80% of congenital cmv is normal. 20% leads to sequelae
C = chorioretinitiss
M = microcephaly
V = periventricular calcification
+ blueberry muffin rash rhingies
Vision loss from chorioretinitsi
even if mother has recovered from primary infection..risk is there if within 6 months
No vaccines or drugs once infected and hard to know whether infected or not = so rather try to prevent it all together by taking precautionary measures
pregnant women mainly get it from her kids
usually igm antibody testing can be used to detect primary infection because rises close to pimary and then fall...BUT cant be used in CMV because igm in cmv remains high
avidity = binding capacity. In primary infections, its weak!
Chicken pox and rubella
Chicken pox is more dangerous in adults (causes pneumonia)
Acyclovir is tero-atogenic but if severe better to give (pro> coms)
Congenital varicella syndrome vs neonatal varicella syndrome?
Two risky periods ⇒ 1. 13-20 weeks 2. around delivery
Can deay delivery??
Post exposure prophylaxis
can get exposed to even asymptomatic patient in prodromal stage before rash has come
VZV vaccineis live so c/i in preganncy
live vaccines can be given in lactation
amniocentesis for confirmatory diogosis ..not just relyig on ultrasound
infective period of chicken pox from prodromal to crusted/scabby stage
Purpose of amniocentesis is to terminiate the pregnancy :( but also can be used to expect and better prepare if not terminating
rash spread from face downwards
R for Rnaa rrrrrubelllaa
Blueberry muffin rash ^^
the other features can be seen with other congeinital infections as well
no drugs or antibodies to treat = so focus on prevention!
Live vaccine so avoid in pregnancy
the management of rubella is mainly about whether to terminate pregnancy or not. And for that must know whether the infection has occurred within the 1st trimester or not .
Amniocentesis a new synthesis won't help it because by the time add new she disease can be performed after 16 weeks it is too late the changes comes afterwards and by that time it's too late
So the only thing to guide termination or not is clinical and anitbodies testing
So antibody titer is more reliable than antibody testing positive and negative so if it's rising we know that the infection is recent
termination should be consensual too
Anitobodies testing are al TORCH
If first child has CRS then obviously 2nd wont have. But test anitobdy titres to be sure
peripartum ⇒ delivery also high risk
HIV is least likely to transmit vertically from placenta
risk is proportionate to the Viral load
But if can afford infant formular milk, then can go for that and dont breast feed.
GO THROUGH THE SRI LANKAN GUIDELINES FOR THE MANAGEMENT OF THESE DISEASES AND ADD
Sri lankan guidelines ⇒ clamp as soon as possible
tissue cysts can be found in many many tissues
Last two mainly immunosupressi
avidity increases with time
After amniocentesis, to detect infections, do pcr
mightn not work , but we try
So once pregannt mother is detected with it (via TORCH test because can be asymptomatic) then start spiramycin until 18 weeks when can test amniocentesis. if posiitve then switch drugs, if not conitnue spiramycin hoping it doesnt cross. anyway less risk if it does later in preganncy.
TORCH testing is controversial because dunno when exactly got the infection as some igm can be risen for months
Syphilis
T. pallidum is an obligate human parasite,
Dissease also called as master imitator
IF not treated then can get into latent phase (organsims still present) and then move into tertiary
Sppread though lymphatic channels and not nerves like in herpes
VDRL can be non specific because some other immune conditions can cause positive
Bascially detect and treat syphhilis in the mother!
Genital Herpes
PRimary infection doesnt always cause symptoms!
hsv 1 above the waist. Hsc 2 below the waist.
TWO ⇒ CHU ⇒ eeya
but can have overlap
postpartum due to unhygeinic pratices
promodomal symtoms like feeling tiglish and feverish and warm down there
GBS
Give prophylaxis in the above risk factors
if penincillin allergy ⇒ use clindamycin ⇒ otherwise vancomycin
Bacterial Vaginosis
DOESNT ITCH LIKE IN FNGAL INFECTIONS
screening doesnt improve outcomes in women in genera;
UTI in pregnancy
stasis ⇒ pressure on bladder by uterus + hydroureter cause prgesteeone relaxation
not an issue outside of pregnancy but within almost half will go on to develop symtoms and we dont want pyelonephritis!
better not to use antipyretics to check progress of infections
