ANC - P4 Flashcards
Cause of CMV (cytomegalovirus)
Herpes virus 5
What is the most common virus to be transmitted to the fetus during pregnancy?
CMV
What % of pregnant women are infected by CMV during pregnancy
1%
What % of those infected w/ CMV pass on to fetus
1/3
Of fetuses infected, what % will be caused damaged by CMV
5%
When is the highest risk to fetus for CMV?
1st trimester
PS CMV (3)
Asymp usually
Flu like illness
Or glandular fever type illness - fever, splenomeg, imp LFT
Ix CMV
Viral serology - CMV IgM + G
Mx CMV (3)
Rx to fetal medicine specialist
No Tx for mother
TOP
Features of congenital CMV (6)
IUGR HSmegaly TTP Jaundice Microencephaly Chorioretinitis
% mortality congenital CMV
20-30%
What % of pregnant F have GBS commensally
25%
RF GBS infection (6)
GBS infection in previous baby Prematurity ROM >24hrs before delivery Pyrexia during labour \+ve test GBS in mother Mother diagnosed w/ UTI
CF GBS mother (4)
UTI
Chorioamnionitis
TachyC
Endometritis
CF GBS neonate (5)
Neonatal pyrexia Cyanosis difficulty breathing Difficulty feeding FLoppiness
Ix GBS
Swabs (culture on enriched culture medium)
Urine cultures??
Preventing GBS (2)
High dose IV BEN PEN throughout labour
If ROM >37w - induce to reduce amount of time fetus is exposed
Transmission of Parovirus B19
Respiratory droplets
Blood
What % of women become infected w/ parovirus in pregnancy
1/400
Often those infected, what % of pregnant women pass parovirus on to their fetus
33%
Oft those infected w/ parovirus, what is the outcome for 9% of fetuses
Spontaneous miscarriage
Or intrauterine death
CF parovirus in mother
Asymp
Or symmetrical arthralgia
CF parovirus in baby (5)
URTI Malaise Headaches Low grade fever Slapped cheek syndrome
Ix parovirus
Viral serology
IgM = recent infeection
IgG = past infection (immunity)
Mx parovirus in pregnancy (3)
Rx
Mum = self limiting
Fetus - main risk = fetal hydrops –> Rx 3’ centre for intrauterine erythrocyte transfusion
Why is rubella no longer screened for antenatally
Due to success of MMR vaccine
Maternal features rubella (6)
Asymp Or non specific: Malaise Headache COryza Lymphadenopathy Fine maculopapular rash
Ix rubella
ELISA - IgG +M
Mx rubella if <12w
Rx fetal medicine specialist
due to 90% risk vert transmission –> multiple defects –> TOP
Mx rubella if >20w
Despite 45% risk vert transmission –> no additional risk to fetus :)
Congenital rubella syndrome - features present at birth: (6)
SNHL Cardiac defects (PS/PDA/VSD) Retinopathy/Congenital cataracts LD Microencephaly Thrombocytopenia, blueberry muffin appearance
Congenital rubella syndrome - features present later on (4)
DM
Thyroiditis
GH abnormalities
Behavioural disorders
CF chickenpox in mothers (6)
Pneumonia Hepaitis Encephalitis Fever Malaise Pruritic maculopapular rash
Ix chicken pox in preg
Typically clinical
if in any doubt - immunofluorescence or PCR
Maternal Mx chicken pox (5)
Test for immunity
If not immune - VZIG within 10 days contact + before rash appears
If with rash - aciclovir within 24hrs rash onset
USS - check fetal abnorm
Vaccine pre-preg or postpartum
When does varicella of the newborn occur
If chicken pox is within the last 4 weeks of pregnancy
Sx varicella of the newborn
Often asymp
Tx varicella of the new born
VZIG
Aciclovir
What is fetal varicella syndrome
