ID in pregnancy?

Question 1

If viral load high in HBV- ie over 200 000 copies, do what

Answer 1

Give Tenofovir in Trimester Three- from 32 weeks to 6-8 weeks post partum

(3 Ts)

Also in ALL give immunoglobulin at birth
and vaccinate
NO EVIDENCE FOR CESARIAN

Reduce risk by 95%

Question 2

HCV- if RNA neg…

Answer 2

Low risk

Question 3

Can you give IFN a in preg?

Answer 3

might be ok

DONT give ribavirin

Question 4

When do you do a caesarian in women with HIV?

Answer 4

Viral load over 1000

Question 5

H1N1 in preg…

Answer 5

BAD- gets much worse
If suspect give tamiflu
Vaccinate all against flu and pertussis over 28 weeks

Question 6

Septic post delivery…what bug?

Answer 6

Thing GROUP A STREP

Give ceftriaxone and metronidazole

Question 7

Stopping smoking in pregnancy?NRT?

Answer 7

BEHAVIOURAL ASSISTANCE IS BEST

Nicotine itself may be harmful for the baby, and increase metabolism so increase requirements in preg. If use, short use with rests

Question 8

Cutoff for hep B treatment

Answer 8

Load over 10 to the 6 copies or 200 000 IU per mL

Question 9

Final rate of HCV transmission?

Answer 9

5.8%
natural history same as for adults
Increase risk if HIV coinfection

spontaneous resolution in 20% as in adult disease
Less likely if gen-1, more likley if cc IL28B

Question 10

What vaccinations suggested in preg?

Answer 10

Flu vax all preg women

single booster dTpa for all pregnant women in T3

Question 11

HIV- does the infant get ART?

Answer 11

Yes within 4 hours delivery

and if breastfeeding give AZT neonatal proph

Question 12

If post partum and get septic… suspect?

Answer 12

GAS

Urgent IV ceftriaxone and metronidazole

Question 13

What to do if mother uncertain immunity and more than 5 mins face to face varicella exposure?

Answer 13

Urgent check serology
If neg–>ZIG
Even if doesnt get chicken pox need to monitor baby for fetal malformations

Highest risk malf is T1
High risc neonatal varicella if 5 days before to 2 days after the mum gets it