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Obstetrics > Antenatal Care: Infections in Pregnancy > Flashcards

Antenatal Care: Infections in Pregnancy Flashcards

1
Q

What is group B streptococcus

A

Commensal of the vagina in 25% women

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2
Q

What can group B streptococcus colonisation cause

A

Group B streptococcus infection of the newborn

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3
Q

What are the 6P’s of risk factors for GBS disease of new-born

A 
Previous GBS 
Prematurity 
PROM
Pyrexia
Positive GBS UTI 
Positive mother
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4
Q

What group B streptococcus leads to disease

A

Streptococcus agalctiae

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5
Q

How can GBS present

A

Asymptomatic
UTI
Chorioamnionitis
Endometritis

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6
Q

What are symptoms of UTI

A

Urgency
Frequency
Dysuria

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7
Q

What are symptoms of chorioamnionitis

A

Fever
Lower abdominal pain
Foul-smelling discharge
Tachycardia

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8
Q

What are symptoms of endometritis

A

Fever
Lower abdominal pain
Foul-smelling discharge
Bleeding

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9
Q

How will neonatal GBS present

A

Floppy
Cyanosis
Tachypnoea
Pyrexia

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10
Q

What type of organism is Group B streptococcus

A

Gram +ve diplococcus

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11
Q

What is first line investigation for GBS

A

vaginal and rectal swab

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12
Q

What does RCOG recommend about GBS screening

A

Do not screen all women for GBS. Screen if - UTI symptoms, STI symptoms, Chorioamnionitis, previous GBS infection

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13
Q

What is first-line management for GBS

A

IV penicillin

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14
Q

Who is IV penicillin offered to

A

PUG-PUP:

Pre-term (Less than 37W)

UTI GBS

GBS culture positive

PROM >18h

Unduly high T

Past GBS

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15
Q

What type of organism is rubella

A

SSRNA

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16
Q

How does congenital rubella present clinically (7)

A
  • Blueberry muffin rash
  • Chorioretinitis
  • Congenital cataracts
  • PDA
  • Hepatosplenomegaly
  • Cerebral palsy
  • Microencephaly
  • SNHL
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17
Q

What is first-line investigation for rubella

A

ELISA for IgM and IgG

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18
Q

How is maternal rubella managed

A

No treatment - support symptoms

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19
Q

What does risk of vertical transmission depend on

A

Gestation

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20
Q

When is risk of transmitting rubella to foetus highest

A

<12W

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21
Q

If rubella <12W what should be done

A

Advise TOP

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22
Q

If rubella 12-20W gestation what should be done

A
  • RT- PCR on amniotic fluid sample

- If positive, offer TOP or frequent growth scans

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23
Q

If rubella >20W gestation what should be done

A

No management

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24
Q

What is CMV also known as

A

HHV5

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25
Q

What is the most common virus transmitted via pregnancy

A

CMV

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26
Q

What proportion of CMV is transmitted to the foetus

A

1/3

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27
Q

What proportion of CMV will cause foetal damage

A

5%

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28
Q

When is CMV risk of foetal damage highest

A

First trimester

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29
Q

What are 6 features of congenital CMV

A
  1. Blueberry muffin rash = pinpoint petechial rash
  2. Growth retardation
  3. SNHL
  4. Encephalitis
  5. Hepatosplenomegaly
  6. Microcephaly
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30
Q

How will maternal CMV present

A

CMV mononucleosis

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31
Q

How is mum investigated for CMV

A

IgM and IgG

32
Q

How is foetus investigated for CMV

A

Amniocentesis and PCR at 21W

33
Q

At what age do foetuses receive amniocentesis for CMV if mother is positive

A

21W

34
Q

How is a mother’s CMV treated if pregnant

A

No treatment. Anti-virals are teratogenic and cannot be given.

