pregnancy and infection

Information about pregnancy and infection

Published on December 18, 2009

Author: hamoda1992

Source: authorstream.com

Content

viral Infection with Pregnancy : viral Infection with Pregnancy Dr. Mohammed Abdalla Domiat general hospital Antenatal screening : Antenatal screening All pregnant women are offered screening for rubella antibody, syphilis, HIV and hepatitis B as an integral part of their antenatal care during their first and all subsequent pregnancies. UK National Screening Committee (NSC). Antenatal screening : Pregnant women arriving in labour who have not received antenatal care elsewhere are offered screening for infectious diseases. Priority is given to hepatitis B and HIV screening Antenatal screening Antenatal screening : It is suggested that laboratories carrying out antenatal screening perform a minimum of 1000 tests per year (per infection screened), have consultant-level microbiological support and work to recognized independent national standards. Antenatal screening detailed infective screening : detailed infective screening Sporadic miscarriage is so common that detailed infective screening cannot be justified economically. detailed infective screening : TORCH screening is unhelpful and should be abandoned in the investigation of recurrent miscarriage. detailed infective screening detailed infective screening : Where it is found helpful in cases of fetal hydrops, fetal brain lesions, unexplained severe growth restriction or in utero demise are recommended. (Grade C) detailed infective screening IMMUNIZATION : IMMUNIZATION The measles, mumps, rubella (MMR) vaccine is a single vaccine that grants immunity to all three infections. women who are not already immune should receive MMR before becoming pregnant and should then avoid conception for the following 28 days. IMMUNIZATION : The Varicella vaccine grants immunity to chickenpox. Because it is a live vaccine, it should be given before the onset of pregnancy, IMMUNIZATION IMMUNIZATION : The hepatitis B vaccine is given through a series of injections and can be safely administered during pregnancy. The vaccine should be given to pregnant women who at high risk for acquiring hepatitis B. Women at high risk include: Health care workers who may be exposed to blood or body fluids contaminated by blood Women who have a sexual partner who has hepatitis B Hemodialysis patients Patients who receive blood clotting factors. IMMUNIZATION Rash illness : Rash illness Non vesicular vesicular rubella and parvovirus B19(a non vesicular rash illness) : rubella and parvovirus B19(a non vesicular rash illness) Slide 13: The consequences for the fetus of primary rubella infection during the first trimester of pregnancy are devastating. It is therefore critically important to identify mothers who lack rubella-specific antibody so that advice on postpartum immunization can be offered to protect them in subsequent pregnancies rubella and parvovirus B19 rubella and parvovirus B19 : All pregnant women with significant contact with a non-vesicular rash illness (defined as being in the same room for over 15 minutes or face-to-face contact) should be investigated for parvovirus B19 and rubella infection, irrespective of whether they develop a rash or not, Testing is considered unnecessary if there is documented evidence of two tests on different blood samples both confirming the presence of rubella-specific IgG, even if contact with a suspected rubella case or a rubella-like rash occurs rubella and parvovirus B19 rubella and parvovirus B19 : Screening results are reported as rubella-specific IgG detected/not detected rather than immune/susceptible. rubella and parvovirus B19 rubella and parvovirus B19 : for results reported as rubella-specific IgG not detected The laboratory advises on any further follow-up required (e.g. “immunization advised postpartum”). rubella and parvovirus B19 rubella and parvovirus B19 : detection of rubella-specific IgG does not exclude the possibility of recent infection, evidence of rash in early pregnancy is sought and communicated to the laboratory to allow interpretation of results rubella and parvovirus B19 rubella and parvovirus B19 : All pregnant women presenting with a non-vesicular rash compatible with a systemic viral infection should be investigated for rubella and parvovirus B19 infection, irrespective of a prior history of rubella vaccination or previous positive rubella antibody tests. (Grade C) rubella and parvovirus B19 rubella and parvovirus B19 : All requests for laboratory investigation must give the following information in addition to the usual demographic details: (date of last menstrual period). date of onset of rash,, type and distribution of rash. past history of rubella antibody tests or rubella vaccination . any known contact with rash illness and dates of contact. (Grade C) rubella and parvovirus B19 rubella and parvovirus B19 : When serology shows potential for early infection with parvovirus B19, the patient should be referred to a fetal medicine unit capable of fetal blood sampling and intravascular transfusion. (Grade C) rubella and parvovirus B19 varicella-zoster virus (vesicular rash illness) : varicella-zoster virus (vesicular rash illness) varicella-zoster virus : Varicella, the primary infection with varicella zoster virus (VZV), in pregnancy may cause maternal mortality or serious morbidity. It may also cause fetal varicella syndrome (FVS) – previously known as congenital varicella syndrome – or varicella infection of the newborn. varicella-zoster virus varicella-zoster virus : The primary infection is characterised by fever, malaise and a pruritic rash that develops into crops of maculopapules, which