perinatal lecture april09
TRANSCRIPT
-
8/8/2019 Perinatal Lecture April09
1/47
Understanding terminologyUnderstanding terminologycongenitalcongenital
prenatal/antenatalprenatal/antenatalperinatalperinatalpostnatal infectionspostnatal infections
April 2009April 2009
-
8/8/2019 Perinatal Lecture April09
2/47
P renatal, perinatal & postnatalP renatal, perinatal & postnatalinfectionsinfections
many factors and sources involved,many factors and sources involved,primarily bacteria & virusesprimarily bacteria & virusesmay be opportunistic or pathogenicmay be opportunistic or pathogenic
-
8/8/2019 Perinatal Lecture April09
3/47
Congenital infections
Congenital infections
in uteroin utero infectionsinfections
infections from mother to foetusinfections from mother to foetustransplacental infectionstransplacental infections
-
8/8/2019 Perinatal Lecture April09
4/47
Mother s symptoms in congenitalMother s symptoms in congenital
infectionsinfectionsusually asymptomaticusually asymptomatic
often mildoften mildsometimes overt sometimes overt
-
8/8/2019 Perinatal Lecture April09
5/47
Effects on foetusEffects on foetus
no effect e.g.no effect e.g.common coldcommon cold
localized infectionslocalized infectionsadverse effect e.g.adverse effect e.g.
congenital infectionscongenital infections
-
8/8/2019 Perinatal Lecture April09
6/47
Consequence toConsequence to foetusfoetus
deathdeath - - spontaneous abortionspontaneous abortion(syphilis)(syphilis)
malformations (rubella)malformations (rubella)chronic infection (HIV)chronic infection (HIV)overt symptoms (see next slide)overt symptoms (see next slide)
-
8/8/2019 Perinatal Lecture April09
7/47
Consequence to foetusConsequence to foetus
Aborted foetus - rubellaStillborn - parvovirus
-
8/8/2019 Perinatal Lecture April09
8/47
Consequence to foetus (newborn)Consequence to foetus (newborn)
failure to thrive (rubella, toxoplasmosis)failure to thrive (rubella, toxoplasmosis)mental deficiencies (toxoplasmosis)mental deficiencies (toxoplasmosis)
malformations (rubella)malformations (rubella)hepatosplenomegaly (parvovirus)hepatosplenomegaly (parvovirus)chronic infection (HIV)chronic infection (HIV)
-
8/8/2019 Perinatal Lecture April09
9/47
Consequence to newbornConsequence to newborn overt symptomsovert symptoms
hydrocepalus - toxoplasmosis
hepatosplenomegal y
S yphilis - nasal Rubella - ras h
-
8/8/2019 Perinatal Lecture April09
10/47
P revention of congenital infectionsP revention of congenital infections
antenatal screening testsantenatal screening testsToRCHeS programmeToRCHeS programmeHIV, HBs/HBeHIV, HBs/HBechlamydia, gonorrhoea, group B strept.,chlamydia, gonorrhoea, group B strept.,etc.etc.If positive, what then??If positive, what then??
-
8/8/2019 Perinatal Lecture April09
11/47
ToRCHeS screeningToRCHeS screening
toxoplasmosistoxoplasmosisrubellarubellaCM VCM V -- cytomegaloviruscytomegalovirusherpes simplex virus (HSV)herpes simplex virus (HSV)
syphilissyphilis
-
8/8/2019 Perinatal Lecture April09
12/47
ToRCHeS screeningToRCHeS screening Types of TestsTypes of Tests
Antibody detectionAntibody detection Ig M &/or IgGIgM &/or IgGAntigen detetctionAntigen detetctionPC R (detects specific DNA or RNA)PC R (detects specific DNA or RNA)
-
8/8/2019 Perinatal Lecture April09
13/47
P renatal infectionsP renatal infections
before birthbefore birthfoetal membrane may rupture for a 1foetal membrane may rupture for a 1- -33
daysdaysinfection of chorioinfection of chorio- -amniotic membraneamniotic membraneinfection of mother & foetusinfection of mother & foetus
-
8/8/2019 Perinatal Lecture April09
14/47
Source of prenatal infectionSource of prenatal infection
normal floranormal floravaginavagina
reproductive tract reproductive tract
Staph.Staph.
Strept.Strept.
