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Pregnancy Infections - Coggle Diagram
Pregnancy Infections
Syphilis
Characteristics
Treponema Pallidum (Spirochete)
Transmitted sexually or vertical
Congenital rates increasing with increasing incidence in western world
Primary
Presentation
Chancre (painless ulcer) that selfresolved
Regional Adenopthies (bilaterla)
Unnoticed in women
Secondary
Highly Infectious, Flu-Liek symptoms, Maculopapular rash involving palms, soles, mucous membranes, Condylomata lata
Latent
Asymptomatic (Early <1 year), or Late (>1 year)
Tertiary
CNS, Cardiovascualr systema, Skin manifestations (1/3 if no treatment)
Screening
First prenatal visit and repeat if ongoing risk at 28 weeks and at delivery
Diagnosis
Treponemal antibody test and Non-Treponemal Antibody Test
Maternal-Fetal Transmission
Transmission
Decreases with stage of disease
Increases with gestational age
Severity
Decreases with stage and gestational Age
Consequences
Spontaenous abortion, death in utero, restricted growth, fetal hydrops, prematurarity, hepatosplenomegaly, placentomegaly
Manifestations
Early (Before 2 years)
2/3 Asymptomatic
Hepatomegaly, splenomegaly, jaundice, viral symptoms, peeling skin/rash, parrot's pseudoparalysis
Late
Saddle nose, saber shins, hutchinson teeth, mulberry molars, interstitial keratitis, frontal bossing, Rhagades, Clutton's Joints
Treatment
Penicillin (desensitize if allergic)
Varicella
Characteristics
DNA Virus, 90% of pregnant women are positive for VZV antibodies
Transmission
Respiratory Droplets, direct contact wtih vesciular fluid
Clinical Manifestation
Fever, hepatitis, Pneumonia, meningitis, Disseminated maculopapular rash
Diagnosis
Vrial culture/PCR/Serology for varicella
Maternal Risks
5-10% varicella pneumonia, increased risk if smoking, high rate of intubation and mechanical ventilation, higher mortality rate than the general population
Neonatal/peripartum Exposure
Maternal Sx <5 days before delivery up to 2 days after
Fulminant infection-visceral dissemination and CNS
Often fatal
Peripartum Prophylaxis
Varicella Zoster Immunoglobulin
Onlily given to susceptible women, decreased rate of infection if admistered <96 hrs after exposure, aim is to reduce maternal complications
Treatment
Acyclovir for severe infection
Prophylaxis with live attenuated vaccine (not recommended in pregnancy)
Toxoplasmosis
Routes of Transmission
Raw or undercooked meat, exposure to feces of infected hosts, Vertical Transmission (transfusion, organ transplant)
Clinical Manifestations
90% asymptomatic
Diagnosis
IgG and IgM for toxoplasmosis, and IgG avidity testing
Amniocentesis - PCR amniotic fluid
Transmission to Fetus
Occurs 1-4 months after placental colonization typically later in pregnancy
More concerned about infections that occur later in pregnancy
Fetal Consequences
Intracranial calcifications, Chorioretinitis, Hydrocephalus, Convulsions
Treatment and Prevention
Treatment
PCR Negative
Spiramycin Phrophylaxis
PCR Positive
Pyrimethamine, Sulfadiazine, leucovorin
Prevention
Properly cooking meats, thoroughly wash fruits and vegetables, wash hands, wear gloves in garden and changing cat littler
Rubella
Characteristics
RNA Virus, Transmission via droplets
Clinical Manifestations
25-50% asymptomatic, Rsh, 60-70% polyarthritis/polyarthralgia
Diagnosis
Maternal IgG, and IgM for rubella
Amniocentesis
Maternal- Fetal Transmission
Risk of congential deformities up to 20 weeks Ga
16-20 weeks
Risk of sensoneurinal hearing Loss
Neonatal Manifestation
Sensoneurinal Hearing loss, Heart defect (Pulmonic stenosis), Retinopathy, cataract, glaucoma, CNS (Cognitive disability, microcephaly), blueberry muffin rash
Severe morbidiy and mortality in infants (profound congenital delay)
Treatment and prvention
No Treatment in pergnancy
Rubella Vaccine
Contraindicated in pregnancy
Administered postpartum in non-immunized patients
Cytomegalovirus
Characteristics