become vesicular and crust over before healing. The incubation period is 10–21 days and the disease is infectious 48 hours before the rash appears and continues to be infectious until the vesicles crust over. varicella-zoster virus varicella-zoster virus : FVS is characterised by one or more of the following: skin scarring in a dermatomal distribution eye defects (microphthalmia, chorioretinitis, cataracts) hypoplasia of the limbs; neurological abnormalities (microcephaly, cortical atrophy, mental retardation and dysfunction of bowel and bladder sphincters). varicella-zoster virus varicella-zoster virus : varicella-zoster virus Women without a previous history of varicella should be screened for varicella-zoster virus antibodies, by a sensitive method, at booking or rapidly after contact or exposure, i.e. within 48 hours. varicella-zoster virus : After a significant varicella zoster contact, a susceptible pregnant women (regardless of gestational age) should be given VZIG (up to 10 days after contact). (Grade B) varicella-zoster virus varicella-zoster virus : VZIG has no value to be given after 10 days of exposure or after appearance of rash. varicella-zoster virus varicella-zoster virus : VZIG should be given to newborns, born to mothers who develop varicella rash less than seven days before and up to seven days after delivery, and they should be followed up for any subsequent infection. (Grade B) varicella-zoster virus varicella-zoster virus : Mothers developing chickenpox should be counselled concerning the risks of fetal varicella syndrome (approximately 2% risk in the first 20 weeks) and a risk assessment undertaken for severe maternal varicella. (Grade C) varicella-zoster virus varicella-zoster virus : Oral aciclovir should be recommended to women over 20 weeks of gestation on the first day of the rash. Oral aciclovir should be offered to women at less than 20 weeks of gestation. Full informed consent should be obtained because, although the safety profile is reassuring, approval for use in pregnancy does not yet exist. (Grade C) varicella-zoster virus varicella-zoster virus : intravenous aciclovir should be given to those patients with varicella pneumonitis and in those over 36 weeks of gestation or with clinical deterioration after day six of appearance of rash, to avoid the consequences of varicella pneumonitis and other serious sequelae. (Grade C) varicella-zoster virus varicella-zoster virus : Any woman who is already pregnant and is not immune to varicella should talk with her doctor about whether or not others in her family, such as small children, should receive routine varicella immunization. Because the vaccine uses live virus, there is a very slight risk of the pregnant woman becoming infected from exposure to a recently vaccinated child. varicella-zoster virus Quiz : Quiz She is a teacher in a primary school , pregnant at 13 wk. Told you that one of her class boys has been affected with rash . What is your advise? Slide 34: cytomegalovirus cytomegalovirus : cytomegalovirus Amniocentesis is the method of choice for fetal sampling in the case of possible congenital infection but should be delayed until six weeks after maternal cytomegalovirus(CMV) seroconversion. (Grade A) cytomegalovirus : Neonates with congenital (CMV) infection and central nervous system signs at birth should be treated with ganciclovir according to the recent protocol from the Collaborative Antiviral Study Group. (Grade A) cytomegalovirus Slide 37: herpes simplex virus (HSV) herpes simplex virus (HSV) : herpes simplex virus (HSV) a patient presents with a primary episode of herpes simplex virus (HSV) and is in labour, caesarean section is advised. (Grade B) herpes simplex virus (HSV) : IF a patient presents with a primary episode of HSV > 34 weeks, and before the onset of labour, she should be commenced on aciclovir and continued until delivery. If the interval between initiating therapy and delivery is (more than four weeks) , vaginal delivery is appropriate. (Grade C) herpes simplex virus (HSV) herpes simplex virus (HSV) : There is NO evidence to support routine antenatal screening for HSV 1 and 2 antibodies, or for virus detection in the cervix from patients with a history or recurrent HSV. (Grade B) herpes simplex virus (HSV) herpes simplex virus (HSV) : with a history of recurrent HSV There is no agreement on the use of caesarean section or aciclovir in the management of patients. IF a patient presents in early labour with a visible herpetic lesion, caesarean section is recommended. IF a patient has frequent symptomatic recurrences during pregnancy, the use of aciclovir from 36 weeks is recommended, and vaginal delivery would not be contraindicated. (Grade C) herpes simplex virus (HSV) HIV : HIV HIV : HIV Voluntary testing for HIV should be an integral part of antenatal care, offered and recommended to all pregnant women. (Grade C) HIV : HIV-positive women should be offered a package of care that includes: safe obstetric practices; anti-retroviral treatment to reduce the risk of mother-to-child transmission of HIV, to the fullest extent that is available; information on infant feeding risks and benefits; and supportive counselling. (Grade C) HIV Slide 45: The care of HIV-positive women should include appropriate postpartum care with access to contraception and follow-up medical care for the woman and her child. (Grade C) HIV Hepatitis B and C viral infections : Hepatitis B and C viral infections Hepatitis B and C viral infections : If hepatitis B infected mothers (HBsAg positive) transmit infection to their infants there is a high risk of the child developing chronic infection, which may result in liver cirrhosis or liver cancer later in