GmGm--neg.neg. bacteriabacteria
-
8/8/2019 Perinatal Lecture April09
15/47
P renatal infections of the motherP renatal infections of the mother
localised infection of thelocalised infection of thegenitogenito--urinary tract urinary tract
pyrexia of unknown originpyrexia of unknown origin(P UO)(P UO)
-
8/8/2019 Perinatal Lecture April09
16/47
P renatal infectionP renatal infection foetusfoetus
deathdeath stillbirthstillbirthpremature delivery & respiratorypremature delivery & respiratorydistress syndromedistress syndromedeformities & other defectsdeformities & other defects
-
8/8/2019 Perinatal Lecture April09
17/47
P erinatal infectionsP erinatal infections
during birthduring birthduring passage down the birth canalduring passage down the birth canal
infection to newborninfection to newborn
-
8/8/2019 Perinatal Lecture April09
18/47
P erinatal infectionsP erinatal infections
normal flora of genitonormal flora of genito- -urinaryurinarytract tract ORORestablished pathogensestablished pathogens
-
8/8/2019 Perinatal Lecture April09
19/47
P erinatal infection by normal floraP erinatal infection by normal flora
opportunistic infectionopportunistic infectionespecially premature deliveryespecially premature delivery
low birth weight low birth weight E. coliE. coli, coliforms, streptococci,, coliforms, streptococci,BacteroidesBacteroides, staphylococci, etc., staphylococci, etc.
-
8/8/2019 Perinatal Lecture April09
20/47
Normal floraNormal flora
Staph.Staph.
Strept.Strept. GmGm--neg.neg.
ClostridiumClostridium
-
8/8/2019 Perinatal Lecture April09
21/47
P erinatal opportunistic infectionsP erinatal opportunistic infections
of newbornof newbornnormal floranormal flora
neonatal sepsisneonatal sepsisimmunoimmuno--compromised newbornscompromised newborns
-
8/8/2019 Perinatal Lecture April09
22/47
P erinatal infections by viral pathogensP erinatal infections by viral pathogens
human immunodeficiency virushuman immunodeficiency virus(HIV)(HIV)hepatitis B virus (HBV)hepatitis B virus (HBV)herpes simplex virus (HSV)herpes simplex virus (HSV)
-
8/8/2019 Perinatal Lecture April09
23/47
HIV infection of newbornHIV infection of newborn
congenital (transplacental)congenital (transplacental)20% of HIV+ mothers20% of HIV+ mothers
perinatal (blood)perinatal (blood)postnatal (milk)postnatal (milk)lab. diagnosis is difficult lab. diagnosis is difficult
-
8/8/2019 Perinatal Lecture April09
24/47
HIV infection of newbornHIV infection of newborn
symptoms appear latersymptoms appear later
susceptible to other infectionssusceptible to other infectionslymphadenopathylymphadenopathypoor weight gain, etc.poor weight gain, etc.
-
8/8/2019 Perinatal Lecture April09
25/47
HBV infection of newbornHBV infection of newborn
mother HBs &/or HBe +vemother HBs &/or HBe +ve
bloodblood8080--90% newborns become infected90% newborns become infectedHBsAg+ve after 2HBsAg+ve after 2- -5 months5 months
-
8/8/2019 Perinatal Lecture April09
26/47
P revent HBV infection of newbornP revent HBV infection of newborn
screen mother for HBs & HBescreen mother for HBs & HBeduring pregnancyduring pregnancyif +ve, ...if +ve, ...protect newborn after birthprotect newborn after birth
-
8/8/2019 Perinatal Lecture April09
27/47
P rotect newborn against HBVP rotect newborn against HBV
HBs vaccine plusHBs vaccine plus
specific hyperspecific hyper- -immunoglobulinimmunoglobulinwhat does this mean?what does this mean?
-
8/8/2019 Perinatal Lecture April09
28/47
HSV infection of newbornHSV infection of newborn
infected mother with HSV lesionsinfected mother with HSV lesions
tend to be severe & disseminatedtend to be severe & disseminatedhepatitis, pneumonitis, encephalitishepatitis, pneumonitis, encephalitis
acyclovir for treatment acyclovir for treatment
-
8/8/2019 Perinatal Lecture April09
29/47
HSV infection of newbornHSV infection of newborn
80% confined to skin lesions80% confined to skin lesions
60% haveC
NS signs60% haveC
NS signsfits, bulging fontanelle, etc.fits, bulging fontanelle, etc.
