infection in pregnancy

1. INFECTION IN
PREGNANCY:
TB, MALARIA AND
CHICKENPOX
Nur Amalina bt. Aminuddin Baki
082012100067

3.  1-2 %
 Risk factors
 Positive family/past history
 Low socioeconomic status
 HighTB prevalence area
 HIV infection
 IV drug abuse
 Diabetes

4.  Pregnancy aggravatedTB
 Lesions remain same
 Same mortality rate for pregnant and non-
pregnantTB women (treated)
 No increase in relapse
 No increase in risk of activeTB in HIV (+)ve
mothers

5.  Affect fertility if associated with genitalTB
 Slight increase in abortion, IUGR and preterm
labour
 Rare transplacental infection
 Neonatal infection mainly by postpartum
maternal contact or aspiration of amniotic
fluid

6.  May be delayed
(nonspecific early
symptoms)
 Cough, haemoptysis,
fever, weight loss
 Any
pregnant/puerperal
women with
unexplained cough and
sputum
 Tuberculin skin test
 Chest X-ray (>12w)
 Early morning sputum
for AFB
 Gastric washings
 Diagnostic
bronchoscopy
 Direct amplification
tests

8.  Lesion in first week of life
 Primary hepatic complex / caseating hepatic
granuloma by percutaneous liver biopsy at
birth
 Infection in maternal genital tract or placenta
 No evidence of post natal transmission

10. Prophylaxis
 Asymptomatic women (>35y/o) with (+)ve
PPD
 Isoniazid 300mg/day after 1st trimester for 6-9
months
 Pyridoxine 50 mg/day

12.  Thoracic surgery
 Hold back if possible
 Restricted to 12 to 20 weeks

13.  Therapeutic termination:
 maybe in MDR-TB
 Avoid breastfeeding if mother and child is on
drugs
 Prophylaxis for baby if mother have activeTB
 isoniazid 10-20 mg/kg/day for 3 months till
mother become sputum (-) ve.
 BCG given as soon as possible.
 Avoid pregnancy till two years of quiescence
 Avoid OCP with rifampicin

15.  Tropical disease causing complication in
pregnancy.
 Female Anopheles mosquito
 Haemolysis of RBC and microcirculation
blockage due to sequestrated RBC.
 Pregnancy increases risk, severity and
complication of infection

17. MOTHER
 Megaloblastic anemia
 Hypoglycemia
 Metabolic acidosis
 Jaundice
 Renal failure
 Pulmonary edema
 Cerebral malaria
FETUS
 Due to high fever and
placental parasitization.
 Mostly in p. falciparum
infection and 2nd half of
pregnancy.
 Abortion, preterm labor,
IUGR and IUFD
 Congenital malaria is rare
unless placenta is damaged

19.  Prevention
▪ Pyrethroid-impregnated mosquito nets
▪ Electrically heated mats
▪ Chloroquine 300mg weekly
▪ Mefloquine 250mg/week ( chloroquine-
resistant)
▪ from 2 weeks before travel to 4 weeks after
travel.

20.  Chloroquine
▪ 10 mg base/kg PO
▪ 10mg/kg at 24 hours
▪ 5mg/kg at 48 hours
 Primaquin (radical cure) postponed till end of
pregnancy
 Quinine ( chloroquine-resistant) 10 mg salt/ kg
every 8 hours for 7 days
 Folic acid 10mg daily

21.  IV artesunate 2.4mg/kg at 0 ,12 , 24 hours , then
daily
 Oral artesunate 2mg/kg starts when patient is
stable
 IV quinine can also be given
 Limited use
▪ Only in 2nd or 3rd trimester when other drugs are
resistant

23.  Cross placenta congenital/neonatal
chickenpox
 High maternal mortality due to varicella
pneumonia

24.  Limb hypoplasia
 Limb deformity ( absent if infection after 20
weeks)
 Choroidoretinal scarring
 Cataracts
 Microcephaly
 Cutaneous scarring

25.  Varicella PCR
 ELISA

26.  Live attenuated varicella vaccine not
recommended
 Varicella Zoster Immunoglobulin to
 exposed non-immune person
 Newborn exposed within 5 days of delivery
 Oral acyclovir ( within 24 hours ) decrease
illness duration

27.  IntracellularGm (+)ve bacillus
 In soil and vegetation
 Eating infected food/ animal products
 Reliable serological test: blood culture during
septicemia

28.  Flu-like/ food poisoning maternal symptoms
 Obstretric complication:
 Late miscarriage ,preterm labor, stillbirth
 Neonatal death (10%)

29.  Treatment:
 Ampicillin and gentamicin
 Trimethoprim and sulfamethoxazole
 Prevention
 Unpasteurized milk, soft cheese,
refrigerated smoked seafood

30.  Hookworms : 700-900 million worldwide
 Roundworms : 25% of world’s population
 Most common infestation in tropics
 Diagnosis: stool examination
 Treatment :
 deworming ( excluding 1st trimester)
 Iron therapy for anemia