life Hepatitis B and C viral infections Hepatitis B and C viral infections : Infectivity markers are determined for all samples confirmed as HBsAg positive. The current routine infectivity markers are hepatitis B e-antigen and e-antibody. Hepatitis B and C viral infections Hepatitis B and C viral infections : Hepatitis B and C viral infections Hepatitis B and C viral infections are not contraindications to breastfeeding. (Grade C) Hepatitis B and C viral infections : Hepatitis B immunoglobulin should be given to babies of mothers of high infectivity, e.g. those who are hepatitis Be antigen-positive. (Grade C) Hepatitis B and C viral infections Hepatitis B and C viral infections : Hepatitis B vaccine, but not HBIG , is recommended for babies born to mothers who are hepatitis Bs antigen +ve but known to be anti-HBe +ve Hepatitis B and C viral infections Hepatitis B and C viral infections : If a woman books late and/or a hepatitis B test result is not available, hepatitis B vaccine is given to the infant unless a result will be available within 24 hours of delivery or before discharge (whichever is sooner). Hepatitis B and C viral infections Bacterial and other infections : Bacterial and other infections bacterial vaginosis : bacterial vaginosis Clinical trials of screening for and treatment of bacterial vaginosis have yielded conflicting results but treatment may reduce the risk of preterm birth in women with a previous preterm delivery. (Grade C) asymptomatic bacteriuria : asymptomatic bacteriuria 3-8% of women have asymptomatic bacteriuria in pregnancy and about 30% of these will, if untreated, develop symptomatic infection. Screening followed by antibiotic therapy is beneficial in reducing the development of symptomatic infection and its complications Type I evidence asymptomatic bacteriuria : There is evidence that single dose therapy may be effective in the management of asymptomatic bacteriuria Type I evidence asymptomatic bacteriuria group B streptococcus : group B streptococcus There is no evidence to support the antenatal treatment of asymptomatic women colonised with the group B streptococcus (GBS). (Grade C) group B streptococcus : group B streptococcus Current recommendations are that all women with a history of having delivered an infant with GBS infection or of preterm rupture of the membranes, and all women found incidentally to have GBS in the urine or vagina during the current pregnancy should be offered intrapartum chemoprophylaxis. (Grade C) chlamydial infection : Screening for, and appropriate antibiotic treatment of, chlamydia in pregnancy is likely to be beneficial, especially as newer testing methods utilizing urine make testing more acceptible to the pregnant woman Cochrane Library 1997 Issue 4 chlamydial infection chlamydial infection : chlamydial infection Women with genital chlamydial infection need adequate chemotherapy and counselling, and a test of cure not less than three weeks after end of therapy. (Grade C) chlamydial infection : chlamydial infection Women with genital chlamydial infection must have contact tracing and appropriate management of their partners in a genitourinary medicine clinic. (Grade C) malaria : malaria Non-immune pregnant women should be advised against travel to a malarious area. If travel is unavoidable, advice should be given about personal protection and chemoprophylaxis (quinine). malaria : malaria Non-immune pregnant women with malaria need to be admitted to hospital, monitored closely (with particular attention to blood sugar and haemoglobin) and treated with an effective antimalarial such as quinine. (Grade C) malaria : Recent immigrants from malaria-endemic areas are at risk of having placental malaria infection irrespective of whether they have a fever or peripheral parasitaemia. Malaria should be suspected and treated if women are anemic or if there is evidence of intrauterine growth restriction. Unsuspected congenital malaria may occur in their infants with onset between birth and several weeks of age. (Grade C) malaria vaginal candida : vaginal candida Clotrimazole is beneficial in the treatment of vaginal candida infection and associated with better compliance and this should be used in preference to nystatin Cochrane Library 1997 Issue 4. trichomonal vaginitis : trichomonal vaginitis Metronidazole remains the drug of choice for symptomatic trichomonal vaginitis in pregnancy. A single oral dose of Tinidazole is effective (93% of women were free of infection after 4 weeks) but should be avoided in the first trimester Cochrane Library 1997 Issue 4. prophylactic antibiotics : prophylactic antibiotics Data from the Cochrane Library support the use of prophylactic antibiotics for emergency and elective caesarean sections, unless there are clear reasons why they should not be given. (Grade A) prophylactic antibiotics : prophylactic antibiotics The antibiotic used for prophylaxis before caesarean section should be limited to one dose to reduce the possibility of antibiotic resistance. (Grade A) antibiotic therapy : antibiotic therapy When infection develops and the patient is systemically ill, urgent and repeated bacteriological specimens, including blood cultures, must be obtained. The advice of a microbiologist must be sought at an early stage to assist with the use of appropriate antibiotic therapy. In serious cases, doctors should be prepared to give parenteral antibiotics before the diagnosis can be confirmed. (Grade C) antibiotic therapy : antibiotic therapy Until further evidence becomes available, the optimum treatment for postpartum endometritis is clindamycin and an aminoglycoside. (Grade A) Thank you : Thank you

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