifth disease
Usually asymptomatic in adult
Fetus could have CNS abnormalities, IUGR/IUFD
The gold standard for the diagnosis of fetal CMV infection is the amniotic fluid CMV nucleic acid amplification testing
How does cytomegalovirus affect the fetus?
What is toxoplasma/mode of transmission?
Parasite Ingestion of infected meat/ exposure to
infected cat feces Infection in early pregnancy/ less incidence
of fetal infection but it will be serious Infection in late pregnancy /higher incidence of fetal infection
ToxoplasmosisToxoplasmosis
The reported overall risk of congenital toxoplasmosis ranges from 18% to 44% .
The risk is low in early pregnancy (7-15 weeks) at 6% to 26% but with severe damage to the
fetus .
And rising to 32% to 93% at 29 to 34 weeks of gestation with less fetal damage
Subclinical disease
Acute toxoplasma infection can be indicated if maternal serum shows igG+, igM+, igG avidity index low
IUGR, IUFD
Multiple systems affection, CNS
Scan---calcification—brain--liver
Antiparasite therapy can prevent fetal sequel
What is the significance of toxoplasmosis in pregnancy?
Does maternal varicella infection pose risks during pregnancy? What about herpes zoster?
Acute varicella infection=chicken poxReactivation=shingles=zoster
Chicken pox----maternal pneumonia/ death
Time of fetal infection if infection happen ( ) 13-20wk mainly skeletal deformities, skin, CNS, Eyes defects
Infection after 20 wks--- congenital zoster syndrome is uncommon
Vaccination is contraindicated during pregnancy
VZIG to susceptible individuals
Can varicella-zoster infection be prevented by VZIG?
How does infection with human immunodeficiency virus (HIV) impact pregnancy?
Maternal concern is to control the diseasePregnancy does not worsen the disease in mother
Vertical transmission 50% occur during labour10-20% with breast feeding
Can anti-retroviral therapy( AZT) be safely used in pregnancy?
Safety concern need to be balanced against the potential benefit to mother and baby
Antiretroviral reduces viral load
What steps can be taken to reduce the risk of vertical transmission ?
Antiretroviral during antepartum period
Cesarean section even with ROM
No breast feeding
The risk is 15-25% without prevention versus <5% with preventive measures
What is the significance of rubella in pregnancy?
Maternal : It cause german measles
100% of infants infected during the first 11 weeks of pregnancy will have rubella defects.
and reduced to 25% at the end of the second trimester .
Sensorineural deafness is the most common single defect,
heart, CNS defect, IUGR ,
preconception vaccination can give protection
Rubella susceptibility screening should be offered early in antenatal care to identify women at risk of contracting rubella infection and to enable vaccination in the postnatal period for the protection of future pregnancies .
6.
What are the fetal effects of congenital syphilis ?Treponema pallidum
Tests of diagnosis VDRL, TPHA, TPI
TPHA false +ve results(pregnancy, malaria, leprosy, glandular fever)
Hydrops, hepatosplenomegally, IUFD,
Congenital syphilis (frontal bossing, high arched palate, hutchington,s teeth, 8th nerve deafness, interstitial keratitis)
Antenatal screening is recommended
Treatment is by penicillin
What are the fetal effects of congenital syphilis? Treponema pallidum
In pregnant women with early untreated syphilis , Mother-to-child transmission of
syphilis in pregnancy is associated with
70% to 100% of infants will be infected ,
41% congenital syphilis (which may cause long-term disability) ,
25% stillbirth
25% preterm birth. [EL = 3]
14% neonatal death,
.
How does herpes simplex virus (HSV) affect pregnancy?
During vaginal delivery
Primary infection
Secondary infection
Neonatal disease ranges from asymptomatic infection to disseminated disease and death
How is transmission of HSV to the fetus/newborn prevented?
by CS if delivery can happen within a month from the primary infection.
Screening for Hepatitis B virus
The prevalence of hepatitis B surface antigen (HBsAg) in pregnant women in the UK range from 0.5% to 1% .
85% of babies born to mothers who are positive for the hepatitis e antigen (eAg) will become HBsAg carriers and
subsequently become chronic carriers ,
Compared with 31% of babies who are born to mothers who are eAg negative (RR2.8, 95% CI 1.69 to 4.47).
Screening for Hepatitis B virus
Mother-to-child transmission of the hepatitis B virus is approximately 95% preventable through administration of vaccine and immunoglobulin to the baby at birth.
Serological screening for hepatitis B virus should be offered to pregnant women so that effective postnatal intervention can be offered to infected women to decrease the risk of mother-to child transmission.
Screening for Hepatitis C virus
Incidence ranges from 0.14 in the West Midlands (95% CI 0.05 to 0.33) to 0.8 in London (95% CI 0.55 to 1.0).
Mother-to-child transmission in the UK is estimated to lie between 3% and 5% .
A higher proportion of infected babies has been observed among those delivered vaginally compared with those delivered by caesarean section but only one study has demonstrated a statistically
significant difference .
Screening for Hepatitis C virus
All infants with HCV-RNA will be negative and lost HCV antibodies by 6 months after birth.
Pregnant women should not be offered routine screening for hepatitis C virus because there is insufficient evidence to support its effectiveness and cost-effectiveness.
HIV
Is a retrovirusAsymptomatic infection has no significant effect on pregnancy complicationDoes not influence the mode of deliveryAbout 15% of babies will remain HIV +ve at 6 months of ageCan be isolated from cervical secretion
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All pregnant women are still screened for syphilis
VDRL test is a specific testVDRL remain +ve for evercongenital syphilis causes skeletal damageTtt in early pregnancy will not protect fetusUntreated syphils may result in prematurity
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Which of the following vaccines is recommended to be given during pregnancy?
A- MMR
B- Varicella
C- Influenza
D- All of the above
C
Rubella infection
Rapidly cross the placentaMay lead to fetal cataractMay cause thrombocytopeniaCan be confirmed by fetal blood sample to detect IgG antibodiesCan be confirmed by CV sampling at 10 wk
abce
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