Infection in Pregnancy

Question 1

what viral load and CD4 count is safe to deliver vaginal if mother has HIV?

Answer 1

cd4 count >350
<50 viral load

Question 2

who looks after you in pregnancy with HIV confirmed status

Answer 2

a doctor who specialises in HIV
an obstetrician (a doctor who specialises in the care of pregnant women)
a specialist midwife
a paediatrician

Question 3

viral load of how much means c-section is recommended HIV+ women?

Answer 3

400> viral load

Question 4

chorioamnionitis

Answer 4

pPROM

triad: maternal pyrexia, maternal tachycardia, foetal tachycardia

Question 5

UTI in pregnancy
1st line?
2nd line?

Answer 5

Nitrofurantoin 50mg QDS 7 days
but not in 3rd trimeseter

2) Cefalexin

trimethoprim contraindicated because it is a folate antagonist - but can give in 3rd trimester

Question 6

Syphilis Mx?

Answer 6

IM stat benzylpenicillin
refer to GUM

Question 7

toxoplasmosis 1st line?

Answer 7

1 - spiramycin (3-week course of 2-3g OD) which may reduce the risk of
transmission to the foetus

Question 8

if foetus has toxoplasmosis confirmed?

Answer 8

pyrimethamine and sulfadiazine 12 months with folic acid

Question 9

what can toxoplasmosis cause in infant?

Answer 9

mental retardation
convulsions
spasticities
visual impaired

Question 10

with cytomegalovirus in pregnancy how can you treat antenatally?

Answer 10

no antenatal treatment available
> audiology /opthalmology F/U
> offer TOP

Question 11

herpes simplex virus if primary illness

Answer 11

ensure aciclovir from 36 weeks
if active infection / vesicles c section
if no active then vaginal

Question 12

how is HSV diagnosed?

Answer 12

PCR

Question 13

can you give the VCV vaccine in pregnancy?

Answer 13

no it is a live vaccine

Question 14

When do you give oral aciclovir in suspected chickenpox infection

Answer 14

> 20 weeks and after 7 days of contact
have a rash
AND no immunoglobulins obvs

Question 15

when do you manage chickenpox - pregnancy with VZIG

Answer 15

varicella zoster immunoglobulin given if <20 weeks
exposed to chickenpox
NO immunoglobulin
<10 days since exposure

Question 16

what is the biggest risk with parovirus?

Answer 16

foetal hydrops - suppresses anaemia
specialist
30% risk of transmission

Question 17

if foetal hydrops detected?

Answer 17

Foetal blood sampling and intrauterine red blood cell transfusion, which may
reduce the foetal mortality rate.

Question 18

how is syphilis , HIV and hep B detected for pregnancy?

Answer 18

HBsAg
PCR?- HIV
syphilis antibodies IgM?

Question 19

listeria monocytogenes mangement?

Answer 19

IV amoxicillin 2mg every 6 hours - 14 days

Question 20

mx of hep ?

Answer 20

refer to hepatologist
High HBV viral load - DNA >10IU/mL

offer TENOFOVIR

Question 21

neonate Hep B high risk

Answer 21

IVIG - wihtin 24 hours
vaccine, birth, 4 weeks, 12 months

Question 22

baby HIV when to test?

Answer 22

birth
discharge
6 weeks
6 months

Question 23

Group A streptococcus

Answer 23

beta haemolytic
Lancefield group A

IV benzylpenicillin infusion during labour

then neonate pencillin and gentamicin