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What is syphilis What is the incidence of congenital syphilis How is the fetus infected with syphilis Infection with the spirochete Treponema pallidum Less than 40 per 100,000 live births in the United States Transplacental transmission, typically during the second half of pregnancy Women with primary or secondary syphilis are the most likely to transmit the disease Fetal manifestations: stillbirth Spontaneous abortion Hydrops fetalis Prematurity Manifestations before 2 years: lesions on palms and soles Hepatosplenomegaly
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9: Complications of Pregnancy
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Jaundice Anemia Snuffles Manifestations after 2 years: congenital anomalies Active congenital syphilis Hutchinson triad What is the Hutchinson triad Hutchinson teeth (blunted upper incisors), interstitial keratitis, and eighth nerve deafness Veneral Disease Research Laboratory (VDRL) or vapid plasmin reagin (RPR) are used as screening tests If positive, microhemagglutination T pallidum (MHA-TP) or fluorescent treponemal antibody absorbed (FTAABS) are done as confirmatory tests With adequate screening and then treatment (with penicillin) of infected mothers With IV or IM penicillin G With desensitization, because alternative drugs are teratogenic Non-treponemal antibody serologic titers should be checked at 1, 3, and 6 months, 1 year, and 2 years after treatment to ensure proper falls of levels If they do not fall, she should be treated for reinfection An acute febrile reaction precipitated by treatment of syphilis thought to result from the release of large amounts of treponemal lipopolysaccharide (LPS) It may precipitate preterm labor, contractions, or non-reassuring fetal heart tracings in pregnant women
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Varicella-Zoster Virus
What is varicella-zoster virus A double-stranded, linear, DNA herpes virus that causes both chickenpox (varicella) and shingles (zoster)
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Section III: Topics in Obstetrics
What is the incidence of VZV in pregnancy What are the clinical features of varicella in adults What are the complications of varicella infection
1 5 cases per 10,000 pregnancies (most women are immune secondary to prior infection) It includes a prodrome of fever, malaise, and myalgia followed, 1 4 days later, by a vesicular rash Bacterial superinfection of vesicles Pneumonia Arthritis Glomerulonephritis Myocarditis Ocular disease Adrenal insufficiency Death CNS abnormalities
Why is varicella in pregnancy a medical emergency What is varicella pneumonia
Because varicella pneumonia can develop and it is very severe in pregnancy An infection that develops within a week of the varicella rash that presents as cough, dyspnea, fever, pleuritic chest pain, and/or hemoptysis It is very severe in pregnant women as it can rapidly progress to respiratory failure It occurs in 10 30% of all VZV cases in pregnancy A diffuse or miliary/nodular infiltrative pattern usually in a peribronchial distribution in both lungs Supportive care and acyclovir All women with VZV require a CXR to rule out varicella pneumonia Untreated, it carries a 40% mortality rate Chorioretinitis Cortical atrophy Dermatologic conditions Hypoplastic lower limbs Hydronephrosis Clubbed feet
What is the incidence of varicella pneumonia during pregnancy What are the chest x-ray (CXR) findings of varicella pneumonia
What is the treatment of varicella pneumonia during pregnancy What is the mortality rate associated with varicella in pregnancy What are the features of congenital varicella syndrome
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9: Complications of Pregnancy
Optic atrophy Failure to thrive Cataracts Horner syndrome Microophthalmos Nystagmus Low birth weight Mental retardation Early death What is the congenital infection rate if the mother has VZV When is the fetus most likely to be affected by congenital varicella syndrome How can varicella infection during pregnancy be prevented in a patient with a recent exposure When should VariZIG be given 25 50% if the mother develops a rash 5 days before or 2 days after birth When the mother is infected between 8 and 20 weeks of gestation By giving VariZIG, a purified human varicella zoster immune globulin if she is IgG seronegative (not previously immune) To the mother within 96 hours after viral exposure if she is IgG seronegative To the neonate (if there is exposure) within 4 days prior or 2 days after delivery How should a patient with varicella be managed if she is more than 5 days from delivery How should a pregnant woman exposed to zoster be treated With close observation (for any signs/sx of varicella pneumonia) and possibly with acyclovir Reassurance it is only contagious from direct contact with open lesions
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