TORCH INFECTIONS DURING PREGNANCY Part 02

  Herpes DNA herpes virus   transmission: intimate mucocutaneous contact primary infection during pregnancy increases risk of neonata...

 
Herpes

1. DNA herpes virus 
2. transmission: intimate mucocutaneous contact
3. primary infection during pregnancy increases risk of neonatal  complications
4. 50% transmission if primary infection, 4% transmission if secondary
   recurrence
5. infection to fetus may occur in utero but more commonly occurs
   during delivery
6. C-section if active genital lesions present within 4-6 hours of ROM, even if lesions remote from vulvar area

Syphilis

1. Treponema pallidum
2. may have transplacental transmission
3. serological tests
• VDRL screening done at first prenatal visit (non-specific)
4. to confirm a positive VDRL
   • TPHA (Treponema Pallidum Hemagglutinating Ab)
   • FTA-ABS (Fluorescent Treponema Antibody Absorption) Test
5. risk of preterm labour, fetal death
6. treatment: Penicillin G 2.4 million units IM, monthly VDRL during pregnancy to ensure treatment is adequate

Hepatitis B

1. transmitted via blood, saliva, vaginal secretions, semen, breast milk,
   transplacental
2. fetal infection most likely with T3 maternal infection
3. risk of vertical transmission 10% if asymptomatic HBsAg +ve
4. risk of vertical transmission 85-90% if HBsAg +ve and HBcAg +ve
5. chronic active hepatitis increases risk of prematurity, low birth weight,neonatal death
6. treatment of neonate with Hep B immune globulin (HBIG) and vaccine (at birth, one and six months) is 90% effective
7. vaccine safe during pregnancy

Erythema Infectiosum (Fifth Disease)

1. parvovirus B19
2. febrile illness with bilateral erythema of cheeks (slapped cheek rash) followed by maculopapular rash of trunk and extremities
3. fetus of infected woman may develop hydrops in utero
• follow fetus with weekly U/S (if hydrops occurs, consider  fetal transfusion)
4. risk of intrauterine death 1-12 weeks after infection

HIV

1. offer screening to all women
2. risk of vertical transmission 12 to 28%; more likely if maternal CD4 count < 300
3. risks to infected mom include decreased CD4 count, cancer, increased opportunistic infection (PCP, TB, CMV, toxoplasmosis, mycoplasma)
4. care of HIV positive patient
• PCP(Pneumocyctis Pneumonia) prophylaxis with Bactrim if CD4 < 200
• AZT (azidothymidine) shown to decrease transmission to fetus from 25% to 8% risk
• exclude cervical dysplasia
• toxoplasmosis and CMV antibodies

Group B Streptococccus (see Prenatal Care Section)

plez check TORCH INFECTIONS DURING PREGNANCY Part 01 for song