Coughs and colds
these common infections pose little threat to the fetus and symptom relief is all that is necessary. Advise fluids, rest, and paracetamol up to normal maximum doses, e.g. 1g four times a day. Inhaled decongestants are safe but cough linctus should be avoided.
A productive cough could be a sign of bacterial infection requiring anti-biotic treatment and the woman should be referred to her Gp.
Influenza
pregnant women and their unborn children are at high risk of morbidity and mortality from influenza infection.
Flu can cause maternal intensive care admission, preterm labour, low birthweight, and other problems for the mother and baby. One in 11 mater-nal deaths during 2009– 2012 was caused by influenza. public Health england and the WHO therefore recommend annual influenza vaccination for all pregnant women.
the injectable vaccine is inactivated and does not contain live virus; the vaccine can be given safely during any trimester and there are no increased risks of maternal complications or poor fetal outcomes associated with inactivated influenza vaccination in pregnancy.
the most common side effect is a sore arm at the site of injection; occa-sionally mothers may briefly feel systemically unwell due to an immune response; the vaccine cannot cause influenza infection as it does not contain live virus.
Flu vaccination reduces the risk of prematurity and the risk of low birth-weight. the vaccine provides passive immunity to the fetus, which can protect the infant for up to 6 months following birth. the vaccine reduces adverse maternal outcomes attributed to influenza infection.
Midwives should be aware of vaccination arrangements in their local area and encourage mothers to understand the risks of influenza and benefits of vaccination. patient information leaflets are available to support these messages.
Urinary tract infections
Women should be offered screening by mid- stream urine (MSu) culture for asymptomatic bacteriuria early in pregnancy, as identification and treatment reduce the risk of preterm birth.6
Around one in 25 women develop a urinary tract infection during preg-nancy. the symptoms are:
• Discomfort or a burning sensation on micturition
• pain in the bladder region/ lower pelvis
• Frequency of micturition.
An ascending infection involving the kidneys or bloodstream may cause:
• Loin pain
• Vomiting
• Fever
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• uterine contractions— the symptoms of premature labour may mask a urinary tract infection and an MSu should be obtained for culture to rule this out.
Mild infections are treated with oral antibiotics, but a more serious infection requires admission to hospital for IV antibiotic therapy and rest.
Chickenpox
this is a fairly common infection and many women are exposed during pregnancy.
If a woman has already had chickenpox, there is no risk to the fetus, but if a woman has never had chickenpox and contracts it before 20 weeks’ ges-tation, there is a risk of the fetus developing a severe infection— chickenpox syndrome.
Women who have not had chickenpox, or are known to be seronegative for chickenpox, should be advised to avoid contact with chickenpox and shingles during pregnancy and to inform health- care workers of a potential exposure without delay
When contact occurs with chickenpox or shingles, a careful history must be taken to confirm the significance of the contact and the susceptibility of the patient.
pregnant women with an uncertain or no previous history of chicken-pox, or who come from tropical or subtropical countries, who have been exposed to infection should have a blood test to determine varicella- zoster virus (VZV) immunity or non- immunity.
If the pregnant woman is not immune to VZV and she has had a significant exposure, she should be offered varicella- zoster immunoglobulin (VZIG) as soon as possible.
VZIG is effective when given up to 10 days after contact (in the case of continuous exposures, this is defined as 10 days from the appearance of the rash in the index case). Non- immune pregnant women who have been exposed to chickenpox should be managed as potentially infectious from 8 to 28 days after exposure if they receive VZIG and from 8 to 21 days after exposure if they do not receive VZIG.
A pregnant woman who develops a chickenpox rash should be isolated from other pregnant women when she attends a Gp surgery or a hospital for assessment.
Oral aciclovir should be prescribed for pregnant women with chickenpox if they present within 24h of the onset of the rash and if they are 20+0 weeks of gestation or beyond. use of aciclovir before 20+0 weeks should also be considered. Aciclovir is not licensed for use in pregnancy and the risks and benefits of its use should be discussed with the woman. IV aciclovir should be given to all pregnant women with severe chickenpox.
If maternal infection occurs in the last 4 weeks of a woman’s pregnancy, there is a significant risk of varicella infection of the newborn. A planned delivery should normally be avoided for at least 7 days after the onset of the maternal rash to allow for the passive transfer of antibodies from mother to child, provided that continuing the pregnancy does not pose any additional risks to the mother or baby.
A neonatologist should be informed of the birth of all babies born to women who have developed chickenpox at any gestation during pregnancy.
Women with chickenpox should breastfeed if they wish to and are well enough to do so.
Toxoplasmosis
toxoplasmosis is caused by the parasite Toxoplasma gondii, which is found in raw meat and in cats that eat raw meat and their faeces. It rarely causes illness in an adult, although it can present as a flu- like illness with swollen lymph glands (E see also Food safety, p. 98).
In pregnant women it is of concern as it can lead to fetal infection and the following potential problems:
• Miscarriage
• Stillbirth
• Growth problems
• Blindness
• Brain damage
• epilepsy
• Deafness.
prevention is the best strategy. Women may be offered pyrimethamine or sulfadiazine to limit transmission of the infection.
Advise pregnant women to:
• Cook all meat thoroughly until there are no pink areas and the juices are clear
• Wash hands, utensils, and surface areas after preparing raw meat
• Wash soil from fruit and vegetables before eating
• Always use gloves when gardening and wash hands afterwards
• Ask someone else to clean litter trays if a cat owner, or to wear gloves and wash hands thoroughly afterwards.
Reference
6 National Institute for Health and Care excellence (2008). Antenatal care for uncomplicated pregnan-cies. NICe guidelines CG62. Available at: M www.nice.org.uk/ guidance/ cg62.
Further reading
public Health england (2015). Influenza vaccination in pregnancy: information for healthcare profession-als. Available at: M www.gov.uk/ government/ uploads/ system/ uploads/ attachment_ data/ file/
393974/ Influenza_ vaccination_ in_ pregnancy_ factsheet_ v15_ Ct_ _ 2_ .pdf.
Royal College of Obstetricians and Gynaecologists (2015). Chickenpox in pregnancy (Green- top guide-line No. 13). Available at: M www.rcog.org.uk/ globalassets/ documents/ guideguide-lines/ gtg13.pdf.
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