35
Q

How is a foetus with CMV managed

A

TOP

36
Q

How does herpes simplex present in neonates

A

5-21d post-delivery with vesicular rash

37
Q

If mother has herpes in last trimester what is done

A

Oral acyclovir

38
Q

If mother has a primary attack of genital herpes more than 28W what should be done

A

C-Section

39
Q

If maternal VZV infection occurs in last 4W of pregnancy, what is the risk of transmitting it to the new-born

A

50%

40
Q

How can VZV be transmitted to the new-born

A

Trans-placental

Trans-vaginal

41
Q

How is VZV in last four-weeks pregnancy managed

A

IVIg and oral acyclovir

42
Q

What is foetal varicella syndrome

A

If mother is infected with VZV (re-activation) before 20W it can pass in-utero

43
Q

When does foetal varicella syndrome occur

A

Before 20W

44
Q

How will foetal varicella syndrome present

A

Eyes: micropthalmia, chorioretinitis, cataracts
Limb hypoplasia
Neurological: microcephaly, spinal atrophy

45
Q

If pregnant mother comes into contact with someone with chickenpox and has not had chickenpox before what should be done

A

Test for IgG to assess immunisation status. If not immunised give VZIg in 10d

46
Q

When should acyclovir be given for maternal chickenpox

A

Presents within 24h with a rash and >20W gestation

47
Q

What follow-up should happen if mother has had chickenpox

A

US scan 5W post-infection to look for anomalies

48
Q

Explain VZV vaccine in pregnancy

A

Do not give during pregnancy. If mother is not immunised offer 1m afterwards

49
Q

How can hepatitis B be transmitted to neonate

A

Trans-placental.

50
Q

How is hepatitis B not transmitted

A

Breast-Feeding

51
Q

What are mothers screened for antenatally

A

HbsAg

52
Q

How should babies born to hepatitis B positive mothers be managed

A

Ig at birth and vaccination

53
Q

How is HIV in pregnancy transmitted to neonates most commonly

A

Delivery

54
Q

What are 5 risk factors that increase risk transmitting HIV

A
  1. Breast Feeding
  2. PROM >4h
  3. Pre-term
  4. Hep C
  5. High viral load >400
  6. Seroconversion
55
Q

What are 3 factors that decrease risk transmitting to neonate

A

Bottle Feeding
ART
C-Section

56
Q

When are women tested for HIV

A

Booking visit. If declined, re-test at 28W

57
Q

What immunisations should patients with HIV be offered

A

Pneumococcal
Influenza
Hep B

58
Q

Explain HARRT during pregnant if women is on it

A

Continue HAART

59
Q

If HIV positive women is not on HAART when should it be started during pregnancy

A

24W until delivery

60
Q

When is a vaginal delivery allowed in HIV +ve pregnancies

A

<50 viral copies

61
Q

If on zidovudine monotherapy when is a C-section offered

A

38W

62
Q

If on other HAART when is a C-section offered

A

> 39W

63
Q

If neonates are born to HIV +ve mother and viral load is less than 50, how are they managed

A

Give zidovudine within 4h and continue for 4W

64
Q

If neonates are born to HIV +ve mother and viral load is more than 50, how are they managed

A

ART

65
Q

Explain breast feeding in HIV

A

Do not breast feed. May give cabergoline to suppress breast milk.

66
Q

What will in-utero infection with parvovirus B19 cause

A

Foetal hydrops

67
Q

What will neonatal infection with parvovirus B19 present

A

Malaise
URTI
Headaches
Low-grade fever

Erythema infectiosum = maculopapular rash sparing nose, eyes and mouth

68
Q

How is a mother with parvovirus B19 managed

A

Self-resolving

69
Q

How is a foetus with parvovirus b19 managed

A

Serial scans every 1-2W from 16 to 30W to assess growth. If evidence of foetal hydrops give erythrocyte transfusion

70
Q

How will congenital chlamydia infection present

A

Conjunctivitis 5-14d post-birth

71
Q

How is congenital chlamydia infection managed

A

Azithromycin

72
Q

What are in-utero complications of chlamydia

A

Low birth-weight

PROM

73
Q

What are neonatal complications of chalmydia

A

Conjunctivitis
Pneumonitis
Otitis media

74
Q

How will congenital chlamydia infection present

A

Conjunctivitis 5-14d post-birth

75
Q

How is congenital chlamydia infection managed

A

Azithromycin or Erythromycin

76
Q

What are in-utero complications of chlamydia

A

Low birth-weight

PROM

77
Q

What are neonatal complications of chalmydia

A

Conjunctivitis
Pneumonitis
Otitis media

Obstetrics (27 decks)

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