Subsequent reactivation of the virus in utero
PS fetal varicella syndrome
Skin scarring
Eye defects
Hypoplasia of limbs
Neurological defects
Neurological defects in fetal varicella syndrome (4)
Microcephaly
Cortical/spinal atrophy
Seizures
Horners syndrome
Eye defects in fetal varicella syndrome (4)
Microophthalmia
Chorioretinitis
Cataracts
Optic atrophy
PS GAS (group A strep) in pregnancy
Chorioamnionitis
Or Sepsis
Tx GAS in pregnancyt
Abx
Impact of syphillis in pregnancy
Miscarriage/stillbirth
Or –> congenital sypphillis
Tx HSV during pregnancy
Aciclovir
Deliver w/ CSC if within 6w 1st attack or genital lesions @ time delivery
Impact of herpes zoster <20w pregnant
Rarely teratogenic
Impact of herpes zoster at time of delivery
Severe neonatal infection
Mx herpes zoster
IgG to neonate
Mx chlamydia in pregnancy
ABx - azithro/erythro
What is the leading cause of maternal mortality
VTE
Why does risk of VTE increase greeatly in pregnacy (2)
Due. tochangesin. the clotting cascade
Incr fibrinogen
Decr protein S
What period of pregnancy has the highest risk of VTE
Post partum
Why is the L leg most commonly affected by DVT in pregnancy
Due to compression of uterus on L iliac vv
Ix VTE
raised D dimer is norm in preg
FBC/U+E/LFT/Coag screen
Extra Ux DVT (2)
Compression duplex uSS
Venograms
Extra Ix PE (2)
ECG/CXR
CPTA V/Q scan
Mx VTE (3)
LMWH until 6-12w post partum
Compression stockings
Mobilisation + hydration
VTE prophylaxis in pt who has had CSC
10 day course LMWH
Obesity in pregnancy - risks to mum (7)
Higher risk VTE Pre-eclampsia Diabetes CSC wound infections More difficult CSC PPH Death
Obesity in pregnancy - risk to fetus (4)
Congen abnorms (NTDs)
Diabetes
Incr mortality
USS less acurate
Mx of obesity during pregnancy
W advice
5mg preconceptual folic acid
+ Vit D
Maintain weight throughout pregnancy as losing weight during pregnancy isnt a good idea
Mx pregnancy BMI >35
Screen for GDM
BP surveillance
Mx Pregnancy BMI >40
Formal anaesthetic risk assessment
Antenatal thromboprophylaxis recommended
E.g.s of high risk thrombophilias (4)
APLS
Protein S/C deficiency
Activated protein C resistance
Antithrombin III deficiency
E.g.s of lower risk thrombophilias (4)
Factor V Leiden
Prothrombin gene variant
Hyperhomocysteinaemia
Antiphospholipid Ab with no syndrome
Complications of thrombophilias in pregnancy (6)
VTE Miscarriage Preterm Pre-eclampsia IUGR Placental abruption
Mx of thrombophilias in pregnancy (4)
Incr maternal + fetal surveillance
Aspirin
LMWH postnatally +/- antenatally
ANtenatal LMWH if prev preg lol
PS APLS in pregnancy (4)
placental thrombosis --> Rec miscarriage IUGR Early pre-eclampsia Foetal loss
Mx APLS
USS + elective induction
Post natal anti-coag - prevent VTE
Conseq hyperchromocysteinaemia in pregnancy
Pregnancy loss
Pre-eclampsia
Tx hyperchromocysteinaemia in pregnancy
High dose folic acid
Mx of pre-existing cardiac disease in pregnancy (7)
Swap out 'bad' meds Acei --> B-blockers/nifedipine Warfarin --> LMWH Echo Regular anaemia checks Avoid epidural and forceps ABx in labour to prevent against endocarditis in high risk pt
Mx of epilepsy in pregnancy (4)
Preconceptual assessment
Use as few anti-E drugs as poss + 5mg folic acid
Avoid Na valporate
From 36w - 10mg vit K PO
Which anti-epileptic meds are safest in pregnancy (2)
Carbamazepine
Lamotrigine
