Infection in pregnancy and after birth

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1 Maternity Unit Patient Information Infection in pregnancy and after birth Group A Streptococcus sore throats / fever / scarletina / scarlet fever Group A Streptococcus is a common bug which often causes sore throats and fevers in children, which usually get better without treatment. Sometimes it may cause scarlet fever, also known as scarletina. It can cause serious infection in pregnancy and after birth, so while you are pregnant ensure you wash your hands thoroughly after blowing noses / dealing with sick children. After birth, wash your hands before and after going to the toilet to reduce the chance of infection. If you are unwell with a sore throat in pregnancy, or if you develop fever with shivering or stomach pain, you should call your midwife or doctor. Flu Flu (influenza) is caused by a number of different viruses. It causes fever, cough, breathlessness, tiredness and achy muscles. It is spread by contact with infected people. In pregnancy, because your immunity is lower than when you are not pregnant, you are more at risk of getting flu, and of being more seriously ill. This can then cause problems for the baby. Because of this, all pregnant women are advised to have vaccination against flu viruses ( flu jab ). The vaccination protects against many different flu viruses including the virus that causes swine flu. It is also the only way we have to protect the newborn baby against flu, as the mother s immunity is transferred to the baby in the womb. You should also take steps to protect yourself against infection: Cover your nose and mouth when coughing or sneezing and use a tissue, then dispose of used tissues promptly and carefully Wash your hands with soap and water to reduce the spread of the virus Clean hard surfaces like door handles using a normal cleaning product Make sure your children follow this advice 2013 Dorset County Hospital NHS Foundation Trust 1

2 Because pregnant women are more at risk, if you become unwell with flu you should see a doctor. There are medicines that can be given in pregnancy (and whilst breastfeeding) to help recovery from flu. Parvovirus / slap cheek / fifth disease Slap cheek or fifth disease is caused by a virus called parvovirus B19 it is common in young children and causes a rash on the face, coughing, sneezing and fever. The rash can also be seen on the trunk, hands, wrists and knees. It is most common in the winter months. If a pregnant woman is infected the virus will pass to the baby in about a third of cases, and can cause serious problems for the baby. There is no specific antiviral medicine or vaccine available for parvovirus B19 infection, but if a woman is known to have been infected we can monitor the baby closely for problems. If you think you have been in contact with someone with slap cheek, please let your midwife know. She will take a blood test and also ask the lab to test a blood sample taken at the beginning of the pregnancy to see if you are immune to parvovirus. About 60% of adults in the UK are immune - if you are you will be reassured that your baby is not at risk. If you are not immune, we will monitor you and the baby for signs of infection. Chicken pox and shingles Chicken pox is caused by the varicella virus, which can be passed to the baby in the womb causing serious problems. Fortunately, most adults in the UK are immune to chicken pox because they had it in childhood. If you come into contact with someone with chicken pox or shingles, and you think you are not immune (in other words, that you have not had chicken pox yourself) please contact your midwife as soon as possible. She will ask the hospital lab to test a blood sample taken at the beginning of the pregnancy to see if you are immune to chicken pox. The result will be available within one to two days. If the blood test shows you are immune, there is no risk to your baby from the Varicella virus. However, you may still go on to develop shingles, which is due to a reactivation of the varicella virus if you develop a rash you should contact your GP for advice and avoid contact with other pregnant women (e.g. at antenatal clinic) until recovered. If the blood test shows you are not immune, you will be offered treatment (an injection called VZIG) to reduce the risk of the baby getting infected. Mumps Most people in the UK have been vaccinated against mumps, so it is uncommon. It is a viral infection that causes fever and swollen neck glands. If you have had mumps yourself, or if you had the vaccine, you are protected, so you are not at risk in pregnancy. If you are pregnant and you are not protected (non-immune) and you come in to contact with someone with mumps, you may be at risk of the infection but it will not harm your baby Dorset County Hospital NHS Foundation Trust 2

3 Measles Most people in the UK have been vaccinated against measles, so it is uncommon. It is a very infectious viral infection that spreads when someone with the infection coughs or sneezes. It causes cold-like symptoms, fever, greyish spots in the mouth and throat and a red-brown spotty rash. If you catch measles during pregnancy, it can be passed on to your baby, which can be very damaging or even fatal to your baby, and it can cause miscarriage, premature labour or a baby with low birthweight. If you come into contact with measles when you are pregnant, please let your midwife know as soon as possible. You will have a blood test if this shows you are not immune you may be offered an immunoglobulin injection to reduce the effects of measles to you and the baby. Hand foot and mouth This is a common viral infection (not the same as foot and mouth) caused by the coxsackie virus. It is quite common in childhood, so many adults will be immune as you cannot get it twice. Typically it causes fever, a blistery rash on the hands and feet, and mouth ulcers. No treatment other than regular paracetamol is necessary. It is rare for the infection to affect your baby, but if it occurs right at the end of pregnancy it is possible for the baby to have problems when newborn, so let your midwife and doctors know. Group B Streptococcus (GBS) GBS is one of many bacteria that can be present in our bodies. It usually causes no harm. This situation is called carrying GBS or being colonised with GBS. It is estimated that about 1 in 4 pregnant women in the UK carry GBS. Around the time of labour and birth, many babies come into contact with GBS and are colonised by the bacteria. Most babies are unaffected, but a small number can become infected. Every year in the UK (with 680,000 births a year) around 340 babies will develop GBS infection in the first week after birth. Most babies who become infected can be treated successfully and will make a full recovery. However, even with the best medical care, 1 in 10 babies diagnosed with early-onset GBS infection will die, and two in 10 will have permanent problems such as cerebral palsy, deafness, blindness and serious learning difficulties. It has been found that giving antibiotics to treat the GBS during pregnancy so that it is not in the vagina at the time of birth does not work. We could give everyone antibiotics, just in case, but this would have its own risks, such as death or serious injury to a very few women from an allergic reaction (anaphylaxis) to the antibiotics, and strains of bacteria becoming resistant to antibiotics Dorset County Hospital NHS Foundation Trust 3