DNA virus (herpes Family), and transmitted through body fluids
Most common intraureine infection
Clinical Manifestations
Asymptomatic/Viral Symptoms
Diagnosis
IgG and IgM for CMV, Amniocentesis
Neonatal manifestations
Congenital sensoneurinal hearing loss
Maternal/Fetal Transmission risk
Priamry infection 30-40%, Secondary infection 1%
Treamtnet/Prevention
Treatment in pregnancy
High Dose Acyclovir
Prevention
Hand washing/Screening Blood products
Herpes
Characteristics
DNA Virus
Acquired in utero
Clinical Manifestations
Genital Ulcers/Labial Ulcers
DIagnossi
CLinical, PCR confirmation is preferred
Neonatal
Exposure via maternal genital tract
Iatrogenic/Familial trnamission after birth via skin lesions
Primary infection in third trimester
Treatment/Prevention
Suppressive Treatmetn from 36 weeks
C-Section if lesion or prodrome at time of delivery
Acyclovic IV to decrease mortality and neurologic deficits
Neonatal Manifestations
Infection of skin, eyes, mouth, CNS infection, Disseminated disease
Group B Streptococcus
Characteristics
1/5 asymptomatic rectovaginal colonization
1/2 newborns will be colonized
1/100 newborns will develop sepsis
Risk Factors
Prematurity, intrapartum maternal fever, rupture of membranes >18 hrs, Have GBS infected child, GBS bacteriuria during current pregnancy
Neonataal Manifestations
Early Onset: Rapid deterioration, Septic shock, RDS, Meningitis
Late Onset: Most often Meningitis
Maternal manifestations
Chorioamnionitis, endometritis
Diagnosis
Rectovaginal culture 35-37 weeks
Treatmetn
Penicillin q4h until delivery
Indications for treatment
Culture positive for GBS, GBS bacteriuria, Past history of GBS infection, les htan 37 weeks pregnant
Sexually Transmitted Disease
Hepatitis B
Characteristics
DNA Virus
Transmission
Parenteral, sexual contact, vertical
Reduced with prophylaxis
Prop[hylaxis
Hepatitis B immunoglobulins within 12 hrs of birth
Hepatitis B vaccine before leaving hospital
Hepatitis C
Characteristics
RNA virus
Often Asymptomatic
Transmission
Parenteral, sexual contact, perinatal
low if low level, ut hgiehr for high level viremia
Chlamydia
COnsequiences
Prematurity, premature rupture of membranes, Low brith weight, Neonatal death, conjunctivityis
Treatmetn
Azithryomycin, amoxicillin, test cure 3 weeks later
Gonorrhea
Characteristics
Gram negative diploccous
Risk factors
,25 years old, previous infection, presence of other STI, NEw sexual partner, drug use, sex trade worker
Disseminated infection
Increased risk in 2nd and 3rd trimester
Bacteremia, Skin rash, Hepatitis, rarely endocaridtis or meningitis, septic arthriits
Treatment
Ceftriaxone and azythromycin
HPV
Characteristics
dsDNA virus
Treamtnet
C-section for severe cases
Condylomas: Trchloroacetic acid, excision, electrosurgery
HIV
Characteristics
RNA Retrovirus
Transmission
Sexual contact, shared injection drug use equipment, vertical, contaminated blood products or orans
Diagnosis
HIV serology
Clinical PResentation
Acute
Flu-like illness, fever, adenopathy, weight loss, diarrhea
Chronic
Diarrhea, wasting, opportunistic Infections
Mother to Child Transmission
Majority occurs at or after delivery
Low chance if appropriate treamtent for mother during pregnancy/labour and for newborn in first weeks
Causes
Peripartum, in utero, Breastfeeding
Prevention
ART to suppress viral load, ZIdovudine, PEP
Maintain low viral load
Parovirus B19
Characteristics
DNA virus, usually outbreak in spring
Women of reporductive age are immune, more at risk when with children
Fetal Manifestations
Spontanenous abortion, hydrops, deaht in utero, anemia, thormbocytopenai
Transmission
Respiratory secretionos, blood products, transplacental
Clinical Manifestations
Asymptomatic, Viral symptoms, facial rash (slapped cheeks), Arthralgia
Diagnossi
IgG and IgM for parvovirus
Management
Hydrops
Tertiary care centre, consultation in maternal fetal medicine (cordocentesis +/- intrauterine transfusions)