-
8/8/2019 Perinatal Lecture April09
30/47
P erinatal infections by bacteriaP erinatal infections by bacteriapathogenspathogens
Neisseria gonorrhoeaeNeisseria gonorrhoeaeChlamydia trachomatisChlamydia trachomatisGroup B streptococciGroup B streptococciStaphylococcus aureusStaphylococcus aureus
-
8/8/2019 Perinatal Lecture April09
31/47
Ophthalmia neonatorumOphthalmia neonatorum
staphylococci ( sticky eye )staphylococci ( sticky eye )
gonorrhoea (refer STD)gonorrhoea (refer STD)chlamydia (refer STD)chlamydia (refer STD)
-
8/8/2019 Perinatal Lecture April09
32/47
Chlamydia infections of newbornChlamydia infections of newborn
ophthalmia neonatorumophthalmia neonatorumatypical pneumoniaatypical pneumonia
-
8/8/2019 Perinatal Lecture April09
33/47
Group B streptococci of newbornGroup B streptococci of newborn
normal vagina flora of mothernormal vagina flora of motherrespiratory route to...respiratory route to...septicaemia & meningitissepticaemia & meningitisother symptomsother symptoms
L ancefield grouping
-
8/8/2019 Perinatal Lecture April09
34/47
Group B streptococci infectionsGroup B streptococci infections - -specimensspecimens
blood cultureblood culture
cerebrospinal fluidcerebrospinal fluid
B lood culture
-
8/8/2019 Perinatal Lecture April09
35/47
Group B streptococciGroup B streptococci - - lab. diagnosislab. diagnosis
microscopymicroscopycultureculturedirect (latex)direct (latex)agglutinationagglutination
G ram stain
L atex agglutination
-
8/8/2019 Perinatal Lecture April09
36/47
Group B streptococciGroup B streptococci - - treatment treatment
penicillin, antibiotic of choicepenicillin, antibiotic of choice
-
8/8/2019 Perinatal Lecture April09
37/47
Group B streptococciGroup B streptococci - - preventionprevention
antenatal screeningantenatal screening
prenatal screeningprenatal screeningif +ve, when to treat.if +ve, when to treat.
-
8/8/2019 Perinatal Lecture April09
38/47
P erinatal staphylococci infectionsP erinatal staphylococci infections
Staphylococcus aureusStaphylococcus aureus
toxintoxin--producing strainsproducing strainscellulitis (epidermolytic toxincellulitis (epidermolytic toxin - -scalded skin)scalded skin)
toxaemiatoxaemia
-
8/8/2019 Perinatal Lecture April09
39/47
scalded babyscalded babysyndromesyndrome
-
8/8/2019 Perinatal Lecture April09
40/47
P ostnatal infectionsP ostnatal infections
Respiratory Distress SyndromeRespiratory Distress Syndrome---- neonatal I CUneonatal I CU
nosocomial infectionsnosocomial infectionsrespiratory tract to septicaemiarespiratory tract to septicaemia
-
8/8/2019 Perinatal Lecture April09
41/47
P ostnatal infectionsP ostnatal infections
other hospital acquired infectionsother hospital acquired infections
rotavirus, herpes simplex virus (HSV)rotavirus, herpes simplex virus (HSV)MRSA (MRSA (methicillin resistant Staph. aureusmethicillin resistant Staph. aureus ))
-
8/8/2019 Perinatal Lecture April09
42/47
Neonatal tetanusNeonatal tetanus
home deliveryhome delivery
traditional practice ontraditional practice onumbilical cordumbilical cord
-
8/8/2019 Perinatal Lecture April09
43/47
Neonatal tetanusNeonatal tetanus - - symptomssymptoms
classical tetanus symptoms (tetanospasm)classical tetanus symptoms (tetanospasm)risus sardonicus (lockjaw), opisthothonusrisus sardonicus (lockjaw), opisthothonus
(arching of the back)(arching of the back)treatment treatment
-
8/8/2019 Perinatal Lecture April09
44/47
prevention measuresprevention measurestrained doctors/midwivestrained doctors/midwivesantenatal immunisationantenatal immunisation
Neonatal tetanusNeonatal tetanus
-
8/8/2019 Perinatal Lecture April09
45/47
P ostnatal infections to the motherP ostnatal infections to the mother
delivery or abortion = traumadelivery or abortion = traumatrauma = infection risktrauma = infection riskinfections:infections:
endogenous & exogenous microbesendogenous & exogenous microbes
-
8/8/2019 Perinatal Lecture April09
46/47
P ostnatal infections to the motherP ostnatal infections to the mother
puerperal sepsis (childbirth fever)puerperal sepsis (childbirth fever)
nonnon--aseptic techniques / instrumentsaseptic techniques / instruments
-
8/8/2019 Perinatal Lecture April09
47/47
Thank you!!Thank you!!
Any questions??Any questions??