**Infections during pregnancy

Question 1

Pyelonephritis in preg

Answer 1

E coli - mcc
Dysuria with fever

1. Admit for IV antibiotics
2. IV Amoxicillin x2days
   f/b oral 500mg 8hrly x14days
   or
3. Ceftriaxone 1gm IV
   f/b cephalexine 500mg oral

Question 2

Acute cystitis in preg

Answer 2

1. Cephalexin oral
   or
2. Amoxiclav
   or
   Nitrofurantoin 50mg
   (C/I in T3 - hemolytic disease of newborn)

Question 3

Asymptomatic bacteriuria

Answer 3

Non preg - no need rx

Rx based on Culture in preg
Can wait till T1 passes

Question 4

GBS and prophylaxis for neonate

Answer 4

Group B strep -
Mom- asymptomatic
Neonate - sev pneumonia - death

*Screen @36wks - rx

*Rx - during labour
*IV Benzyl penicillin 1.2gms, 4hrly until delivery

*Penicillin allergy - Clindamycin 600mg IV 8hrly

Question 5

Puerperial infection with GBD

Answer 5

Laceration/episiotomy wounds
-endometritis
1. Fver, discharge, abd pain, collapse
2. Genital tract swab, FBC (raised neuto/leukocytes)

3. Only fever - Amoxiclav x1wk
4. Sepsis - IV
   Amoxicillin +
   Gentamycin +
   Metronidazole

Question 6

Rubella

Answer 6

check infectious diseases :P

Question 7

Chicken pox in preg

Answer 7

High risk in T1 and late preg
(HSV, not HZV)

Inv:
IgM+ - recent infection
IgG+ = antibodies for infection+ (safe, reassure)

Question 8

Fetal varicella syndrome

Answer 8

1. Limb abn
2. Optic atrophy
3. Microcephaly
4. IUGR
5. Mental impairment

Question 9

Preg comes in contact with Varicella pt: Contact+, no symptoms, IgG -ve, mx?

Answer 9

VZ immunoglobulin within 2days of contact

Vaccination C/I as it is a live vaccine

Question 10

Preg gets infected with varicella zoster virus, mx?

Answer 10

Early preg:
1. Antivirals - oral acyclovir
2. USG to r/o fetal abn

Late preg:
1. 7 days before delivery to 1 month postpartum - dangerous
2. Isolate mom and baby until mother non infectious
3. VZ Ig for baby

Question 11

Parvovirus B19 infection in preg

Answer 11

Danger at any trimester
1. Slapped cheek appearance
2. IgG+ = antibodies for infection+ (safe, reassure)
IgM+ = infection+
3. Infection @T3 = sev anaemia, hydrops, cardiac anomalies, stillbirth

4. USG… hydrops… Blood transfusion

Question 12

Mcc of intrauterine infection and birth defects

Answer 12

CMV

Question 13

CMV in preg

Answer 13

1. Early preg
2. IgG+ = antibodies for infection+ (safe, reassure)
   IgM+ = infection+
3. Mental impairment, hearing loss
4. No routine tests or rx present
5. USG, amniocentesis

Question 14

Hepatitis B and C in preg

Answer 14

1. Every preg screened in T1
2. vertical transmission - during labour
3. Serology:
   HBsAg, HBcAg+ = infection+
   Anti Hbs = recovery, immunity
   HBeAg= high infectivity, low transmission
4. Newborns = chronic carries with liver disease
5. Rx: Vaccine AND HBIb (immunoglobulin)
   for baby (of carrier mom)

Booster @ 2,4,6/12months

For Hep C - no vaccine present
Screen baby @12,18months
Antivirals if positive

*Best mode of delivery - CS in both

Question 15

Genotal herpes

Answer 15

1. Highest risk @T3
2. Cervical swab - PCR for HSV
3. Prophylactic antiviral- 38wks till delivery
   ●Must in PCR+
   ●Can give in previously infected
4. CS if active lesion/PROM <4hrs
5. If vaginal delivery - Rx neonate with antiviral