4 Instead, we recommend antibiotics for women whose babies are at more risk, including:- If GBS has caused a urine infection in pregnancy If you have had a baby with GBS infection If spread to the baby it is more likely, for example:- o you have a high temperature during labour o you go into labour before 37 weeks o you give birth more than 18 hours after your waters have broken Chlamydia Chlamydia is the most commonly diagnosed sexually transmitted infection in the UK. Often people can be carrying the infection without knowing it. Self-testing is quick and easy. If a pregnant woman has chlamydia it is a good idea that it is treated before the baby is born. If it is left untreated it can pass to the baby causing eye and lung infections (pneumonia). It is easily treated using antibiotic tablets that are safe to take in pregnancy. Herpes Genital herpes, like cold sores and varicella (the chicken pox virus), is an infection which can keep coming back. The main risk of infection passing to the baby is if the woman has her very first attack of herpes in the last stages of pregnancy (after 34 weeks) or if she has herpes around the vagina when she goes into labour. In these cases, she might be advised to have the baby by caesarean section. If you have herpes and it keeps recurring you may be offered Aciclovir tablets for the last stages of pregnancy (from 36 weeks) to reduce the chance of an attack at the time of labour. If your partner has herpes, you should use condoms during pregnancy to reduce the chances of infection. HIV, Hepatitis B and C, Syphilis We offer routine screening for HIV, Hepatitis B and Syphilis to all pregnant women under our care, and more than 95% of women have testing. These conditions can be present without causing symptoms, and can be transmitted to the baby, but if we know they are present we can give treatment that reduces the risk of the baby being infected and also helps the mother. We do not screen routinely for Hepatitis C. If you are more at risk of Hepatitis C (if you have a history of injecting drugs in the past, for example) you may be offered testing Dorset County Hospital NHS Foundation Trust 4

5 Rubella / German measles Rubella is the virus that causes German measles. If a pregnant mother gets German measles during her pregnancy it can be transmitted to the baby and cause serious problems. We therefore test all mothers in early pregnancy to see if they are immune. Those who are immune can be reassured that they are not at risk, whilst those who are not can be warned to stay away from people with rashes, and to seek medical attention if they become unwell with a rash themselves or come into contact with someone with German measles. Vaccination against rubella cannot be done in pregnancy, but we can give the first part of the vaccine just after birth the second part is given at the 6 week postnatal check. MRSA Staphylococcus aureus is a common bacterium (germ) which lives harmlessly on the skin or in the nose of 20-40% of people. These germs sometimes cause skin infections such as boils, abscesses and spots. Methicillin is an antibiotic. MRSA means that the staphylococcus aureus has become resistant to treatment with this antibiotic, and usually several others as well. Consequently there are a limited number of antibiotics which can be used to treat MRSA infections. Whilst it is not a problem for healthy people, MRSA can cause a problem if it infects wounds as the infection is difficult to treat. Dorset County Hospital currently screens all elective admissions (patients coming in for planned surgery) for MRSA by taking swabs (like cotton buds). If MRSA is discovered, we can arrange easy, effective treatment before the operation date. Food acquired infection There is advice about do s and do not s of eating in pregnancy, and food hygiene, in the NHS Pregnancy Book. This explains how to guard against infections such as toxoplasma and listeria, which can be transmitted through our food. After birth The following may aid comfort, reduce the risk of infection, and help stitches to heal:- Wash your hands before and after going to the toilet Bath or shower with plain warm water Dry yourself carefully Change your sanitary pad often Pelvic floor exercises Mild painkillers from the chemist such as paracetamol or ibuprofen Ask your midwife for her recommendation 2013 Dorset County Hospital NHS Foundation Trust 5

6 Usually stitches just dissolve once the tear or cut has healed, sometimes they have to be taken out. Further Information If you need any further information please contact the Maternity Unit on If you need this information in large print, easy read, on audiotape or in another language please call or If you wish to obtain a list of the sources used to develop this information leaflet please call or patient.info@dchft.nhs.uk Authors: Miss Audrey Ryan (Consultant Obstetrician and Gynaecologist) Publication Date: December 2011 Review Date: December Dorset County Hospital NHS Foundation Trust 6