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Obstetrics > Infection in pregnancy > Flashcards

Infection in pregnancy Flashcards

1
Q

What is the TORCH screen?

A 
group of blood tests to check for infections in newborn.
Toxoplasmosis
Rubella
Cytomegalovirus
HSV, HIV
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2
Q

In what family of viruses is cytomegalovirus?

A

Herpes

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3
Q

What can cytomegalovirus infection in pregnancy result in for newborn?

A

deafness, mental impairment

no prenatal treatment.

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4
Q

Vertical transmission of Herpes simplex is low - only happens if mum has active primary infection at vaginal delivery. But if neonate gets infected, high mortality. What is the management of primary herpes infection in preg?

A

acyclovir for mum.
C section within 6wks of primary inf.
acyclovir for neonate.

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5
Q

Which four infections in pregnancy are particularly bad news?

A

cytomegalovirus
toxoplasmosis
syphilis
rubella

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6
Q

A woman is not vaccinated against Rubella. If she gets rubella before 16wks, what would you do?

A

offer termination.

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7
Q

What can rubella infection in pregnancy result in for newborn?

A

deafness, mental impairment

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8
Q

Which protozoan infects you through cat poo and infected meat?

A

Toxoplasma gondii (protozoan parasite)

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9
Q

To diagnose whether the mum has cytomegalovirus or toxoplasmosis you test maternal IgM. How do you diagnose whether there has been VERTICAL TRANSMISISON of these infections?

A

amniocentesis

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10
Q

What is the treatment for toxoplasmosis in pregnancy?

A

spiromycin

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11
Q

If a lady has chickenpox in early pregnancy, you treat with oral acyclovir and it’s fine. If a non-vaccinated mum-to-be is exposed to chickenpox near delivery, what do you give her to prevent infection?

A

immunoglobulin

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12
Q

Which virus suppresses foetal erythropoiesis if it crosses the placenta?

A

B19 Parvovirus (slapped cheek)

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13
Q

How do you diagnose Parvovirus in the mum in pregnancy?

A

maternal IgM

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14
Q

Mum’s IgM has tested positive for Parvovirus. On ultrasound surveillance, unfortunately the infection has crossed the placenta and the baby develops hydrops. What would Doppler of middle cerebral artery show?

A

increased blood flow

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15
Q

Group B strep a.k.a.

A

Strep. agalactaie

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16
Q

What percent of pregnant woman are asymptomatic carriers of Group B strep?

A

25%

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17
Q

What is the intervention to prevent Group B strep vertical transmission and at what time do you give it?

A

IV penicillin

in labour

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18
Q

In what scenarios do you use IV penicillin in labour to prevent neonatal Group B Strep infection?

(4 RFs)

A

where RFs:

  • PROM >18h
  • preterm labour
  • maternal fever
  • previous GBS neonate

or acutal positive urinary culture for GBS

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19
Q

The risk of vertical transmission Hep B is much more likely is which antigen is positive in mum?

A

HBeAg

HEP B VACCINATION AT BIRTH

20
Q

What measures should be taken to prevent vertical transmission of HIV through pregnancy, childbirth and breastfeeding?

A

HAART for mum
C section
HAART nor neonate
avoid breastfeeding

*HAART = highly active antiretroviral therapy

21
Q

Group A Strep a.k.a.

A

strep. pyogenes

22
Q

Group A strep in pregnancy can lead to puerperal sepsis with high maternal mortality. The infected foetus often dies in utero and labour ensures. What is the treatment for the mother?

A

high dose IV Abx , ITU

Ix: culture.
in preg group A strep causes chorioamnionitis, abdo pain, diarrhoea

23
Q

What can be the complications of syphilis in pregnancy and how is it treated in mother during pregnancy?

A

miscarriage, stillbirth, congenital syphilis

IM Penicillin

24
Q

Why should you avoid soft cheese in pregnancy?

A

high risk for listeria monocyotgenes –> listeriosis

bacteraemia –> potentially fatal foetal infection

25
Q

Which congential infections present with conjunctivitis in the newborn (aka opthalmia neonatorum)?

A

Chlamydial conjuntivits
Gonococcal conjunctivitis

(chlamydia may also cause pneumonia)
treat with Abx

26
Q

If the neonate catches Hep B via vertical transmission, they are at high risk of chronic Hepatitis . True or false?

A

true

27
Q

What is the treatment for bacterial vaginosis in pregnancy?

A

oral clindamycin

28
Q

What two main complications can bacterial vaginosis in pregnancy cause?

A

preterm labour

late miscarriage

29
Q

Why do you do urine culture on booking visit?

A

5% preggers have asymptomatic bacteriuria

UTI can cause pyelonephritis or preterm labour

30
Q

Which bacterium is most commonly responsible for aysymptomatic bacteriuria in pregnancy?

A

E.coli

31
Q

Give me two antibiotics that are okay for treating UTIs in pregnancy

A

nitrofurantoin

amoxicillin

32
Q

What is chorioamnionitis?

A

inflammation of the foetal membranes due to bacterial infection

33
Q

Chorioamnionitis is usually from bacteria ascending from the vagina. When does it often happen?

A

during prolonged labour

34
Q

define shock.

A

circulatory failure resulting in inadequate organ perfusion.

35
Q

define sepsis.

A

Systemic inflammatory response syndrome (SIRS) in presence of infection.

severe if evidence of organ hypoperfusion (e.g. oliguria)

36
Q

name the four things about systemic inflammatory response syndrome.

A
  • fever/hypothermia (>38/<36)
  • tachycardia (>90)
  • tachypnoea (>20)
  • leukocytosis
37
Q
  • fever/hypothermia
  • tachycardia
  • tachypnoea
  • leukocytosis

=?

A

systemic inflammatory response syndrome

38
Q

define septic shock.

A

severe sepsis

WITH HYPOTENSION RESISTING FLUID RESUSCITATION

39
Q

RFs for sepsis in preg?

A

prolonged ROM
diabetes
amniocentesis
infections!!!! (STI, UTI, flu, wound inf w strep A)

40
Q

what’s the management of sepsis in preg? (clue: sepsis 6 + 2) (clue: BUFALO)

A 
Blood cultures
Urine output (monitor)
Fluids resusc IV
Abx IV 
Lactate (>2)
O2

plus 2:
+ consider delivery / ERPC
+ DVT prophylaxis!!

41
Q

give two examples of broad spec Abx that you might use in sepsis

A

gentamycin

tazobactam

42
Q

BUFALO in sepsis management is:

Blood cultures
Urine output 
Fluids IV
Abx IV
Lactate (>2)
O2

what are the plus 2 in preg??

A

+ consider delivery / ERPC

+ DVT prophylaxis!!

43
Q

circulatory failure resulting in inadequate organ perfusion = ?

A

shock

44
Q

SIRS in presence of infection = ?

A

sepsis

45
Q

severe sepsis with hypotension resisting fluid resucitation = ?

A

septic shock

Obstetrics (6 decks)

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